Introduction: An immature permanent tooth having blunderbuss canal and open apex can be an endodontic challenge because of difficulty in obtaining an apical seal, and existing thin radicular walls which are susceptible to fracture. Teeth with open apices, such as in immature teeth are clinical cases with difficult immediate resolution. With the use of mineral trioxide aggregate (MTA) and similar calcium silicate cements, it is possible to get a better prognosis of the treated teeth. MTA sealing ability has been shown to be superior to that of super EBA and other cements and was not affected by blood contamination. Case Report: A 15-years-old patient came with a chief complaint of fractured maxillary anterior teeth due to trauma. Examination showed Ellis Class II Fracture on tooth 11. Radiograph showed blunderbuss canal with open apex and periapical radiolucency. Root canal treatment was planned. Upon access, weeping canal was seen. Circumferential canal preparation was employed due to thin dentinal walls. Conclusion: When attempts to achieve apexogenesis fails or the pulp is necrotic, apexification must be done. Apical surgery is now considered a predictable treatment option to save a tooth with apical pathology that cannot be managed by conventional, non-surgical endodontics.
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