Non-Surgical Treatment of a Traumatized Tooth With Periapical Injury and Immature Apice Using Mta as an Apical Barrier: A Case Report

Abstract

A clinical case is described of a 17-year-old patient who suffered a trauma at the age of 8, compromising the upper right incisor, which prevented complete apical closure and the presence of a periapical lesion. The patient reports having interrupted the root canal treatment one year ago, in the diagnostic periapical radiograph the endodontic treatment already started is confirmed and temporary crown filling material is observed, the presence perhaps of calcium hydroxide inside the root canal, incomplete apical formation and a periapical radiolucent lesion. Root canal treatment was resumed using K-type manual files until reaching a #140 apical caliber, 5.25% sodium hypochlorite was used as irrigant, Ultrapex (Ca(OH)2 + Iodoform) was placed as intracanal medication for several months. Two years after resuming treatment, the patient was asymptomatic, and in the control periapical radiograph it was possible to observe the considerable decrease in the periapical lesion, therefore it was decided to obturate using the classic lateral condensation technique, AH Plus sealant and previous at this stage, 4mm of MTA was placed as an apical barrier. Conclusions The importance of using intracanal medication in situations of dental necrosis with a periapical lesion of considerable size is shown through this clinical case. This case was caused due to dental trauma which, as we know, can evolve in very different ways and in many situations the dental prognosis ends up being very unfavorable. In addition, because it is an immature apex, the use of an MTA apical barrier was essential for containing the filling materials to avoid their extrusion into the periapical tissues and ensuring a better sealing in the apical third.