TITLE:
Apexification Using Mineral Trioxide Aggregate in a Previously Treated Tooth with Wide Periapical Lesion and Resorbed Root: A 2-Year Follow-Up Detailed Case Report
AUTHORS:
Sadel Khaoula, Skalli Radia, Laslami Kaoutar
KEYWORDS:
Apexification, Mineral Trioxide Aggregate, Open Apex, Apical Periodontitis, Retreatment, Endodontics
JOURNAL NAME:
Open Access Library Journal,
Vol.13 No.4,
April
2,
2026
ABSTRACT: Background: Managing teeth with open apices, particularly after trauma, failed root canal treatment and the presence of apical periodontitis, poses significant clinical challenges. Apexification using Mineral Trioxide Aggregate (MTA) has emerged as a predictable technique. Case summary: A 23-year-old patient presented with persistent fistula between the central and the lateral incisor, previously treated and associated with a resorbed open apex and apical radiolucency. Non-surgical retreatment was initiated. After thorough disinfection, an MTA apical plug was placed and backfilled with a bioceramic sealer and gutta-percha. The access was restored with composite. Follow-ups at 6, 12, and 24 months revealed complete resolution of periapical pathology and functional tooth retention. Conclusion: MTA apexification is a reliable option in managing post-treatment apical periodontitis in teeth with open apices and resorption. Long-term follow-up confirms the healing potential of this technique. The use of MTA created a stable apical barrier, while bioceramic sealers enhanced the seal and promoted long-term healing. NaOCl with ultrasonic activation, and double-sided vented needles ensured thorough irrigation and disinfection, especially in complex canal anatomy.