Apexification of post orthodontic treatment tooth with open apex using bioceramic materials: A case report

Introduction: Treating teeth with open apex might be difficult for clinicians.  Advanced apical root resorption can occur following orthodontic treatment and is influenced by biological factors. Although generally minimal and clinically insignificant in most patients, resorption is irreversible and unpredictable. In a small subset, extensive resorption exceeding half the root length may impair function and jeopardize tooth survival. Some studies suggest that teeth with incomplete root development exhibit greater resistance to orthodontically induced resorption.

Case report: A 25-year-old female came to the Department of Conservative Dentistry, Airlangga University Hospital, with a feeling of discomfort in her lower right tooth, with a recurrent fistula. Radiograph showed a post-endodontic treated tooth with a periapical lesion. Tooth 45 was diagnosed with a previously treated tooth with chronic apical abscess. The proposed treatment plan is endodontic retreatment combined with apexification utilizing bioceramic root repair material (Bio-C® Repair) as an apical plug, followed by restoration using a direct composite. Bioceramic materials serve as artificial barriers in the management of open apex, offering multiple advantages, including reduced treatment duration, reinforcement of dentin structure, and bioactive properties that promote healing. The use of bioactive materials may also minimize the risk of complications associated with material extrusion.

Conclusion: Apexification using bioceramic materials offers numerous advantages as an apical barrier and is considered the treatment of choice for managing teeth with open apex, thereby facilitating the long-term preservation of tooth function throughout the patient’s lifetime. appointments, increased patient convenience, and reduced inter-appointment contamination risk.