Cone beam-computed topographic evaluation of a central incisor with an open apex and a failed root canal treatment using one-step apexification with Biodentine™: A case report

A symptomatic endodontically treated immature tooth with periapical pathology presents multiple challenges to the clinician. Owing to incomplete root formation, gutta percha removal has to be done carefully without further damaging the periapical tissue or pushing the obturating material beyond the apex. Nonsurgical approach toward treating such a tooth would necessitate the creation of an apical barrier followed by conventional root canal treatment. Current literature suggests one-step apexification with mineral trioxide aggregate (MTA), with an apical matrix as the treatment of choice. A new calcium silicate-based cement also called as dentine substitute by the manufacturers with good handling properties has been introduced recently by the trade name Biodentine™ (Septodont, St. Maurdes Fossés, France). This case report presents management of a secondary endodontic case with an open apex treated with the concept of 'lesion sterilization and tissue repair (LSTR)' using triantibiotic paste and Biodentine™ for apical barrier formation. A 12-month follow up with cone beam-computed topography (CBCT) exhibited progressive involution of periapical radiolucency with indications of good healing of the periapical tissues and absence of clinical symptoms.