European Archives of Paediatric Dentistry

, Volume 19, Issue 1, pp 65–71 | Cite as

Root lengthening with apical closure in two maxillary immature permanent central incisors after placement of mineral trioxide aggregate (MTA) as an apical plug

  • F. MasmoudiEmail author
  • I. Bourmeche
  • A. Sebai
  • Z. Baccouche
  • F. Maatouk
Case Report



Necrosis of permanent immature teeth is a common reason for consultation in paediatric dentistry. Apexification is a therapeutic procedure aiming to create an apical calcified barrier in open apex teeth.

Case report

Two cases are presented in which apexification were completed on immature permanent traumatised incisors using a mineral trioxide aggregate (MTA) plug.


At 2 and 5 years showed apical closure and radicular elongation beyond the MTA plug.


Unexpectedly, a regeneration of mineral tissues beyond the MTA plug occurred which is an uncommon outcome.


Permanent immature teeth Apexification Mineral trioxide aggregate (MTA) Radicular elongation Regeneration 


  1. Alagl A, Bedi S, Hassan K, et al. Use of platelet-rich plasma for regeneration in non-vital immature permanent teeth: clinical and cone-beam computed tomography evaluation. J Int Med Res. 2017;45(2):583–93. Scholar
  2. Alobaid A, Cortes L, Lo J, et al. Radiographic and clinical outcomes of the treatment of immature permanent teeth by revascularization or apexification: a pilot retrospective cohortstudy. J Endod. 2014;40(8):1063–70. Scholar
  3. Andreasen JO, Farik B, Munksgaard EC. Long-term calcium hydroxide as a root canal dressing may increase risk of root fracture. Dent Traumatol. 2002;18(3):134–7. Scholar
  4. Annamalai S, Mungara J. Efficacy of mineral trioxide aggregate as an apical plug in non-vital young permanent teeth: preliminary results. J ClinPediatr Dent. 2010;35(2):149–55. Scholar
  5. Atabek D, Alaçam A, Aydintuğ I, et al. A retrospective study of traumatic dental injuries. Dent Traumatol. 2014;30(2):154–61. Scholar
  6. Camilleri J, Pitt Ford TR. Mineral trioxide aggregate: a review of the constituents and biological properties of the material. Int Endod J. 2006;39:747–54. Scholar
  7. Cehreli ZC, Isbitiren B, Sara S, et al. Regenerative endodontic treatment (revascularization) of immature necrotic molars medicated with calcium hydroxide: a case series. J Endod. 2011;37(9):1327–30. Scholar
  8. Chen MY, Chen K, Chen CA, et al. Responses of immature permanent teeth with infected necrotic pulp tissue and apical periodontitis/abscess to revascularization procedures. Int Endod J. 2012;45:294–305. Scholar
  9. Duggal M, Tong HJ, Al-Ansary M, et al. Interventions for the endodontic management of non-vital traumatised immature permanent anterior teeth in children and adolescents: a systematic review of the evidence and guidelines of the European Academy of Paediatric Dentistry. Eur Arch Paediatr Dent. 2017;15:1–13. Scholar
  10. Felippe W, Felippe MC, Rocha MJ. The effect of mineral trioxide aggregate on the apexification and periapical healing of teeth with incomplete root formation. Int Endod J. 2006;39(1):2–9. Scholar
  11. Hecova H, Tzigkounakis V, Merglova V, Netolicky J et al (2010) A retrospective study of 889 injured permanent teeth. Dent Traumatol 26(6):466–475Google Scholar
  12. Jeeruphan T, Jantarat J, Yanpiset K, et al. Mahidol study 1: comparison of radiographic and survival outcomes of immature teeth treated with either regenerative endodontic or apexification methods: a retrospective study. J Endod. 2012;38(10):1330–6. Scholar
  13. Kahler B, Rossi-Fedele G, Chugal N, et al. An evidence-based review of the efficacy of treatment approaches for immature permanent teeth with pulp necrosis. J Endod. 2017;43(7):1052–7. Scholar
  14. Lanagan TA. What can cause the pulps of immature, permanent teeth with open apices to become necrotic and what treatment options are available for these teeth. Aust Endod J. 2014;40:95–100. Scholar
  15. Lee L, Hsieh C, Lin H, et al. Comparison of clinical outcomes for 40 necrotic immature permanent incisors treated with calcium hydroxide or mineral trioxide aggregate apexification/apexogenesis. J Formos Med Assoc. 2013;114(2):139–46. Scholar
  16. Lin JC, Lu JX, Zeng Q, et al. Comparison of mineral trioxide aggregate and calcium hydroxide for apexification of immature permanent teeth: a systematic review and meta-analysis. J Formos Med Assoc. 2016;115(7):523–30. Epub 2016 Feb 22.CrossRefPubMedGoogle Scholar
  17. Miltiadous M, Floratos S. Regenerative endodontic treatment as a retreatment option for a tooth with open apex-a case report. Braz Dent J. 2015;26(5):552–6. Scholar
  18. Moretton T, Brown C, Legan J, et al. Tissue reactions after subcutaneous and intraosseous implantation of mineral trioxide aggregate and ethoxybenzoic acid cement. J Biomed Mater Res. 2000;52:528–33.<528:AIJBM11>3.0.CO;2-9.CrossRefPubMedGoogle Scholar
  19. Nagaveni N, Pathak S, Poornima P, et al. Revascularization Induced maturogenesis of non-vital immature permanent tooth using platelet-rich-fibrin: a case report. J Clin Pediatr Dent. 2016;40(1):26–30. Scholar
  20. Nagy M, Tawfik H, Hashem AR, et al. Regenerative potential of immature permanent teeth with necrotic pulps after different regenerative protocols. J Endod. 2014;40(2):192–8. Scholar
  21. Patil SA, Patil AA, Dodwad PK. Management of non-vital teeth with open apices using MTA as an apical plug: two case reports. World J Dent. 2011;2(1):45–8. Scholar
  22. Rafter M. Apexification: a review. Dent Traumatol. 2005;21(1):1–8. Scholar
  23. Shabahang S, Torabinejad M, Boyne PP, et al. A comparative study of root-end induction using osteogenic protein-1, calcium hydroxide, and mineral trioxide aggregate in dogs. J Endod. 1999;25(1):1–5. Scholar
  24. Torabinejad M, Hong C, Lee S, et al. Investigation of mineral trioxide aggregate for root-end filling in dogs. J Endod. 1995a;21(12):603–8. Scholar
  25. Torabinejad M, Hong CU, McDonald F, et al. Physical and chemical properties of a new root-end filling material. J Endod. 1995b;21(7):349–53. Scholar
  26. Torabinejad M, Chivian N. Clinical applications of mineral trioxide aggregate. J Endod. 1999;25(3):197–205. Scholar
  27. Torabinejad M, Pitt Ford TR, McKendry DJ, et al. Histologic assessment of mineral trioxide aggregate as a root-end filling in monkeys. Int Endod J. 2009;42:408–11. Scholar
  28. Vijayran M, Chaudhary S, Manuja N, et al. Mineral trioxide aggregate (MTA) apexification: a novel approach for traumatised young immature permanent teeth. BMJ Case Rep. 2013; bcr2012008094.

Copyright information

© European Academy of Paediatric Dentistry 2018

Authors and Affiliations

  • F. Masmoudi
    • 1
    • 3
    Email author
  • I. Bourmeche
    • 1
    • 3
  • A. Sebai
    • 1
    • 3
  • Z. Baccouche
    • 2
  • F. Maatouk
    • 1
    • 3
  1. 1.Department of Paediatric Dentistry, Faculty of DentistryUniversity of MonastirMonastirTunisia
  2. 2.Department of Endodontics, Faculty of DentistryUniversity of MonastirMonastirTunisia
  3. 3.Biological and Clinical Dento-Facial Approach Laboratory LR12ES10MonastirTunisia

Personalised recommendations