Platelet rich fibrin - The rescuer after evanescence of mineral trioxide aggregate placed in an immature tooth with a periapical lesion

Abstract

The absence of a natural apical constriction in a nonvital young permanent tooth makes endodontic treatment a challenge. Mineral trioxide aggregate (MTA) is the material of choice for apical barrier techniques. This paper reports a case of the immature permanent maxillary left central incisor, which presented pulp necrosis secondary to dental trauma and was treated by apexifi cation with white MTA apical plugging followed by conventional root canal therapy. The operative procedures are described, and the technique is discussed. As purulent exudate was observed from the root canal, calcium hydroxide intracanal medicament was placed for a week, followed by MTA apexifi cation at a later date. After 2 days, on clinical examination, hard resistance was not felt and radiographic examination revealed that MTA was missing. The acidic pH and increased protein content of the periapical lesion might have resulted in the acidic dissolution of MTA. So for eff ective management, in the present case report one step apexifi cation using MTA as an apical barrier and autologous platelet rich fi brin as an internal matrix was done which resulted in better healing.