Co esponding au ho : Widya Sa aswa i
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Apexi ica ion o a auma ic cen al inciso wi h bioce amic pu y: A case epo
B ian Dwi Basko o, El i a Widya Panges ika and Widya Sa aswa i *
Depa men o Conse a i e Den is y, Facul y o Den al Medicine, Uni e si as Ai langga, Su abaya, Indonesia.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(01), 1426-1429
Publica ion his o y: Recei ed on 02 June 2025; e ised on 13 July 2025; accep ed on 15 July 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.27.1.2668
Abs ac
In oduc ion: Apexi ica ion is a well-es ablished endodon ic ea men aimed a inducing apical closu e in imma u e
pe manen ee h wi h nec o ic pulp and open apices, o en esul ing om auma. The in oduc ion o bioce amic
ma e ials has enhanced he p edic abili y and e iciency o his p ocedu e.
Desc ip ion o Case: An 18-yea -old emale p esen ed wi h a discolo ed, non- i al maxilla y igh cen al inciso ( oo h
11) wi h a his o y o auma a age 10. Clinical and adiog aphic examina ion e ealed an open apex, wide oo canal,
and pe iapical adiolucency, consis en wi h a diagnosis o pulpal nec osis and symp oma ic apical pe iodon i is.
Apexi ica ion was pe o med using a bioce amic oo epai ma e ial as a 4 mm apical plug, ollowed by he moplas ic
ob u a ion. Subsequen isi s included in aco onal bleaching and es he ic es o a ion using di ec composi e esin. The
pa ien emained asymp oma ic, and ollow-up showed success ul pe iapical healing and es he ic es o a ion.
Discussion: Bioce amic ma e ials o e nume ous ad an ages o e adi ional calcium hyd oxide, including supe io
biocompa ibili y, sho e se ing ime, and eliable sealing in mois condi ions. This case suppo s exis ing li e a u e
indica ing high success a es wi h bioce amic apexi ica ion, pa icula ly in auma- ela ed nec o ic ee h whe e
egene a i e endodon ic he apy may be less p edic able.
Conclusion: Apexi ica ion using bioce amic pu y is a p edic able and e icien ea men o managing non- i al
imma u e ee h. In his case, he ea men esul ed in success ul apical closu e, symp om esolu ion, and es o a ion o
unc ion and es he ics, ein o cing he ole o bioce amic ma e ials in con empo a y endodon ic p ac ice.
Keywo ds: Apexi ica ion; Apical End Closu e; Bioce amic Pu y; Den al T auma
1. In oduc ion
Apexi ica ion is an endodon ic p ocedu e used o manage pe manen ee h wi h nec o ic pulp and open apices, o en
esul ing om auma. These cases p esen unique clinical challenges due o he wide oo canal and he absence o an
apical cons ic ion, which complica es he con ol o ob u a ion ma e ials and comp omises he long- e m p ognosis i
le un ea ed [1,6].
Wi h he ad en o bioce amic ma e ials such as mine al ioxide agg ega e (MTA) and o he hyd aulic calcium silica e
cemen s (HCSCs), single- isi apical plug echniques ha e shown compa able success a es, o en exceeding 90%, wi h
imp o ed e iciency and educed isk o ein ec ion [4].
T auma ic den al inju ies, especially in he an e io egion such as he maxilla y inciso s, a e he mos common cause
o pulpal nec osis in young pa ien s. Apexi ica ion is a p e e ed op ion in cases whe e he apical issues a e insu icien
o suppo egene a i e ou comes o whe e he exis ing oo s uc u e is deemed adequa e o unc ion [7].
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(01), 1426-1429
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This case epo desc ibes he apexi ica ion ea men o an 18-yea -old emale pa ien p esen ing wi h a discolo ed,
non- i al maxilla y igh cen al inciso ( oo h 11) as a esul o den al auma du ing childhood using bioce amic apical
plug ma e ial and he moplas ic ob u a ion. This case unde sco es he clinical ele ance and e ec i eness o
apexi ica ion as a p edic able and e icien ea men op ion o imma u e non- i al ee h.
2. Desc ip ion o Case
Figu e 1 Ini ial pho og aph (a) showing a discolo ed inciso . (b) pe iapical adiog aph showing an open apex
An 18-yea -old emale p esen ed wi h a chie complain o discolo a ion in he uppe igh on oo h ( oo h 11), which
had become no iceably da ke . She epo ed no cu en pain bu exp essed a desi e o ha e he oo h aes he ically
es o ed. He den al his o y e ealed auma o he oo h a he age o 10 due o an impac . The oo h had p e iously
unde gone se e al ea men sessions a a public heal h cen e be o e being e e ed o he Den al Hospi al o
Uni e si as Ai langga (RSGM Unai ). The pa ien had no sys emic illnesses o known d ug alle gies.
Clinical examina ion e ealed a ac u e on he incisal one- hi d o oo h 11 and isible discolo a ion. The oo h was
ende o pe cussion bu nega i e o bi e es . Su ounding gingi al issue appea ed no mal. Vi ali y es ing con i med
he oo h was non- i al. Radiog aphic examina ion showed adiolucency in he c own sugges i e o ca ies, a wide pulp
chambe and oo canal, open apex, and he p esence o a pe iapical lesion. Based on hese indings, he diagnosis was
pulpal nec osis wi h symp oma ic apical pe iodon i is on oo h 11.
The ea men plan in ol ed apexi ica ion using an apical plug echnique wi h bioce amic oo epai ma e ial, ollowed
by he moplas ic ob u a ion and inal es o a ion h ough in aco onal bleaching and di ec composi e esin
es o a ion. The p ognosis was conside ed good. T ea men was ca ied ou o e se en isi s. Du ing he i s isi ,
pa ien educa ion, consen , ubbe dam isola ion, access opening, wo king leng h de e mina ion (20 mm) using an apex
loca o , and canal deb idemen using he ci cum e en ial iling echnique we e pe o med. I iga ion was done using
NaOCl 1,5%, dis illed wa e , EDTA 17%, and ac i a ed wi h passi e ul asonic i iga ion. The canal was hen medica ed
wi h a bioce amic d essing and sealed empo a ily.
Figu e 2 (a) pe iapical adiog aph wi h No. 90 K-File es ablishing app oxima e wo king leng h. (b) 4 mm apical plug
o bioce amic pu y was con i med adiog aphically. (c) inal ob u a ion esul
In he second isi , wo weeks la e , he pa ien epo ed no complain s. The bioce amic d essing was emo ed, and
i iga ion was epea ed. A collagen sponge was placed apically o se e as a ma ix, ollowed by he placemen o a 4
mm bioce amic apical plug, which was con i med adiog aphically. A he hi d isi , one week la e , ob u a ion o he
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(01), 1426-1429
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oo canal was comple ed using a esin-based seale and he moplas ic gu a-pe cha back ill echnique, ollowed by
e ical condensa ion and adiog aphic e i ica ion.
The ou h isi included in aco onal bleaching using 35% hyd ogen pe oxide was applied as he bleaching agen . The
i h isi , inal es o a ion wi h composi e esin was comple ed.
Du ing ollow-up isi , he pa ien emained asymp oma ic, wi h heal hy su ounding gingi a and s able colo . The
composi e es o a ion showed excellen es he ics and unc ion. O e all, he apexi ica ion p ocedu e was success uly
comple ed wi h a a o able ou come.
Figu e 3 (a) clinical pho og aph a e in aco onal bleaching and (b) adiog aph a e apexi ica ion
3. Discussion
The managemen o non- i al imma u e pe manen ee h wi h open apices due o auma emains a signi ican clinical
challenge. Apexi ica ion has long been ecognized as an e ec i e ea men op ion o induce apical closu e and allow
o ob u a ion in such ee h. In he p esen ed case, he use o a bioce amic ma e ial o he c ea ion o an apical plug in
oo h 11, combined wi h he moplas ic ob u a ion and aes he ic es o a ion, yielded a a o able ou come—clinically
and adiog aphically [1,6].
His o ically, calcium hyd oxide was he ma e ial o choice o apexi ica ion. While e ec i e in p omo ing ha d issue
o ma ion, i s p olonged ea men ime, mul iple isi s, and po en ial o weakening den inal walls due o long- e m
applica ion ha e led o a shi owa d ma e ials like mine al ioxide agg ega e (MTA) and newe bioce amics. MTA-
based apexi ica ion, as shown in he 20-yea ollow-up s udy by Bogen and Ricucci, demons a ed no only high success
a es in apical ba ie o ma ion bu also he po en ial o con inued oo de elopmen in some cases [2].
In his case, bioce amic oo epai ma e ial was used o a one-s ep apexi ica ion app oach, which is consis en wi h
cu en bes p ac ices. These ma e ials exhibi excellen biocompa ibili y, an ibac e ial p ope ies, and he abili y o
o m a igh seal in mois en i onmen s—c ucial o success ul ou comes. Addi ionally, newe o mula ions such as BC
RRM Pu y ha e o e come some o he limi a ions o MTA, such as ex ended se ing ime and handling di icul ies [2,5].
The clinical decision o op o apexi ica ion o e egene a i e endodon ic ea men (RET) was app op ia e in his case.
RET is indica ed wi h e y hin den inal walls o when u he oo de elopmen is desi ed in younge pa ien s.
Howe e , RET ou comes in auma cases a e o en less p edic able due o he po en ial damage o he apical papilla and
he egene a i e cell popula ions, which a e c i ical o con inued oo de elopmen . In pa ien s wi h su icien oo
leng h, he c ea ion o an apical ba ie ia apexi ica ion o e s a p edic able and e ec i e ea men al e na i e [5,6].
Mo eo e , he case was managed me iculously wi h mul iple i igan s (NaOCl, EDTA, and dis illed wa e ), ul asonic
ac i a ion, and ci cum e en ial iling o ensu e p ope disin ec ion. Canal deb idemen and e ec i e i iga ion as
essen ial s eps p io o apical plug placemen [6].
Radiog aphically, he ea ed oo h showed esolu ion o he pe iapical lesion and a well-placed bioce amic apical plug.
The ollow-up con i med he absence o symp oms and he s abili y o he es o a ion. This ma ches he c i e ia o
success ul apexi ica ion ou comes: esolu ion o clinical signs and symp oms, pe iapical healing, and main enance o
oo h unc ion [6,7].
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(01), 1426-1429
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In summa y, apexi ica ion using mode n bioce amic ma e ials p o ides a eliable, e icien , and biologically a o able
app oach o ea ing non- i al imma u e ee h, especially in auma cases whe e egene a i e echniques may be less
p edic able. This case ein o ces he con inued ele ance o apexi ica ion in con empo a y endodon ic p ac ice and
highligh s he impo ance o ma e ial selec ion, p ecise echnique, and indi idualized pa ien assessmen in ensu ing
long- e m ea men success [8].
4. Conclusion
Apexi ica ion using bioce amic pu y p esen s a eliable and e ec i e ea men o imma u e pe manen ee h wi h
nec o ic pulp and open apices, pa icula ly in cases esul ing om den al auma. In his case, he applica ion o a
bioce amic apical plug in a non- i al maxilla y cen al inciso p o ided a p edic able apical ba ie , allowed o
success ul ob u a ion, and p ese ed he oo h bo h unc ionally and es he ically. The case ou come—ma ked by clinical
esolu ion o symp oms, adiog aphic healing, and es he ic es o a ion— ein o ces cu en e idence suppo ing
bioce amic apexi ica ion as a con empo a y s anda d in managing such complex endodon ic condi ions.
Compliance wi h e hical s anda ds
Acknowledgmen s
The au ho s hank he e iewe s o hei insigh ul sugges ions.
Disclosu e o con lic o in e es
The au ho s decla e ha he e is no con lic o in e es ega ding he publica ion o his documen .
S a emen o in o med consen
In o med consen was ob ained om pa ien included in he s udy.
Re e ences
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