Apexification with Biodentine for Management of an Immature Necrotic Permanent Tooth: A Clinical Case Report

Abstract

Background: Immature permanent teeth with necrotic pulps and open apices present a challenge for endodontic treatment due to wide canals, thin dentinal walls, and lack of an apical stop. Apexification aims to create an apical barrier and allow proper obturation. Biodentine, a bioactive calcium silicate material, offers advantages such as rapid setting, biocompatibility, and dentin-like mechanical properties. Case Report: A 27-year-old male with a history of trauma presented with discoloration and pain in tooth #21. Clinical and radiographic examination revealed an Ellis Class III fracture, an open apex, and periapical radiolucency. After cleaning and shaping, calcium hydroxide was used as an intracanal medicament for two weeks. Biodentine was then placed to form a 3–4 mm apical plug, followed by sectional obturation and composite restoration. A lithium disilicate crown was later cemented. Outcome: At the 3-month follow-up, the tooth was asymptomatic and radiographic evaluation showed periapical healing and apical barrier formation. Conclusion: Biodentine is a reliable material for single-visit apexification due to its excellent sealing ability, rapid setting time, bioactivity, and reinforcement of thin dentinal walls. This case demonstrates successful clinical and radiographic outcomes using Biodentine in the management of an immature necrotic permanent tooth.