Mineral Trioxide Aggregate Apexification and Zirconia Crown Rehabilitation of a Traumatically Fractured Immature Maxillary Central Incisor: A Case Report

Abstract

Background: Traumatic injury to an immature permanent incisor may leave limited coronal tooth structure, thin radicular dentine and an incompletely formed apex. These features complicate endodontic treatment and definitive restoration. Case Presentation: A 13-year-old boy presented with an extensive fracture of the maxillary left permanent central incisor (tooth 21) following a bicycle-related injury approximately five years earlier. The clinical assessment described an Ellis class VIII fracture; the initial radiograph suggested an open apex and periapical pathology. Canal debridement and an intracanal Metapex dressing were followed seven days later by mineral trioxide aggregate (MTA) apexification using a collagen matrix at the apex. The tooth was subsequently restored with a fibre post, core and zirconia crown. Outcome: The patient was reported to be symptom-free at the three-month clinical review, and the patient and his parent expressed satisfaction. A comparable follow-up radiograph was not presented, precluding a conclusion about radiographic periapical healing. Conclusion: In this case, an MTA-based endodontic approach followed by post-supported crown rehabilitation enabled short-term retention and aesthetic restoration of a severely injured immature incisor. Long-term clinical and radiographic surveillance is necessary to assess tooth survival, apical status and restorative durability.