Apexification of a traumatic central incisor with bioceramic putty: A case report

Introduction: Apexification is a well-established endodontic treatment aimed at inducing apical closure in immature permanent teeth with necrotic pulp and open apices, often resulting from trauma. The introduction of bioceramic materials has enhanced the predictability and efficiency of this procedure. 
Description of Case: An 18-year-old female presented with a discolored, non-vital maxillary right central incisor (tooth 11) with a history of trauma at age 10. Clinical and radiographic examination revealed an open apex, wide root canal, and periapical radiolucency, consistent with a diagnosis of pulpal necrosis and symptomatic apical periodontitis. Apexification was performed using a bioceramic root repair material as a 4 mm apical plug, followed by thermoplastic obturation. Subsequent visits included intracoronal bleaching and esthetic restoration using direct composite resin. The patient remained asymptomatic, and follow-up showed successful periapical healing and esthetic restoration.
Discussion: Bioceramic materials offer numerous advantages over traditional calcium hydroxide, including superior biocompatibility, shorter setting time, and reliable sealing in moist conditions. This case supports existing literature indicating high success rates with bioceramic apexification, particularly in trauma-related necrotic teeth where regenerative endodontic therapy may be less predictable. 
Conclusion: Apexification using bioceramic putty is a predictable and efficient treatment for managing non-vital immature teeth. In this case, the treatment resulted in successful apical closure, symptom resolution, and restoration of function and esthetics, reinforcing the role of bioceramic materials in contemporary endodontic practice.