International Journal of Dental Science and Innovative Research (IJDSIR) IJDSIR : Dental Publication Service Available Online at: www.ijdsir.com Volume – 2, Issue – 3, May - June- 2019, Page No. : 528 - 532 Corresponding Author: Dr.Abu-Hussein Muhamad, ijdsir Volume-2 Issue 3, Page No. 528 - 532 Page 528 ISSN: 2581-5989 PubMed - National Library of Medicine - ID: 101738774 Apexification with apical plug of MTA-Report of Case Abdulgani Azzaldeen, Abu-Hussein Muhamad *Istituto Stomatologico Toscano, University Guglielmo Marconi of ROME,Italy, Al-Quds University, School of Dentistry, Jerusalem, Palestine Corresponding Author: Dr.Abu-Hussein Muhamad, DDS, MScD, MSc, MDentSci (PaedDent) ,FICD, 123Argus Street, 10441 Athens Greece Type of Publication: Case Report Conflicts of Interest: Nil Introduction Traumatic injuries are more common in anterior teeth especially maxillary central incisors where 16% are complicated fractures involving pulp. The prevalence of dental traumatic injuries ranges from 13.8-15.1% [1-3]. When severe, results in inflammation of pulp and later advances to pulpal necrosis. Trauma which occurring in young age affects the root formation and leads to incomplete development of dentinal walls at root apices, which results in Blunderbass canals.[1-6] Morse et al. reported that placing calcium hydroxide in management of incompletely formed roots showed better results, Apexification is the treatment of choice by inducing a calcific barrier at the root apices, which can be done for all ages using MTA, a root canal repair material developed at the beginning of 1990s at Loma Linda University in California. MTA showed better results than multiple visit calciumhydroxides dressing in many recent studies[7-11] The present case reports highlight the non-surgical management of asymptomatic tooth with blunderbuss canal using MTA apical plug technique. Case Report A 17 year old female patient, reported to my pediatric dental clinics ,Athens , with a chief compliant of discoloured left maxillary central ncisor and history revealed that patient had suffered trauma at the age of 10. The concerned tooth showed no response to both electric and heat test. On radiographic examination, it revealed a large blunderbuss canal with a radiolucent area in proximity of the apex of the tooth (Fig. 1). Fig. 1: Preoperative radiograph There are two treatment options either surgical removal of periapical lesion and retrograde filling or apexification using apical plug of MTA, followed by non surgical root canal treatment. Considering the age of the patient ,crown- to-root ratio (the ratio measuring the length of the part of the tooth that protrudes from the bone, versus the length of the part of the tooth that is fully captured in the bone), need for limiting the restoration within the apex and formation of the lost bone structure, nonsurgical treatment was opted. After rubber dam application conventional access opening was prepared and working length was determined (Fig. 2).