Enhancing Aesthetic and Structural Integrity in Necrotic Permanent Incisor with Open Apex: A Case Report

Abstract

Traumatic injuries in immature teeth often lead to complications in endodontic treatment due to difficulty in managing the open apex. Also, the restoration of these teeth poses significant challenges due to thin dentin walls, high configuration factors, and other biomechanical and adhesive issues. Standard fibre posts are often not suited for flared root canal preparations, leaving excessive cement space between the post and the tooth structure. To reduce postoperative complications (e.g. root fracture), reinforcement of radicular dentin becomes mandatory after endodontic treatment. The reinforcement of the canal can be done using a fibre post relined with composite resin. Direct anatomical posts offer a promising alternative that minimises the risk of debonding. This case report details the use of platelet rich fibrin as a internal matrix and how mineral trioxide aggregate can be used to form an immediate apical seal for apexification and a custom fiber post technique for reinforcing an immature maxillary central incisor in an 18-year-old patient. Keywords - Adhesive cement, Apical seal, Dentin reinforcement, Esthetics, Fiberglass, MTA, Post and core technique