Clinical case: Root canal obturation with apical plug in MTA

Prepared by Dr. Christophe Anceaux, endodontist in Revigny-Sur-Ornain (55800).

Case presentation

The patient, aged 23, was referred by his general practitioner for the fortuitous discovery of a periapical inflammatory lesion of endodontic origin (LIPOE) on tooth 21.

In his medical history, he reported a skateboarding accident in his youth that resulted in a fracture of the distal angle of the tooth. This fracture was repeatedly restored with composite resin before being left without a permanent restoration due to repeated debonding. Progressive discoloration developed over time.

Clinical and radiographic analysis

The pre-operative radiograph confirms the presence of the LIPOE associated with an extremely wide canal lumen.

An intraoperative radiograph with a 50/100th file is taken to confirm the working length, previously determined using an apex locator, and to assess the canal anatomy.

The total absence of parietal friction at the working length clearly points to the need to perform an apical plug in MTA.

Disinfection and shaping

Canal disinfection is performed using a 3.6% sodium hypochlorite solution, combined with Dual Rinse (HEDP).

The activation of the irrigants is carried out by Erbium laser, in order to optimize the effectiveness of disinfection in a channel of large dimensions.

Placement of the apical plug

The apical MTA plug is placed in successive stages using a Map One syringe. The material is positioned using a rammer equipped with an endodontic stop, ensuring compliance with the working length (LT – 2 mm initially).

In this case, the placement of an apical sponge was not deemed necessary.
A follow-up X-ray is taken to confirm the correct position and sufficient thickness of the plug.

Final closure

The rest of the canal is then sealed using a hot sealing system.
A semi-definitive coronal composite resin is placed, allowing a watertight restoration while leaving the possibility of subsequent internal bleaching.

Conclusion

This case illustrates the value of an apical MTA plug in the management of open-apex teeth when the canal anatomy does not allow for reliable conventional obturation. The choice of protocol here is based on clinical and radiographic analysis to ensure treatment safety and long-term prognosis.