![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiLzRAuCGa7CWutrvtABU5pAw8M5H69hJhaUnTDQfCvhPrWz2iB_Qd82Lz0ahenkVXcRObQdk5EzqPPN7oKliVgetRDzFtL8EUifkM3Q8a1Ez-MFFbmm1nNIZzqK80pdQ9_6a-AXgLqZp0/s400/Start.jpg)
This 15 year old patient has a history of trauma to #8. Trauma occurred at an age before apical closure occurred. Tooth was diagnosed with necrotic pulp and symptomatic apical periodontitis. Note the large periapical lesion.
Traditional apexification using Ca(OH)2 was used.
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfSF-2dEfLzKsMXjoxH4UICfP29felPe4FSkoBmRdVJsZHN2cLABi306nx7thwKCmYpaFuvHjjZ7E4cGcEesBlShYlEI7TxC7Tz-pFMT7fbI4SZYbuZzUgzj1LFRu6bqrISMPLMfaEZTI/s400/debride.jpg)
Tooth debrided to the apex, NaOCl irrigation.
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgF58uLd1H7iSNbr-K-FxS5UCdBIG7nvCEjVQnmI3xSyOKwt62DHb06YEkUsZ37eBoLRdO38_bj4XJR7HNDEZs0YHUmOFEi4AL92-r3gLIoUfP7bZHWURJd9bAkCxJ9nWyqITZPtfuOfmg/s400/FirstPaste.jpg)
Ca(OH)2 placed.
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEime2LOI4TTHxxhD9wFHxVjd7hnJYAcsTs2gjNB1WlHlNJHh0Es1uiRp8Qhz_aSaeF1lTBCkOBEEivGYpajd1ewYjgQ74SH5QQarM7a4lOrH_3V7FqOcaroN4hA-ztav0c-UlBGB1I-RPU/s400/3monthcheck.jpg)
3 month check shows resorption of Ca(OH)2, but apex still open. Apical lesion almost completely healed.
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiT868CroQHYJO2tK_M4c1keHD4vfpps5qcjitIhNqTQbrTktCCbIJRIlWTIkNtqJYyDojRW21V9QkphI9DFjHLYCWSO7OzpBMNSR0M34g2j9rK20o9TPfBOjaHfPnJzqnhtMs_-XtboB4/s400/Repaste.jpg)
Ca(OH)2 placed again.
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4vEnFQQCmNXowAZM6QqsidQcBtobA4JzAIO-LqT9PlSadRljfRFSEHCcw-_yoxoq5JTRAwNbEBOGAt3omv666o5HWyPqSmP7xsSRfZeqEwwe88eFFq6WJuwIwot_A_rNeEHZu3zWwEB0/s400/10MonthCheck.jpg)
10 month re-evaluation. Apical barrier present, so it was time to obturate. This is a great view of the apical barrier that has formed.
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgq0UcoW-82Kk3E0G3IkGReeeZAtbyL8OoHNIDOCFDsGwCGENtvm-WA7pXeUzadyJts3B73ilp05OWiuqWJ9aTVZjTQy0HLnkgRBbOBiqX4U5EMnSiDP1OOLzoVExffHQffpjZvDAqia4Q/s400/MTAFill.jpg)
Tooth was obturated with MTA. If this tooth ever needs apical treatment, a simple resection will be done without retropreparation or retrofilling.