BMJ Case Reports 2018; doi:10.1136/bcr-2018-227627
  • Novel treatment (new drug/intervention; established drug/procedure in new situation)

Use of mineral trioxide aggregate for retreatment of a tooth with large periapical lesion, wide-open apices and vertical root fracture

  1. Diksha Singh3
  1. 1Conservative Dentistry and Endodontics, King George’s Medical University, Lucknow, Uttar Pradesh, India
  2. 2Department of Periodontology, Regional Institute of Medical Sciences, Imphal, Manipur, India
  3. 3Oral Pathology, King George Medical University, Lucknow, Uttar Pradesh, India
  1. Correspondence to Dr Pragya Pandey, w.pragya78{at}
  • Accepted 16 October 2018
  • Published 5 November 2018


Chronic periapical lesions in necrotic teeth with open apex are difficult to manage. The situation becomes more complex if the tooth has a fracture line. This case report describes the management of a traumatised tooth that had already undergone unsuccessful endodontic treatment with a large periapical lesion and open apex along with a fracture line in the root. An attempt was made to save the tooth by using mineral trioxide aggregate (MTA) cement for orthograde filling, retrograde filling and also for sealing of the fracture line. Moreover, the bone defect was filled with autogenous bone harvested from the external oblique ridge. MTA, a bioactive tricalcium silicate cement, has been used in treating complex endodontic cases as it shows promising potential by inducing the biological mechanisms necessary for repair of involved teeth. A 1-year follow-up showed progressive healing as evident by radiographs and lack of any clinical signs and symptoms.


  • Contributors PP: endodontic management of the case on the first visit, MTA packing and preparation of manuscript, treatment plan. TN: management of dehiscence defect. RB: drafting the article. DS: revising the article critically.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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