Journal of Dentistry

Apexification Treatment of an Open-Apex Mandibular Central Tooth with Dens Evaginatus using the Novel Root Filling Bioactive Material Cold Ceramic: A Case Report

Articles in Press

Document Type : Case Report

Authors

Fatemeh Akbarizadeh 1
Elham Rahimi 2
Ali Pooladi 3

1 Dept. of Oral and Maxillofacial Radiology, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.

2 Dept. of Dental and Maxillofacial Radiology, School of Dentistry, Yasuj university medical science, Yasuj, Iran.

3 Dept. of Endodontics, School of Dentistry, Shiraz branch, Azad University, Shiraz, Iran.

10.30476/dentjods.2026.106112.2633
Abstract
Comprehensive knowledge of canal morphology and its variations is essential for successful endodontic treatment. Mandibular incisors frequently present with two canals, with Vertucci Type III being the most common configuration. Dens evaginatus is a developmental anomaly that may lead to pulp exposure and subsequent necrosis. The present case describes the management of a mandibular incisor with dens evaginatus, pulpal necrosis, open apex, and Vertucci Type III canal configuration. We established the diagnosis through clinical examination and periapical radiography. After chemo-mechanical preparation using standard instrumentation and irrigation protocols, cold ceramic was used as an apical barrier material to induce apexification. We placed the material after the sinus tract had resolved, and treatment was completed in three appointments. Clinical and radiographic follow-ups at 6 and 12 months demonstrated healing of the periapical lesion, absence of symptoms, and satisfactory apical closure. This case suggests that cold ceramic may be a suitable bioactive material for apexification in anatomically complex immature teeth.

Keywords

Apexifications
Root Canal Therapies
Tooth Apex
Mandibular Incisors
Journal of Dentistry

Articles in Press, Accepted Manuscript
Available Online from 19 July 2026

  • Receive Date 04 March 2025
  • Revise Date 28 February 2026
  • Accept Date 12 July 2026
  • First Publish Date 19 July 2026
  • Publish Date 19 July 2026

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