case_images: PMC11750349_01
case_images: Preoperative periapical radiograph of tooth #29 taken from referring provider.
case_images: 10-1055-s-0044-1791218-i2463179-1.jpg
case_images: PMC11750349_01_10-1055-s-0044-1791218-i2463179-1.jpg
case_images: FI2463179-1
case_images: Radiographically, this provider noted immature apices and incomplete root formation of teeth #28 (right mandibular first premolar) and #29 with high pulp horns present ( Figs. 1 2 3 4 ). This periapical lesion displayed extensive bone loss that extended along the mesial and distal aspects of the roots ( Figs. 1 2 3 ).
case_images: Preoperative periapical radiograph of tooth #29 taken at the University of North Carolina at Chapel Hill Adams School of Dentistry.
case_images: 10-1055-s-0044-1791218-i2463179-2.jpg
case_images: PMC11750349_01_10-1055-s-0044-1791218-i2463179-2.jpg
case_images: FI2463179-2
case_images: Radiographically, this provider noted immature apices and incomplete root formation of teeth #28 (right mandibular first premolar) and #29 with high pulp horns present ( Figs. 1 2 3 4 ). Radiographically, a large periapical radiolucent lesion (~7 mm in diameter and extending up the root mesially and distally to the marginal bone level [ Fig. 2 ]) was present at the apex of tooth #29 with a dens evaginatus that had already fractured prior to this appointment ( Figs. 1 2 3 4 ). This periapical lesion displayed extensive bone loss that extended along the mesial and distal aspects of the roots ( Figs. 1 2 3 ).
case_images: Preoperative periapical radiograph of tooth #29 distally shifted taken at the University of North Carolina at Chapel Hill Adams School of Dentistry.
case_images: 10-1055-s-0044-1791218-i2463179-3.jpg
case_images: PMC11750349_01_10-1055-s-0044-1791218-i2463179-3.jpg
case_images: FI2463179-3
case_images: Radiographically, this provider noted immature apices and incomplete root formation of teeth #28 (right mandibular first premolar) and #29 with high pulp horns present ( Figs. 1 2 3 4 ). This periapical lesion displayed extensive bone loss that extended along the mesial and distal aspects of the roots ( Figs. 1 2 3 ).
case_images: Preoperative bitewing radiograph of tooth #29 taken at the University of North Carolina at Chapel Hill Adams School of Dentistry.
case_images: 10-1055-s-0044-1791218-i2463179-4.jpg
case_images: PMC11750349_01_10-1055-s-0044-1791218-i2463179-4.jpg
case_images: FI2463179-4
case_images: Radiographically, this provider noted immature apices and incomplete root formation of teeth #28 (right mandibular first premolar) and #29 with high pulp horns present ( Figs. 1 2 3 4 ).
case_images: Working length periapical film with #60 K file.
case_images: 10-1055-s-0044-1791218-i2463179-5.jpg
case_images: PMC11750349_01_10-1055-s-0044-1791218-i2463179-5.jpg
case_images: FI2463179-5
case_images: CORP., Kyoto, Japan); measurement film was taken with a 60 K file (Dentsply-Sirona, Johnson City, Tennessee, United States) ( Fig. 5 ). 
case_images: Urgent care periapical film of partially washed-out calcium hydroxide medicament.
case_images: 10-1055-s-0044-1791218-i2463179-6.jpg
case_images: PMC11750349_01_10-1055-s-0044-1791218-i2463179-6.jpg
case_images: FI2463179-6
case_images: A periapical radiograph was exposed that revealed the Ca(OH) 2 had partially washed away ( Fig. 6 ).
case_images: Postoperative calcium hydroxide placement second treatment appointment.
case_images: 10-1055-s-0044-1791218-i2463179-7.jpg
case_images: PMC11750349_01_10-1055-s-0044-1791218-i2463179-7.jpg
case_images: FI2463179-7
case_images: As a temporary material, the access was sealed with 3 mm of GC Fuji Triage (GC America) ( Fig. 7 ). 
case_images: Obturation periapical radiograph with EndoSequence BC RRM Fast Set Putty.
case_images: 10-1055-s-0044-1791218-i2463179-8.jpg
case_images: PMC11750349_01_10-1055-s-0044-1791218-i2463179-8.jpg
case_images: FI2463179-8
case_images: Approximately 5 mm of EndoSequence BC RRM Fast Set Putty (Brassler) was then placed directly over the blood clot to the level of the cementoenamel junction ( Fig. 8 ).
case_images: Immediate postoperative periapical radiograph of tooth #29.
case_images: 10-1055-s-0044-1791218-i2463179-9.jpg
case_images: PMC11750349_01_10-1055-s-0044-1791218-i2463179-9.jpg
case_images: FI2463179-9
case_images: A postoperative radiograph was exposed ( Fig. 9 ).
case_images: Six-month follow-up periapical radiograph.
case_images: 10-1055-s-0044-1791218-i2463179-10.jpg
case_images: PMC11750349_01_10-1055-s-0044-1791218-i2463179-10.jpg
case_images: FI2463179-10
case_images: Fig. 10 ). Furthermore, the apical end of tooth #29 appeared to begin to close with dentinal thickening ( Fig. 10 ). However, the root did not appear to have increased in length or only minimally increased by 1 mm to an estimated radiographic length of 19 mm ( Fig. 10 ). Radiographic estimated mesial root canal wall of 1.6 mm and distal root canal wall thickness of 1.6 mm in the apical third of tooth #29 were noted ( Fig. 10 ). The bioceramic material remained unchanged and still in place ( Fig. 10 ). 
case_images: One-year follow-up periapical radiograph.
case_images: 10-1055-s-0044-1791218-i2463179-12.jpg
case_images: PMC11750349_01_10-1055-s-0044-1791218-i2463179-12.jpg
case_images: FI2463179-12
case_images: An intraoral examination of tooth #29 revealed no signs of swelling or sinus tract, mobility, isolated deep probing depths, percussion (vertical or horizontal), or palpation sensitivity ( Fig. 11 ). The occlusal composite restoration had intact margins with no signs of recurrent carious lesions and no crown discoloration ( Fig. 11 ).
case_images: Intraoral picture of tooth #29 at 1-year follow-up. Permanent coronal restoration shade A2 Filtek Supreme flowable composite with intact margins.
case_images: 10-1055-s-0044-1791218-i2463179-11.jpg
case_images: PMC11750349_01_10-1055-s-0044-1791218-i2463179-11.jpg
case_images: FI2463179-11
case_images: Yet, the root did not appear to have increased in length, remaining at an approximate radiographic length of 19 mm ( Fig. 12 ).
case_images: Intraoral picture of tooth #29 at 15-month follow-up. Permanent coronal restoration shade A2 Filtek Supreme flowable composite with intact margins and orthodontic wire and brackets present.
case_images: 10-1055-s-0044-1791218-i2463179-13.jpg
case_images: PMC11750349_01_10-1055-s-0044-1791218-i2463179-13.jpg
case_images: FI2463179-13
case_images: The occlusal composite restoration remained intact; however, the patient was now in orthodontic braces ( Fig. 13 ).
case_images: Multiple sagittal and coronal slices of cone beam computed tomography of tooth #29 displaying root endoclosure and no periapical pathology.
case_images: 10-1055-s-0044-1791218-i2463179-14.jpg
case_images: PMC11750349_01_10-1055-s-0044-1791218-i2463179-14.jpg
case_images: FI2463179-14
case_images: The CBCT slices showed no periapical pathology and root end closure ( Figs. 14 and 15 ).
case_images: Multiple axial slices of cone beam computed tomography of tooth #29 displaying root endoclosure and no periapical pathology.
case_images: 10-1055-s-0044-1791218-i2463179-15.jpg
case_images: PMC11750349_01_10-1055-s-0044-1791218-i2463179-15.jpg
case_images: FI2463179-15
case_images: The CBCT slices showed no periapical pathology and root end closure ( Figs. 14 and 15 ).