case_images: PMC8831214_01
case_images: PMC8831214_02
case_images: A) preoperative view of the amount of structure loss on maxillary right central incisor; B) postoperative view after completion of the intraradicular reinforcement and composite restoration
case_images: PAMJ-40-241-g001.jpg
case_images: PMC8831214_02_PAMJ-40-241-g001.jpg
case_images: F1
case_images: Patient information: a 14-year-old female patient presented to the department of operative dentistry with a fractured right maxillary central incisor (Figure 1A). Therapeutic interventions: after discussing different treatment options with the patient and explanation of the guarded prognosis of the treatment it was decided to perform apexification followed by intra-radicular reinforcement and free hand composite build up (Figure 1B) for tooth 11. A direct composite restoration (Te Econom Plus-Ivovlar Vivadent) was completed over the customized fiber post and a radiograph was taken for final assessment (Figure 1B, Figure 2F).
case_images: A) placement of MTA as apical barrier; B) radiographic confirmation afer MTA placement, note the thin dentinal walls and large root canal space; C) adaptation of the cellulose paper inside the root canal space to serve as a barrier for prevention of composite entrapment and to allow easy withdrawal of the customized fiber post; D) customized fiber post after removing from the root canal space and before peeling of the cellulose paper; E) checking the fit and adaptation of the customized fiber post; F) postoperative radiograph after completion of intraradicular reinforcement
case_images: PAMJ-40-241-g002.jpg
case_images: PMC8831214_02_PAMJ-40-241-g002.jpg
case_images: F2
case_images: Following completion of the apexification procedure using Mineral Trioxide Aggregate (MTA CEM, NEXOBIO CO, Korea) (Figure 2A, Figure 2B) a period of 24 hours was allowed to lapse for maturation of the MTA before beginning the restoration. A small piece of cellulose paper was inserted and adapted to the walls of the root canal space (Figure 2C). After the preliminary curing, the customized fiber post was removed from the root canal space (Figure 2D) and the paper barrier was peeled off to allow additional curing for 20 seconds of the apical half outside the canal, in close proximity to the light source. The customized fiber post was then reinserted to check for adaptation (Figure 2E). A direct composite restoration (Te Econom Plus-Ivovlar Vivadent) was completed over the customized fiber post and a radiograph was taken for final assessment (Figure 1B, Figure 2F).