The use of white Portland cement as an apical plug in a tooth with a necrotic pulp and wide-open apex: a case report

Aim To present a case in which substantial periapical healing occurred with the use of white Portland cement (WPC) to create an apical plug in the root of an immature tooth. Summary Radiographic examination indicated an immature tooth (35) with a wide-open apex and a periapical radiolucency. The canal was mechanically cleaned using intracanal instruments and 5% NaOCl irrigation. Small pieces of resorbable collagen sponge were packed beyond the root apex with the aim of creating a periapical barrier for the compaction of filling material. WPC powder was then mixed with sterile water and delivered to the apical portion of the canal (approximately 3 mm). The patient was asked to return 1 week later for the continuation of treatment but he did return as planned. Seven months after the intervention the patient returned and another radiograph was exposed to reveal complete radiographic healing of the periapical region. The remainder of the canal was filled with thermoplastic gutta-percha. Clinical follow-up 1 year later revealed adequate clinical function, absence of clinical symptoms and no signs of periapical rarefaction. Key learning point The positive clinical resolution of this case is encouraging for the use of WPC as an apical plug in immature teeth with necrotic pulps and wide-open apices.