Fig. 1

A 42 year male patient reported with chief complaint of a discoloured right central incisor . History revealed that the tooth previously root canal treated before 8 years . 

Radiographic examination revealed an apical resorption and wide open apex with large radiolucent area in proximity of the apex of the tooth .

Fig. 2

Isolation with rubber dam and access opening was done under local anaesthesia .

Fig. 3

During gutta percha removal one of the accessory gutta percha was extruded beyond the apex .

Fig. 4

The canal was cleaned and over extruded gutta percha removed. 

Fig. 5

By curving H file at the end (like small hook ) , then going beyond the apex and slightly rotated to catch the extruded gutta percha.

Fig. 6

Periapical radiograph was taken to determine the working length .the root canal was lightly cleaned with hand file under irrigation with 5.25% NaOCl . The root canal was then dried with sterile paper points . Calcium hydroxide was placed in the root canal , and the patient was recalled after two weeks.

Two week later , the tooth was again isolated under rubber dam , the calcium hydroxide was removed by hand instrumentation , and irrigation was done with 5.25% NaOCl and EDTA17% , the root canal was dried with paper points.

Fig. 7

Collagen sponge used to act as artificial barrier , then MTA placed in the canal by MAP one then condensed by large pepper point .

Fig. 8

The remains part of the canal was filled by injectable gutta percha .

Fig. 9

A 8 months follow-up revealed healing and bone formation .


The major problem in cases of a wide open apex is the need to limit the material , thus avoiding the extrusion of a large amount of material into the periodontal tissue .

Using a matrix avoids the extrusion of the material into the periodontal tissues , reduces leakage in the sealing material and allows favorable response of the periodontal tissues . 


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