Fig. 1

A 28 years old female presented complaining of a discolored maxillary left central incisor (UL1). History of trauma 12 years ago. The patient’s chief complain was the discolored UL1 with ugly restoration, as she reported no history of pain nor discomfort.

Fig. 2

On clinical examination, UL1 had negative response to cold test, no tenderness to percussion, no tenderness to palpation on buccal gingiva, and no mobility. While UR1 and UL2 responded normally to cold test.

Fig. 3

From palatal view, the gingiva around UL1 was little swollen with deep probing. There was clinical evidence of pin underneath the composite restoration

Fig. 4

Pre-operative IOPA (intra-oral peri-apical) radiograph revealed large peri-apical lesion around the apices of UL1 and UL2. But according to the clinical examination, UL2 was with clinically normal pulp as it responded normally to cold test.

Diagnosis: UL1 was diagnosed as necrotic tooth with asymptomatic apical periodontitis (AAP).

Treatment plan: 

  1. 1. NSRCT (non-surgical root canal treatment).
  2. 2. Internal bleaching.
  3. 3. Restore the tooth aesthetic by direct composite restoration.
Fig. 5

Endodontics treatment was conducted on two visits.

After access opening, the canal was already wide so there was no instrumentation.

Chemical debridement was conducted with NaOCl 5.25%, EDTA 17%, activated by passive ultrasonic irrigation (PUI).

Apical gauge was measured size #70.

With the use of MAP System (Produits Dentaires SA), it was easy to deliver MTA apical plug.

Fig. 6

8 mm of MTA apical plug was delivered with the use of MAP System and condensed using the flexible Fanta Pluggers

Fig. 7

The rest of the canal was then filled with thermo-placticized gutta percha to a level bellow the crystal bone level.

Fig. 8

Coronal seal was done with SDR. The pulp chamber then was filled with internal bleaching material (Ultradent) for 5 days

Fig. 9

Final situation of UL1 by restoring the function and aesthetic after internal bleaching and direct composite restoration.

Fig. 10

Three years review IOPA showing complete healing of the periapical lesion and new bone formation.

Fig. 11

Normal palatal gingival tissue around UL1 and the disappearance of the pocket after 3 years recall.

Fig. 12

Before and after 3 years, clinical and aesthetic situation of UL1.


Endodontically treated teeth always has to be restored to function and aesthetic. Root canal treatment has surprisingly high and long term prognosis if conducted properly (Ng et al. 2011, Salehrabi & Rotstein 2004, Salehrabi & Rotstein 2010).

On the other hand, since its introduction in the clinical Endodontic treatment Torabinejad et al. in 1993 at Loma Linda University and King’s College London, MTA showed a significant high success rate in different implications in Endodontics (Tang et al. 2010, Torabinejad et al. 1995,  Giovarruscio et al. 2020), owing to it’s biocompatibility, bioactivity, high alkaline pH, and antibacterial activity (Parirokh & Torabinejad 2010).

In this case report, along with good chemo-mechanical debridement and good coronal seal, MTA has played a major role in the healing process of the peri-apical lesion, 


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