Vol. 11, Issue 3, Part E (2025)

The management of endodontic cases complicated by anatomical alterations such as open apices and root perforations remains a significant clinical challenge. These conditions compromise the establishment of an apical seal, hinder complete disinfection, and increase the risk of treatment failure. Recent advances in bioceramic materials have provided clinicians with bioactive, biocompatible alternatives that offer excellent sealing ability, promote periapical healing, and reinforce weakened root structures.

This case report describes the successful management of a maxillary central incisor in a 30-year-old female patient presenting with discoloration, fracture, and a history of incomplete root canal treatment. Radiographic and cone-beam computed tomographic evaluation revealed the presence of an open apex and a strip perforation along the palatal surface, complicating conventional treatment options. Following careful negotiation, debridement, and disinfection using calcium hydroxide medicament, the entire canal space was obturated with a premixed bioceramic putty, eliminating the need for traditional gutta-percha. The material was placed incrementally to seal the perforation and apex while minimizing the risk of extrusion. Subsequent coronal sealing with glass ionomer cement and composite restoration ensured an effective barrier against reinfection. The tooth was later restored with a lithium disilicate crown to achieve both functional and esthetic rehabilitation.

At follow-up, the patient demonstrated satisfactory healing and absence of postoperative complications, highlighting the clinical potential of bioceramic materials in salvaging structurally compromised teeth. This case emphasizes the importance of advanced imaging, meticulous clinical execution, and material selection in overcoming challenges associated with open apices and perforations. The use of full-canal bioceramic obturation provided an effective and conservative solution, reinforcing the role of bioceramics as a reliable alternative in managing complex endodontic cases.