Diagnosis

Fourteen-year-old patient presented with a non-vital pulp and symptomatic apical periodontitis. The preoperative radiograph displayed a periapical radiolucency associated
with an incompletely formed root and dens in dente.

Treatment

Access to the middle and apical portion of the root was obtained by making an opening through the dens in dente. The canal space was cleaned and disinfected and calcium hydroxide was placed to augment disinfection and aid in root end closure (apexification). After medication changes and observation for six months, it was determined that apexification was taking place and the periapical radiolucency was decreasing in size. The canal space was filled by placing a collagen barrier at the apex and then filling the canal space with a bioceramic root repair material and gutta percha.