Calcium hydroxide induced apical barrier in fractured nonvital immature permanent incisors

Management of trauma to an immature permanent incisor is a challenge, especially when the pulp is necrotic. The aim of this study is to discuss the management of fractured maxillary right and left central incisors with immature root apex. Radiographic evaluation revealed that the tooth 11 had convergent apical walls, whereas tooth 21 had parallel apical walls; both the incisors were treated with pure calcium hydroxide paste to induce apical development. Follow-up clinical and radiographic examinations confirmed apical barrier at 3 months. Radiograph of tooth 11 with convergent roots showed continued apical development, whereas tooth 21 showed apical bridging, following which root canal was completed in both the teeth. Therefore, in view of the simplicity of this method, we believe that calcium hydroxide can be reemphasized as one of the treatment alternatives for fractured nonvital immature permanent incisors to induce apical barrier.