Management of an Open Apex Using a Platelet-Rich Fibrin Membrane as an Internal Matrix and Mineral Trioxide Aggregate as an Apical Barrier: A Case Report.

Apexification is a crucial procedure for achieving apical healing in non-vital teeth with open apices. Traditionally, calcium hydroxide has been used for this purpose, but it has significant drawbacks, including prolonged treatment duration, increased risk of root fracture, and the potential for porous barrier formation. Mineral trioxide aggregate (MTA) has emerged as a superior alternative due to its biocompatibility, faster setting time, and better sealing properties. However, MTA extrusion into periradicular tissues can cause persistent discomfort. The use of an internal matrix such as platelet-rich fibrin (PRF) can help contain MTA within the root canal, enhancing treatment outcomes. A 35-year-old female presented with dull, aching pain in tooth 21, a history of trauma 10 years prior, and incomplete root canal therapy 2 years ago. Diagnosis revealed an open apex with chronic apical periodontitis and pulpal necrosis. Initial management involved canal disinfection with sodium hypochlorite (NaOCl) and calcium hydroxide as intracanal medication. One week later, the patient returned asymptomatic. PRF was prepared from the patient's blood and used as an internal matrix. Mineral trioxide aggregate was then placed against the PRF membrane to form an apical stop. The canal was subsequently obturated with thermoplasticized gutta-percha and restored with composite resin. The use of PRF and MTA provided effective apical sealing, preventing material extrusion and promoting tissue healing. The PRF matrix facilitated the controlled placement of MTA, minimizing complications and enhancing periapical healing. The combination of PRF as an internal matrix and MTA for apical barrier formation represents a promising approach for managing non-vital teeth with open apices. This technique ensures better control over material placement, reduces treatment time, and improves the overall success of endodontic therapy. The aim of this case report is to describe the endodontic management of a non-vital permanent tooth with an open apex and chronic apical periodontitis using a single-step apical barrier technique with MTA and PRF as an internal matrix.