<![CDATA[Background: The management of permanent teeth with pulp necrosis and an open apex presents a significant challenge in endodontics because the thin dentinal walls elevate the risk of root fracture and make it difficult to achieve an adequate apical seal without material extrusion. Apexification remains a reliable treatment option for immature permanent teeth with pulpal necrosis before root development is complete. Objective: This report outlines the clinical outcomes of Mineral Trioxide Aggregate (MTA) as a material in apexification for immature permanent teeth with pulpal necrosis and incomplete root formation. Case: A 9-year-old boy presented with pulpal necrosis and incomplete root development of the maxillary central incisor after dental trauma. Case Management: Apexification was completed over three clinical visits, including root canal preparation and disinfection, followed by mineral trioxide aggregate (MTA) placement to create an apical barrier. After the MTA had adequately set, the root canal was obturated, and the tooth was restored with direct composite restoration. At the five-month follow-up, clinical and radiographic examinations demonstrated favorable outcomes, with no patient-reported symptoms and evidence of apical barrier formation. Discussion: MTA apexification remains a reliable and biocompatible treatment option for immature permanent teeth with pulpal necrosis and open apex. This procedure promotes apical barrier formation; however, long-term follow-up is essential to monitor healing and treatment outcomes. Conclusion: MTA apexification is a reliable treatment option for immature permanent teeth in children, providing favorable outcomes and functional restoration.]]>
