Trauma to young teeth with incomplete root formation may cause necrosis and loss of the remaining epithelial root sheath and arrested root development. Such open apecies are a challenge to obturate. Historically, the placement of multiple courses of Ca(OH)2 was required in order for an osteoid like tissue to bridge and close the apex. This allowed obturation without extrusion and expression of the sealer/filling material into periapical tissues.

The use of MTA one step apexification was previously defined in the literature. Since the development of MTA, improved Bioceramics with optimized clinical handling have been developed. This tutorial demonstrates the use of one such material, the EndoSequence BioCeramic Root Repair Material in conjunction with the EndoSequence BioCeramic Putty to complete the endodontic therapy in a single, short visit in a necrotic tooth #9 in a 9 year old female with the history of trauma. The use of EndoSequence .04 taper files and the EndoVac irrigation system to push a large volume of irrigant are further demonstrated by Dr. Nasseh.