International Journal of Dentistry Research 2026; 11(2): 45-49 DOI:10.31254/dentistry.2026.11206

Case Report

Regenerative Endodontic Management of an Immature Maxillary Central Incisor Using a Novel Pre-Set MTA Plug Technique: A 1-Year Follow-Up Case Report

Raghavan Ragu¹ , Shafie Ahamed² , S Bhavani³ , G Rajaraman³

Raghavan Ragu,Shafie Ahamed,S Bhavani,G Rajaraman

1. Postgraduate, Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital, Cuddalore- 608002, Tamil Nadu, India
2. Professor & Head, Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital, Cuddalore- 608002, Tamil Nadu, India
3. Associate Professor, Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital, Cuddalore- 608002, Tamil Nadu, India

*Author to whom correspondence should be addressed.

Received: 12th June, 2026 / Accepted: 8th August, 2026 / Published : 31st August, 2026

Abstract

Regenerative endodontic procedures provide a biologically based approach for the management of immature permanent teeth with necrotic pulps, allowing continued root development and healing of periapical tissues. Mineral trioxide aggregate is commonly used as a coronal barrier; however, placement of freshly mixed MTA over a blood clot scaffold can be technique-sensitive and may disturb the scaffold. This case report describes a novel custom-fabricated preset MTA plug technique for regenerative endodontic treatment of an immature maxillary central incisor. A 15-year-old female presented with pain and discoloration of the maxillary left central incisor following trauma six years previously. Clinical and radiographic examination revealed pulpal necrosis, chronic apical periodontitis, an immature root apex, thin dentinal walls, and periapical radiolucency. Minimal canal instrumentation and irrigation were performed, followed by placement of calcium hydroxide as an intracanal medicament. A canal impression was obtained using polyvinyl siloxane, and a custom MTA plug was fabricated extraorally and allowed to set before clinical placement. At the second visit, the canal was disinfected, apical bleeding was induced to create a blood clot scaffold, and the preset MTA plug was carefully positioned approximately 2 mm below the cementoenamel junction. The tooth was subsequently restored with resin-modified glass ionomer cement and composite resin. The patient remained asymptomatic and functional during follow-up, with progressive reduction of the periapical radiolucency. At one-year follow-up, a positive sensibility response and increased root thickness were observed, suggesting continued root development and favorable periapical healing. The preset MTA plug technique may provide a practical alternative to conventional placement of freshly mixed MTA in regenerative endodontic procedures by facilitating handling, improving placement, and reducing the risk of disturbing the blood clot scaffold. Further clinical studies with larger sample sizes and longer follow-up are required to establish the predictability and long-term effectiveness of this technique.