Wide apical foramen, thin canal walls, necrotic pulp would, in year 2000, condemn this tooth and have it replaced by an implant supported crown.
Thinking out of the box to preserve that tooth, this MTA (Mineral Trioxide Aggregate) apical plug also known as a ceramic material has been performed by the author back in 2001. Legend #1 on XRay dental film displays an MTA apical obturation. Last image to the right is a 5 years follow up X ray dental film showing perfect bone healing. Today, almost 13 years later, the tooth is still asymptomatic and functional. So far so good!
Back then, ceramic material MTA was not intended to be used as a a root canal filler material but as a perforation/resorption repair material or as a retrofill material. Thus using this ceramic material as an orthograde filler to create an apical barrier in this instance makes it most likely one of the earliest ceramic application procedure of this type ever attempted to preserve a tooth. Outcome success in this case is due to the ceramic following advantages:
Highly antibacterial due to its 12,8 pH, biocompatible, non inflammatory in case of material extrusion, has the ability to form hydroxyapaptite thus create a real bond to dentine, hydrophilic, does not shrink
The only drawback is that MTA has such a large particle size which limits its application as a filler to relatively wide canals such as this one.
Back then, MTA was not intended to be used as a filler and most certainly not as a sealer. Today, 13 years later, because of recent nanotechnology development, some researchers pushed the concept one step further and a new type of premixed root canal Bioceramic sealer material is being marketed by Brasseler USA: EndoSequence BC Sealer. According to the manufacturer, the particle size of BC Sealer is so fine (less than two microns), it can actually be delivered with a 0.012 capillary tip. A promising sealer that seems to offer all the benefits associated with bioceramic material. The only drawback is its non recommended use as a filler material in teeth that might one day need an endodontic revision. This material bond to the dentine and cannot be removed from canal, thus surgery is the only left available option for a tooth filled with a Bioceramic sealer.