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| case report use of MTA Fig. 6a Fig. 6b Fig. 6c Figs. 6a & b: MTA REPAIR HP. Capsule containing the powder (a). Vial containing the liquid (b). Fig. 6c: The material after proper manipulation. 24 roots 2 2017 swollen. The temporary fi lling was removed, and the calcium hydroxide paste was removed from the canal using a 2.5 % sodium hypochlorite solution and pas- sive ultrasonic irrigation as previously described. The #80 hand fi le was used again to working length. The canal was then irrigated with 5 ml of 17 % EDTA for three minutes to remove the smear layer, and 5 ml of saline solution was used for the fi nal rinse. The canal was dried with paper points, and MTA REPAIR HP was manipulated according to the manufacturer’s instructions and placed with the aid of pluggers (B&L Biotech) in the last 3 mm of the root canal, forming an apical plug. After ten minutes, the mate- rial had set, and the tooth was obturated using BC Sealer (Brasseler USA) and gutta-percha cones with the lateral condensation technique (Figs. 3a & b). The pulp chamber was cleaned with a sponge soaked in 70 % alcohol, and the access cavity was re- stored using composite (Figs. 4a & b). A high-resolu- tion CBCT scan of the patient was requested immedi- ately after treatment so that it could be used for comparison later in the follow-up. The patient presented for recall one month later without any symptoms. Postoperative radiographic and clinical evaluations were performed at three, six and nine months. The tooth was asymptomatic, and the area did not have any signs of infl ammation. After nine months, another CBCT examination was con- ducted. Comparison of the CBCT images was per- formed, and bone healing and apical closure of the open apex could be observed (Figs. 4a & b, 5a & b). Discussion Previous clinical studies in humans have demon- strated that an apical barrier of MTA can be used with success in the technique of apexifi cation of teeth with open apices. El-Meligy and Avery ran a clinical trial comparing the use of calcium hydroxide and MTA in 30 teeth of 15 patients who had lost pulp vitality through caries or trauma.9 The conventional tech- nique of apexifi cation with calcium hydroxide was performed in one tooth, whereas the barrier tech- nique with MTA was applied to the other tooth in the same patient. The teeth were then followed up for three, six and 12 months. Two of the teeth fi lled using calcium hydroxide failed, while none of the teeth fi lled with MTA showed clinical or radiographic signs of pathology. Simon et al. carried out a prospective clinical trial in 57 teeth of 50 patients with open api- ces treated with MTA plugs and defi nitive fi lling of the canal and observed success in 81 % of the cases.16 In this case report, the use of a modifi ed MTA (MTA— bioceramic-based high-plasticity reparative cement) achieved a good clinical result over the short fol- low-up period. Comparison of CBCT images just after placement of the MTA barrier and after a nine-month period demonstrated bone formation and apical clo- sure by hard tissue. It should be noted that a radiolu- cent area too could be seen at this time. Such a healing pattern could be classifi ed as incomplete healing, according to Molven et al.24 From a clinical perspective, the handling and place- ment of the MTA REPAIR HP was easier than with the conventional MTA. According to the manufacturer, the difference between MTA REPAIR HP and the orig- inal Angelus MTA is the replacement of distilled water with a liquid that contains water and another organic plasticiser that gives the new product high plasticity25 (Fig. 6). The manufacturer claim that the new MTA does not promote dental discoloration could not be studied in this case, since the material was placed in the apical portion of the canal. The importance of case reports is the demonstra- tion of what is possible in our patients using scientifi c clinical treatment protocols. Reports from clinical practitioners have played important roles in the fi eld of dentistry, but should be validated through proper laboratory and clinical research studies. In conclu- sion, the clinical protocol using the new MTA REPAIR HP, as described in this case report, enabled the suc- cessful apexifi cation of a central incisor in a young patient._ Editorial note: This article fi rst appeared in the Endodontic Practice US magazine (Vol. 9, No. 2). Reprinted with permis- sion. A list of references is available from the publisher. contact Dr Mario Luis Zuolo Endodontist Dr Mario Luis Zuolo from São Paulo in Brazil is an internationally prominent speaker in the specialty. He can be contacted at mlzuolo@uol. com.br. Dr Arthur de Siqueira Zuolo runs a private practice in São Paulo and is Adjunct Professor of Endodontics at the Associação Paulista de Cirurgiões Dentistas, the São Paulo association of dental surgeons. He can be contacted at artz@msn.com.