Customized BioRoot Inlay for the Management of an Immature Tooth With a Blunderbuss Canal: A Novel Biomimetic Approach.

Management of immature teeth with open apices and severely divergent blunderbuss canals presents challenges in achieving predictable obturation and apical sealing. This case report describes a customized BioRoot inlay technique for the management of a previously treated immature maxillary central incisor with complex root canal anatomy. A 52-year-old female presented with discoloration of the maxillary left central incisor. The tooth had sustained traumatic injury during adolescence, resulting in pulpal necrosis and arrested root development with an incompletely formed apex. Root canal treatment was performed approximately 10 years before the present evaluation. Clinical and radiographic examination revealed inadequate previous obturation, a wide blunderbuss canal, external inflammatory root resorption, and a large periapical radiolucency. We performed nonsurgical retreatment, followed by chemomechanical debridement, intracanal calcium hydroxide medication, and local application of zoledronic acid. An intracanal impression was subsequently obtained using light-body polyvinyl siloxane. A customized BioRoot inlay was fabricated extraorally by condensing Biodentine into the impression-derived mold and was subsequently cemented within the canal. Postoperative periapical radiographic evaluation demonstrated satisfactory adaptation of the customized inlay and a satisfactory radiographic appearance of the apical obturation. The patient was followed clinically and radiographically, with favorable findings observed during follow-up. This customized BioRoot inlay technique provided a patient-specific method for managing the complex anatomy of an immature tooth with a blunderbuss canal. The technique may facilitate controlled placement and adaptation of the biomaterial within irregular canal anatomy. Further clinical studies with longer follow-up are required to determine its reproducibility and long-term clinical effectiveness.