Carrier Supported Custom Fit Biomaterial Using MTA and Biodentine: A Novel Indirect Single-Step Apexification Technique with Two-Year Follow-Up​

AbstractBackground: Open apex management remains a clinical challenge in endodontics due to limitations of conventional apexification techniques, including material extrusion, multiple visits, prolonged treatment duration, and excessive radiation exposure. This research note presents a novel carrier-supported custom-fit biomaterial and its indirect single-step apexification technique for managing open apex cases.Methods: A custom-fit biomaterial was fabricated using an indirect technique involving light body silicone impression of the root canal, creation of a negative replica in heavy body putty, and packing of biomaterial (MTA/Biodentine) with an embedded twisted ligature wire serving as a carrier. Two clinical cases — a 32-year-old female (tooth #21,  Biodentine) and a 45-year-old male (tooth #44, MTA) — were treated using this novel technique and followed up for 24 months.Results: Both cases demonstrated successful clinical and radiographic outcomes at 2-year follow-up. The custom-fit biomaterial achieved precise three-dimensional apical seal without material extrusion. The procedure was completed in a single visit with minimal radiographic exposures.Conclusion: The carrier-supported custom-fit biomaterial technique offers a predictable, single-step, indirect apexification approach that overcomes the limitations of conventional methods. The 2-year follow-up confirms the long-term clinical viability of this innovative technique.Keywords: Open apex; Apexification; Custom-fit biomaterial; MTA; Biodentine; Ligature wire carrier; Single-step apexification; Endodontics