Endodontic Surgery of a Symptomatic Overfilled MTA Apical Plug: A Histological and Clinical Case Report.
ABSTRACT: This case report presents the successful surgical treatment of a symptomatic open apex upper central incisor with a failed overfilled mineral trioxide aggregate (MTA) apical plug. Unintentional overextension of the MTA had occurred two years before the initial visit. An apical lesion adjacent to the excess MTA was radiographically detectable. Endodontic surgery was performed using calcium-enriched mixture (CEM) cement as a root-end filling material. Curettage of the apical lesion showed a mass of unset MTA particles; histopathological examination revealed fragments of MTA and granulation tissues. Up to 18-month follow-up, the tooth was clinically asymptomatic and fully functional. Periapical radiograph and CBCT images showed a normal periodontal ligament around the root. In conclusion, favorable outcomes in this case study suggested that root-end filling with CEM cement might be an appropriate approach; in addition, however many factors probably related to the initial failure of the case, the extrusion of MTA into the periapical area should be avoided.
Project description:Broken instruments in root canals complicate routine endodontic treatment. This study aimed to compare apical microleakage in root canals containing broken rotary instruments filled with mineral trioxide aggregate (MTA), calcium-enriched mixture (CEM) cement, laterally compacted gutta-percha and injected gutta-percha.In this in vitro, experimental study, 80 extracted human premolars were decoronated and then the roots were randomly divided into four groups (n=20). Root canals were instrumented with Mtwo rotary files. The files were scratched 3 mm from the tip by a high speed handpiece and they were intentionally broken in the apical third of the canals. The middle and coronal thirds of the canals were then filled with MTA, CEM cement, gutta-percha with lateral compaction technique and injected gutta-percha. Apical microleakage was measured using dye penetration method. Data were analyzed using ANOVA and Tukey's test.Root canals filled with CEM cement showed the lowest and those filled with injected gutta-percha showed the highest microleakage according to dye penetration depth. No significant difference was noted between the microleakage of CEM cement and MTA or between lateral compaction of gutta-percha and injected gutta-percha (P>0.05). However, CEM cement and MTA groups had significantly lower microleakage than laterally compacted and injected gutta-percha groups (P<0.05).Due to their superior sealing ability, MTA and CEM cement are suitable for filling of root canals containing a broken instrument compared to laterally compacted and injected gutta-percha.
Project description:Propylene glycol (PG) improves the handling, physical, and chemical properties of mineral trioxide aggregate (MTA). This study aimed to evaluate the effect of PG on the sealing ability of MTA and calcium-enriched mixture (CEM) apical barriers.A total of 70 extracted human maxillary single-rooted teeth were prepared using ProTaper rotary system. The apical 3 mm of the root tips were resected and the root canals were enlarged with Peeso reamers up to #4, to create open apex teeth. The teeth were then randomly divided into four experimental (n=15) and two control (n=5) groups. Group1: MTA+ MTA liquid, group2; MTA+MTA liquid (80%) + PG (20%), group3; CEM+CEM liquid, group4; CEM+ liquid (80%) + PG (20%). Cements were mixed with their respective mixing agents and a 4-mm thick apical plug was fabricated. The microleakage was measured on day 1, 3, 7 and 21 using a fluid filtration technique. The repeated measures ANOVA and Sidak test were used to analyze the data.All experimental groups demonstrated various amounts of microleakage. No significant difference was found between MTA and CEM cement (P=0.193), regardless of time and liquid components. There was no significant difference was observed between liquids (P=0.312) in all time intervals. The rate of microleakage decreased over time and a significant differences was observed between all intervals (P<0.05), except 3-7 and 7-21 (P=0.190) days.PG demonstrated neither a positive nor a negative effect on the sealing ability of Angelus MTA and CEM cement.
Project description:This in vitro study investigated the effect of adding 10% calcium chloride (CaCl2) on push out bond strength of calcium-enriched mixture (CEM) cement and mineral trioxide aggregate (MTA) to root canal dentin.A total of 120 root dentin slices with 2 mm thickness were prepared from sixty single-rooted human teeth. Dentinal discs were enlarged to achieve 1.3 mm diameter. The specimens were randomly allocated into eight groups (n=15). Dentin discs were filled with either CEM cement or MTA with or without CaCl2 and the push out test was performed after 3 and 21 days. Data were analyzed with two-way ANOVA test. The level of significance was set at 0.05.There was an interaction effect amongst all groups (P=0.028). After 3 days, CEM cement showed a significantly lower bond strength than other groups (P<0.05) while MTA demonstrated significantly higher bond strength than CEM cement with or without CaCl2 (P=0.001). After 21 days, CEM cement with or without CaCl2 had no significant difference with other groups (P>0.05). However, the bond strength of MTA decreased when CaCl2 was added (P=0.011).The addition of 10% CaCl2 increased the push out bond strength of CEM cement and improved it over time; while, this substance aggravated this property for MTA.
Project description:Traditionally, immature teeth diagnosed with necrotic pulp and periapical periodontitis were treated by apexification with long-term calcium hydroxide or in one session with mineral trioxide aggregate (MTA) or Biodentine apical plug. However, these teeth become fragile and susceptible to root fracture. Regenerative endodontic procedure is a new therapeutic approach that promotes continuation of root growth in immature necrotic teeth potentially preventing root fracture. Only few case reports have shown the success of this procedure on molar cases. The current case report demonstrates a regeneration of a lower first molar with necrotic pulp and chronic apical abscess treated with Micro Mega-MTA (MM-MTA), a new endodontic biomaterial that has not been described previously. Calcium hydroxide was used as an intracanal medicament for two weeks. Next, calcium hydroxide was removed and after blood clot creation, MM-MTA® was placed over it. Apical healing and continuation of root growth were evident at nine months follow-up. CBCT at two years follow-up confirmed apical closure and complete healing. This case shows that a regenerative endodontic procedure for management of an immature necrotic permanent molar is feasible and can be successfully done using Ca(OH)? and MM-MTA.
Project description:Pulp necrosis is one of the main complications of dental trauma. When it happens on an immature tooth, pulp necrosis implies a lack of root maturation and apical closure. A therapy called apexification is required to induce the formation of a calcified apical barrier allowing a permanent and hermetic root filling. The aim of this prospective randomized clinical trial is to compare Mineral Trioxide Aggregate(MTA)with Calcium Hydroxide(CH)as materials used to induce root-end closure in necrotic permanent immature incisors.This study, promoted by AP-HP, was approved by the ethics committee(CPP Paris Ile de France IV). 34 children aged from 6 to 18 years and presenting a non-vital permanent incisor are selected. Prior to treatment, an appropriate written consent has to be obtained from both parents and from children. Patients are then randomly assigned to either the MTA(experimental)or CH(control)groups. Recalls are performed after 3, 6 and 12 months to determine the presence or absence of a calcified apical barrier through the use of clinical and radiographic exams. Additional criteria such as clinical symptoms, apical radiolucencies, periapical index(PAI)are also noted.ClinicalTrials.gov no. NCT00472173 (First inclusion: May 10, 2007; Last inclusion: April 23, 2009; study completed: April 15, 2010).
Project description:The present study was aimed to evaluate and compare the apical sealing ability of two endodontic root-end filling materials namely, iRoot SP (ceramic based) and ProRoot MTA using the bacterial leakage system.A total of fifty recently extracted, single rooted teeth with a single straight canal were selected for the study. The teeth were chemo mechanically prepared. The apical 3mm of the root was resected and root end cavities were prepared. The teeth were randomly divided into two groups of twenty teeth each for the experimental root end filling materials namely, iRoot SP and ProRoot MTA. A two-chamber model was constructed using pippeter tips and plastic vials. The pipetter tips with the teeth were suspended in these caps and the entire assembly was reattached to the vial. The upper chamber was seeded withEnterococcus faecalis. An Enterococci-selective broth was used in the lower chamber. Leakage was assessed for 90 days and compared using survival statistics.The ProRoot MTA filled root end samples leaked within 30-72 days. The iRoot SP filled root end samples leaked within 51-69 days.Under the parameters of this study, it can be concluded that all the tested materials showed significant apical sealing ability as root-end filling materials over a period of 90 days. iRoot SP exhibited the most effective apical sealing ability as compared to ProRoot MTA. Key words:Apical sealing ability, Bacterial leakage, iRoot SP, ProRoot MTA, Root-end filling.
Project description:We described a combined periodontal-endodontic lesion, which was caused by a palatogingival groove and an additional root. An interdisciplinary approach involving endodontic therapy, mineral trioxide aggregate (MTA) filling, root resection, guided tissue regeneration, and papillary reconstruction was used for the case. The tooth presents morphologically and functionally normal except tooth discoloration caused by MTA.
Project description:This case report aims to describe the management of a complex odontoma with endodontic involvement of surrounding teeth utilizing a new bioceramic cement consisting of five mineral oxides (5MO) as a retro-filling material. The patient presented for routine consultation with slight dental mobility in the antero-superior region. Upon clinical and computed tomography examination, bone rarefaction was observed in the apical region of teeth 11 and 12, external root resorption in the involved teeth and necrotic pulp of tooth 12. Root canal treatment was performed in teeth 11 and 12. Later, local surgical excision of the lesion was carried out, finding a mass with clinical features of complex odontoma, with histopathological examination of the mass confirming this diagnosis. Retro-filling of tooth 12 with 5MO was carried out. No signs and symptoms were observed over twelve-months of follow-up, with bone neoformation observed in the region. Therefore, 5MO appears to be an effective bioceramic cement that has reparative features.
Project description:Background. Mineral trioxide aggregate (MTA) and Calcium-enriched Mixture (CEM) cement are used for pulp capping since they induce the formation of a dentinal bridge. Long setting time is a shortcoming of these types of cement. This study aimed to assess the effect of the incorporation of some alkaline salts to MTA and CEM cement on their setting time, ion release profile, pH, and surface morphology. Methods. In this in vitro experimental study, 5% calcium chloride (CaCl2), calcium oxide (CaO), sodium fluoride (NaF), and calcium nitrate [Ca(NO3)2] were separately added to MTA and CEM cement. The primary and final setting times of the cements were measured using a Gillmore needle apparatus. The samples were immersed in simulated body fluid (SBF) for one, seven, and 14 days and subjected to x-ray diffraction (XRD) and scanning electron microscopy (SEM) for phase identification and surface morphology assessment. The change in the pH of solutions was studied, and the calcium ion release profile was determined using inductively coupled plasma atomic emission spectroscopy (ICP-AES). The data were analyzed with ANOVA, followed by post hoc tests. Results. CaCl2 and CaO decreased the setting time of MTA, and Ca(NO3)2 decreased the setting time of CEM cement. The incorporation of the salts increased the pH and calcium ion release from both cements, and hydroxyapatite deposits were noted to cover the surface of the samples (observed by SEM and confirmed by EDXA). Conclusion. The incorporation of CaCl2 and CaO into MTA and Ca(NO3)2 into CEM cement decreased their setting time and increased their pH and calcium ion release.
Project description:Aim. To compare the periapical status of endodontically treated teeth between Austrian and Croatian adult patients and determine its relation to age, sex, position of teeth, and length of root canal filling. Methods. The study was conducted from 2007 to 2009 at two university dental clinics and included 163 Croatian (412 teeth) and 101 Austrian (430 teeth) patients. We assessed the periapical status of endodontically treated teeth by using the periapical index system and determined its relation to age, sex, position of teeth, and length of root canal filling. Results. Austrian patients had a greater number of diseased endodontically treated teeth than Croatian patients (P=0.001). In the age group 31-40 years, Austrian patients had apical periodontitis significantly more often (22.1% vs 12.2%, P<0.001) than Croatian patients. In relation to sex and position of teeth, no significant difference was found between the two groups. In Croatian patients, apical periodontitis was significantly more often present in molar than premolar (46.2% vs 29.7%, P=0.022) and front teeth (46.2% vs 24.1%, P<0.001). In Austrian patients, apical periodontitis was significantly more often present in molar and premolar than front teeth (molar-front teeth: 38.2% vs 25.5%, P=0.011; premolar-front teeth: 36.3% vs 25.5%, P=0.029). Croatian and Austrian patients with AP significantly differed in the number of adequately filled and underfilled teeth (both P<0.001). Conclusion. Apical periodontitis was significantly more present in endodontically treated teeth in Austrian patients. The difference in the periapical status between Croatian and Austrian patients was most related to age and length of root canal filling.