A technique for placement of apical MTA plugs using modified Thermafil carriers for the filling of canals with wide apices

Abstract

To describe a technique for the placement of apical Mineral trioxide aggregate (MTA) plugs in canals with wide apices. A novel technique to fill root canals with an apical diameter larger than 0.4mm is presented. The technique includes three main stages; three Thermafil carriers of increasing size, previously de-sheathed by removing the Gutta-percha coating, are selected to engage 1, 2 and 3mm short of the apex. Their use allows the negotiation of acute curvatures and ledged canals. Subsequently, an MTA plug matching the apical gauge is pre-formed with a pellet block, placed and condensed using the modified carriers in sequence. The presented protocol for the management of teeth with apices of a diameter greater than 0.4mm allows a favourable apical control of the MTA. Clinical cases completed using this methodology are presented. MTA placement in teeth with wide apices was facilitated by using de-sheathed Thermafil carriers, to create an appropriate seal and stable platform for Gutta-percha backfilling or subsequent fibre post placement. The use of de-sheathed Thermafil carriers of different sizes allows predictable placement of pre-formed MTA plugs. Gauging of Thermafil carriers enhances control of the condensation phase to limit the extrusion of MTA.