Abstract
Apical surgery should be considered as the last treatment option and employed when conventional endodontic treatment does not provide the expected result. In teeth undergoing apical surgery, the type of retrograde filling material is one of the factors interfering with the repair of periapical tissues. The material in intimate contact with the periapical tissues plays a fundamental role in the repair process. Several materials have been studied and indicated for use in apical surgery procedures, but the mineral trioxide aggregate (MTA) is still the most frequently used one. Guided tissue regeneration (GTR) techniques have been proposed as an adjunct to apical surgery to enhance bone healing. Here is reported a clinical case in which apical surgery was performed in conjunction with MTA-based root reconstruction of the maxillary right second incisor. After the apical surgery, a root-end cavity was prepared at the vestibular face of the involved tooth and filled with MTA. A bovine bone graft and a cortical collagen membrane were placed on the bone defect. After 5 years, clinical and radiographic assessments showed that the treatment was successful. It may be concluded that MTA presents favorable characteristics in adverse conditions and can be used in conjunction with GTR in cases involving root reconstruction.
Highlights
The use of mineral trioxide aggregate (MTA) was first reported in 1993 in a study where it was used for treating pathologic and iatrogenic root perforations and root-end cavities [1]
Previous studies have shown that the average success rate of apical surgery is lower than expected [7]
The success rate of apical surgery remains less than 50% in cases of endoperiodontal lesions [6]
Summary
The use of mineral trioxide aggregate (MTA) was first reported in 1993 in a study where it was used for treating pathologic and iatrogenic root perforations and root-end cavities [1]. MTA reportedly has adequate biocompatibility and sealing ability and is less cytotoxic than other currently used materials in endodontic therapy [2,3] It shows favorable characteristics in apical tissues. The relatively low success rate of apical surgery is directly associated with the variety of factors that can influence the healing process in the periapical region [7]. The use of guided tissue regeneration (GTR) in apical surgery can increase the success rate of the procedure [10]. Previous studies have shown that treatment of combined induced perio-endo lesions by using bioabsorbable collagen membranes with bovine bone mineral (BBM) particles provides satisfactory results for the healing process and regeneration of tissues [11]. This article describes a case of an iatrogenic root perforation that initially had a poor prognosis, but was treated successfully with the application of MTA in conjunction with apical surgery and tissue regenerative techniques, and was followed-up for 5 years
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