Mineral Trioxide Aggregate Apical Plug Research Articles

Management of Bilateral Foreign Objects in Immature Permanent Maxillary Central Incisors: A Case Report

AbstractTraumatic dental injuries are more commonly seen in children and it often results in a complicated crown fracture. This case is unique as foreign objects in the form of hand-sewing needles were accidentally lodged bilaterally in both maxillary central incisors. A 13-year-old patient was referred to the Dental Clinics at the College of Dentistry, Jazan University with a complaint of broken needles in her front teeth and a history of trauma 3 years ago. Although the patient had the habit of using a hand-sewing needle to remove the lodged food particles from the open pulp chamber, she was not able to recollect the incidence of needle separations. Radiographic examination revealed radiopaque objects in the middle third of the right maxillary central incisor (#11) and in the apical third of the left maxillary central incisor (#21). Tooth #11 was clinically diagnosed as pulp necrosis with chronic apical abscess and tooth #21 as pulp necrosis with asymptomatic apical periodontitis. The micro tweezer from the broken instrument removal kit (Zumax Medical Co.,Ltd., Jiangsu, China) was used to retrieve the separated needle pieces under the operating microscope. The open apices were managed by the formation of mineral trioxide aggregate apical plug, and the procedure of root reinforcement was achieved by bonded resin cement and fiber resin posts. Finally, teeth were restored with dual cure core build-up composite material and direct composite veneers. Recommendations are made to treat complicated crown fractures, especially in children on priority to minimize the risk of foreign object impaction.

Comparison of MTA versus Biodentine in Apexification Procedure for Nonvital Immature First Permanent Molars: A Randomized Clinical Trial.

This study aimed to evaluate the radiological and clinical outcomes of Biodentine apical plugs compared to mineral trioxide aggregate (MTA) in treating immature molars with apical lesions in children. Materials and Methods: Thirty immature roots of 24 permanent lower first molars with apical lesions were randomly divided into two groups: group 1 (15 roots) treated with MTA apical plugs and group 2 (15 roots) treated with Biodentine apical plugs. Treatment radiological outcomes were assessed using the periapical index (PAI) scale after 6 and 12 months of treatment. The presence or absence of apical calcified barrier (ACB) was assessed after 12 months of treatment. The visual analog scale (VAS) was used to compare the postoperative pain between the two groups after 1, 3, 7, and 14 days of treatment. PAI scores between the two groups were compared using the Mann–Whitney U test, the presence or absence of the ACB was compared using the chi-square test, and the VAS scores were compared using the t-test. The statistical significance threshold was set at 0.05. Results: There were no statistically significant differences in the PAI between the two groups at 6 and 12 months postoperatively. After 12 months, four cases in the Biodentine group showed ACB formation, whereas ACB was not found in any case treated with MTA. The VAS scores were statistically lower in the MTA group on the first day after treatment. Nevertheless, these scores were not statistically significantly different after 3, 7, and 14 days of treatment between the two groups. Conclusions: Biodentine can be used as an apical plug to treat immature permanent molars with apical lesions in a single visit in children. Biodentine showed favorable outcomes in apical lesions healing, which was comparable to MTA but with a decreased treatment time associated with its use.

Radiographic differences observed following apexification vs revascularization in necrotic immature molars and incisors: a follow-up study of 18 teeth

PurposeTo evaluate the effectiveness of apexification versus revascularization in the treatment of necrotic immature teeth and determine which strategy affords the greatest radiological success rate.MethodsAn analysis was made of 18 teeth subjected to mineral trioxide aggregate (MTA) apical plugging and regenerative endodontic treatment, assessing healing of the apical lesions and the changes in root dimensions.ResultsSignificantly greater root growth was observed with revascularization in terms of the percentage change in length (12.75% at 6 months) and dentin thickness (34.57% at 6 months) (p < 0.05). There were no significant differences between the two treatments in terms of the apical healing scores after 6 months of follow-up (p > 0.05).ConclusionApexification with an MTA apical plug and pulp regeneration are reliable treatments for non-vital immature teeth. The radiographic outcomes are comparable between the immature teeth subjected to MTA apexification versus those subjected to revascularization. The results of the present study indicate a greater increase in root length and width with regenerative endodontic treatment.

Comparison of Microleakage of Mineral Trioxide Aggregate Apical Plug Applied by the Manual Technique and Indirect Use of Ultrasonic with Different Powers.

Statement of the Problem: A mineral trioxide aggregate (MTA) apical plug is commonly applied prior to endodontic treatment of open-apex teeth. However, difficult application and condensation of MTA in the apical region is a drawback of this technique.Purpose: This study aimed to compare the microleakage of MTA apical plug applied by the manual technique and indirect use of ultrasonic with different powers.Materials and Method: In this in vitro, experimental study, divergent open apices were created in 48 single-rooted, single-canal teeth using ProFile. The teeth were randomly divided into four experimental groups (n=10). All groups received 5-mm thick MTA apical plug at the apical region using one of the following methods. In group 1, MTA was manually condensed while in groups 2-4, indirect ultrasonic energy with minimum, medium, and maximum power levels was used for MTA plug condensation. After setting of MTA, the apical microleakage of the MTA plug was quantified using the fluid filtration method. Data were analyzed using the Mann-Whitney and Kruskal-Wallis tests (p< 0.05).Results: Significant differences were noted in microleakage of MTA plug between the manual group and ultrasonic groups with medium (p= 0.043) and maximum (p= 0.029) power levels. No significant difference was noted in microleakage of other groups (p> 0.05).Conclusion: Considering the current results, it seems that application of MTA with indirect ultrasonic energy at medium or high power level would decrease the microleakage of MTA plug in open-apex root canals.

Effectiveness of MTA apical plug in dens evaginatus with open apices

BackgroundThe present study aims to evaluate the effectiveness of mineral trioxide aggregate (MTA) application in treating dens evaginatus affected teeth with apical lesions and open apices using haemostatic collagen membrane to prevent the apical extrusion of MTA.MethodsTwelve patients with 14 dens evaginatus affected teeth with apical lesions and open apices were treated with MTA apical plug and haemostatic collagen membrane. Clinical symptoms of subjective pain, pain of palpation, percussion, sinus tract, and the apical lesions' radiographic parameter were recorded at every 3-month interval up to 9 months after treatment. Paired t-test or Wilcoxon signed-rank test was used for statistical analysis with P < 0.05 as the threshold for considering results to be statistically significant.ResultsNo patient experienced clinical symptoms 3 months after endodontic treatment. In addition, there was a significant difference in the dimensions of the apical lesions' before compared to 3 months after endodontic treatment.ConclusionsThe combination of MTA apical plug and haemostatic collagen membrane effectively treated dens evaginatus affected teeth with apical lesions, and open apices.

Intraradicular rehabilitation of a necrotic, immature tooth using MTA, a fiber post and composite resin - A case report

Endodontic treatment of necrotic, immature teeth with open apices can present challenges to debridement, disinfection, and optimal obturation. These teeth may have widely flared canals and thin radicular dentinal walls that are susceptible to fracture. Management of the open apex can be performed using a mineral trioxide aggregate (MTA) apical plug. To ensure a better prognosis in such structurally compromised teeth, internal radicular reinforcement using fiber posts and a self-adhesive cement has been suggested. The present case report illustrates the management of a necrotic, immature maxillary right central incisor in a 10-year-old patient using the MTA apical barrier technique and canal reinforcement using a fiber post.

Conservative management of discolored maxillary central incisor with open apex using Mineral Trioxide Aggregate (MTA) apical plug and walking bleach Method: A case report.

Esthetics enhancement is a better treatment option for a non-fracture discolored traumatic maxillary central incisor (Max CI). The traumatic injury occurred in Max CI teeth because it was present in the most anterior region of the jaw. Necrosis (pulpal) in Max CI is the second commonest complication after fracture due to trauma. Open apex, incomplete root development, root shortening, roots with a poor remaining dentinal thickness (RDT), and a compromised crown root ratio all these factors affect the survival prognosis of traumatized teeth. Nowadays MTA based bio regenerative material helps in treatment strategies like apexification that was a popular treatment of open apex cases. Necrosis associated discoloration is managed with a conservative approach non-vital bleaching, less time consuming, and satisfy the economical and esthetic aspect for the patient.

Apexification or regeneration? A case report of a short mineral trioxide aggregate apical plug: 8-year follow-up

The management of an immature permanent tooth protocol aims to eliminate pulpal pathology, disinfection, and if possible, redevelopment of the root. The paper aimed to present a case report that a successful survival history of a seemingly inadequate mineral trioxide aggregate plug and its 8-year follow-up. In the presented case, all treatment goals such as the elimination of clinical symptoms/signs of infection, apical periodontitis healing, healthy lamina dura, and further root maturation were achieved; however, a formation was observed in an 8-year recall similar to regeneration-associated intracanal calcification. There was no way to clinically understand how the healing process occurred in the area histologically, but the follow-up showed that the relevant tooth met the healing criteria.

Endodontic management of single rooted immature mandibular second molar with a single canal using MTA- A case report

An immature tooth with necrotic pulp and periapical pathology imposes a great difficulty to the endodontists. The case becomes more difficult when the clinician comes across a rare presentation of tooth morphology. Endodontic treatment options for such teeth consist of conventional apexification procedures. This article demonstrates the recent concept of mineral trioxide aggregate (MTA) apical plug technique, for the management of a single rooted immature second molar with a single continuous canal. Keywords: Apexification, apical plug, mineral trioxide aggregate, necrotic teeth with immature apices. Abbreviations: CH-Calcium Hydroxide, MTA-mineral trioxide aggregate.

Mineral trioxide aggregate apical plug method for the treatment of nonvital immature permanent molars

Mineral trioxide aggregate apical plug method for the treatment of nonvital immature permanent molars

Mineral trioxide aggregate apical plug and biodynamic intraradicular restoration for rehabilitation of fractured anterior central incisor with open apex: A case report with 1-year follow-up

Restoration of teeth with the extensive loss of coronal structure requires post and core for its rehabilitation. In this context, Biological post prepared from natural tooth offers a feasible and promising treatment option to restore the tooth with a “biologic restoration”. Properties of biologic post similar to dentin make it a good alternative in comparison to conventional post systems. Along with post and core if teeth have open apices, it needs a more rationalized approach. It becomes necessary to create an apical barrier for root canal filling. For this purpose, MTA has gained enough popularity thanks to its biomimetic properties and good sealing ability. This case report discusses the successful management of fractured anterior teeth having an open apex. Treatment was done under three phases- Formation of apical barrier with MTA apical plug causing root formation, followed by thermoplasticised obturation and final rehabilitation with the placement of biological dentin post. Freshly extracted maxillary canine was trimmed and shaped to form biological post. This customized biological post was sterilized and cemented. One year of follow up showed successful structural functioning, performance and esthetics of the tooth along with apical root formation.

Nonsurgical management of blunderbuss canals

Proper hermetic seal is difficult to achieve in cases of incompletely formed apex of the tooth. In present case reports, apexification procedure was performed with the help of Mineral Trioxide Aggregate (MTA). Case 1 is a 14-year-old female who presented with a chief complaint of discolored tooth and also revealed a history of trauma 5–6 years ago. Case 2 is a 14-year-old male patient who presented with a history of grossly decayed upper front teeth. Proper diagnosis was made with the help of radiographic investigation. Treatment options were discussed with the patient. MTA apical plug formation was done followed by root canal treatment.

Ex Vivo Evaluation of a Restoration Protocol for Teeth with Simulated Incomplete Rhizogenesis

The use of phosphate buffered saline (PBS) as an intracanal medication triggers a biomineralization process within mineral trioxide aggregate (MTA) apical plugs during the apexification process in teeth with incomplete rhizogenesis. However, no consensus is available in the literature regarding a restorative protocol for this type of treatment. Thus, the objective of this study was to use scanning electron microscopy (SEM) to evaluate the processes of biomineralization and adhesion in a restorative protocol for teeth with simulated incomplete rhizogenesis. Methodology: Root sections with a thickness of 2mm and cavities with a diameter of 2mm were used. The sections were randomly prepared and filled with the following materials: Group 1 (n=12), ProRoot MTA; and Group 2 (n=12): MTA Exp. Subsequently, the samples were immersed in PBS for 35 days. Every 5 days, the PBS was replaced, and the precipitates were collected, dried, and weighed. Two samples from each group were analyzed by SEM. Moreover, 24 single-rooted teeth were standardized, incomplete rhizogenesis was simulated, and 5-mm-long apical plugs were created with Pro Root MTA. As an intracanal medication, PBS was used for different periods of time: Group 1:48 h; Group 2:7 days; and Group 3:15 days. Then, fiberglass posts were cemented with the REBILDA® Post System. The samples were prepared and analyzed by SEM. Results: ProRoot MTA and MTA Exp effectively promoted the formation of carbonated apatite precipitates and biomineralization with dentin. ProRoot MTA yielded more carbonated apatite precipitates compared to MTA Exp (p=0.0536). The use of PBS as an intracanal medication for 7 and 15 days promoted intratubular mineralization (MIT), and treatment for 15 days was more effective (p &lt; 0.05). The REBILDA® Post System effectively promoted the microimbrication of the adhesive system and the formation of resinous tags with lateral adhesive branches. Conclusion: Apexification with MTA associated with the use of PBS as an intracanal medication for 15 days, in addition to the use of the REBILDA® Post System, seems to be a feasible restorative protocol.

Impact and Fracture Strength of Simulated Immature Teeth Treated with Mineral Trioxide Aggregate Apical Plug and Fiber Post Versus Revascularization

IntroductionImmature necrotic teeth are at a high risk of fracture, especially at the cervical region, after treatment. This study aimed to compare the impact and fracture strength of immature permanent teeth treated with revascularization versus a mineral trioxide aggregate (MTA) plug and fiber post. MethodsThis in vitro, experimental study was conducted on 160 maxillary central incisors, which were randomly divided into 10 groups. The groups included a fracture (F) and impact (I) negative control group, F and I positive control groups, F and I MTA groups, F and I revascularizing group, and F and I revascularized groups. Fracture strength was measured using a universal testing machine with a crosshead speed of 1 mm/min. Other tooth samples were then subjected to the Charpy impact test for impact strength measurements, and the amount of energy absorbed by the teeth was determined. Data were analyzed using the Kolmogorov-Smirnov test, analysis of variance, and the Tukey test. ResultsThe mean load to fracture of the negative, positive, MTA, revacularizing, and revascularized groups was 1931.8, 1350.1, 1003.8, 1262.5, and 1100.2 N, respectively, and the mean impact strength was 5.04, 3.6, 3.68, 3.16, and 3.65 J, respectively. The fracture and impact strength of the negative control group was significantly higher than that of the other groups (P < .05), but the other groups were not significantly different in this respect (P > .05). ConclusionsDespite the limitations of this study, the results showed that none of the tested modalities could significantly increase the impact and fracture strength of simulated immature teeth.

Analysis of sealing ability of endodontic cements apical plugs.

BackgroundIt is unknown whether the bioactivity of Biodentine characterized by the precipitation of hydroxyapatite and formation of tags into the dentinal tubules improve its sealing ability as an apical plug. Aim: To evaluate the sealing ability provided by Biodentine and mineral trioxide aggregate (MTA) apical plugs, with or without phosphate-buffered saline (PBS) intracanal dressing, using a glucose leakage method.Material and MethodsThe space of the canal of 100 root segments with about 12 mm long was shaped using Gates-Glidden. After created an apical retrograde cavity, the root segments were randomly divided into 4 groups (n = 25): G1 – Biodentine; G2 - Biodentine + PBS intracanal dressing; G3 - MTA and G4 - MTA + PBS intracanal dressing. All access openings were filled with temporary cement and all root segments were introduced in floral foams moistened with PBS. After 2 months, all root segments were prepared to evaluate the glucose leakage. The amount of glucose leakage was quantified by a spectrophotometer and the data were analyzed using chi-square test (p<0.05).ResultsTraces of the glucose were observed in a higher of samples that received Biodentine apical plug (p<0.05). The exposure to intracanal PBS did not influence the sealing provided by Biodentine and MTA.ConclusionsThe Biodentine had lower sealing ability than MTA. The interaction with PBS intracanal dressing did not improve the sealing ability provided by sealers. Key words:Apexification, dental cements, dental leakage, glucose, pressure.

Management of Non-vital Maxillary Central Incisors with Open Apices by MTA Plugging

The major challenge of performing root canal treatment in an open apex pulp-less tooth is to obtain a good apical seal. An 11 year old boy was presented with pain in his upper anterior teeth. On clinical examination both the maxillary central incisors revealed slight discoloration and fracture of the crown. Radiographic evaluation revealed radiolucency and open apices of both central incisors. Apexification with MTA apical plug was carried out before obturation with gutta-percha and sealer and the treatment was completed within 3 consecutive appointments. In twelve months follow up both the teeth were clinically and radiographically asymptomatic and the healing of the apical area was continued. The positive clinical outcome may encourage the future use of mineral trioxide aggregate (MTA) as an apical plug material in case of non-vital open apex teeth.J Bangladesh Coll Phys Surg 2017; 35(4): 196-199

MANAGEMENT OF MISALIGNED CROWN FRACTURE WITH EXTERNAL ROOF RESORPTION USING MINERAL TRIOXIDE AGGREGATE (MTA) AND CUSTOM CAST POST AND CORE RESTORATION

Crown fracture is the most commonly reported traumatic injuries in the permanent dentition. One of the unfavorable response to trauma is the development of external root resorption (ERR). Injuries may also cause tooth angulation changes so it should be treated with a customized cast post and core to produce better aesthetic result and to obtain sufficient compressive strength.The case report describes the use of mineral trioxide aggregate (MTA) as an apical plug to promote periapical healing of an open apex and the use of custom cast post and core to correct the tooth angulation.Case report.A 23-year-old male patient came to RSGM Prof. Soedomo with a chief complaint of a fractured and labial misaligned of upper right central incisor due to trauma 10 years ago. Patient expressed his unwillingness to get orthodontic therapy. Percussion and palpation test showed no discomfort or pain. There was no mobility noticed. Radiograph showed periapical radiolucency and open apex. Tooth was treated with calcium hydroxide dressing and MTA apical plugs were placed in the apical portion of canals. Tooth was restored with custom cast post and core to correct the angulation followed by the placement of an porcelain crown.MTA can be used as apical plug for sealing open apex caused by ERR combined with custom cast post and core for other option for misaligned tooth.

Effect of Mineral Trioxide Aggregate Apical Plug Thickness on Fracture Resistance of Immature Teeth

IntroductionThe aim of this study was to compare the fracture resistance of simulated immature teeth after using different thicknesses of mineral trioxide aggregate (MTA) apical plugs. MethodsFifty-two human maxillary anterior teeth were used. Five teeth were the positive control group; they were prepared using Peeso reamers to simulate immature teeth without any access cavity preparation. Access cavities of the 47 teeth were prepared, and the canals were instrumented with Peeso reamers. Five teeth served as the negative control; they were filled with calcium hydroxide. Forty-two teeth were divided into 3 groups; in groups 1, 2, and 3, MTA was placed into canals as a 3-mm and a 6-mm apical plug and a thorough canal length, respectively. The rest of the canals in groups 1 and 2 were filled with gutta-percha and AH Plus sealer (Dentsply DeTrey, Konstanz, Germany). After the storage period, the roots were covered with a polyether impression material and were embedded into self-curing resin blocks. Each specimen was then subjected to fracture testing using a universal testing machine. Data were analyzed using 1-way analysis of variance with the Tukey post hoc test for multiple comparisons. ResultsThe negative group showed the lowest fracture resistance compared with the other groups. The 3-mm apical plug group showed the highest fracture resistance (P < .05). No significant differences were found between the 3-mm and 6-mm apical plug groups (P > .05). ConclusionsMTA should be used as an apical plug instead of root canal filling material to increase the fracture resistance of immature teeth.

The Effect of Intracanal Medicaments on Microleakage of Mineral Trioxide Aggregate Apical Plugs.

Introduction:The purpose of this in vitro study was to evaluate the effect of calcium hydroxide, double and triple antibiotic paste on the sealing ability of mineral trioxide aggregate (MTA) apical plugs. Methods and Materials:A total of 90 extracted teeth with single canals were prepared and randomly divided into four experimental groups (n=20). Intra-canal medicaments were applied for 3 weeks. MTA was placed through the access opening and condensed to the apical area and then fluid filtration technique was utilized to evaluate sealing ability after 1, 7, 14 and 30 days. Results:Triple antibiotic paste significantly reduced the sealing ability of MTA plug compared with double antibiotic paste (P=0.024) and normal saline (P=0.04) groups on day 1. The sealing ability was not different on days 14 and 30 between experimental groups (P>0.05). Conclusion:All medicaments can be used without any long term effect on microleakage.

Effect of obturating materials on fracture resistance of simulated immature teeth.

Aim:The aim of this study was to evaluate the fracture resistance of simulated immature teeth, when the root canals were completely filled either with mineral trioxide aggregate (MTA) or Biodentine, comparing with that of roots filled with apexification procedure.Materials and Methods:Sixty mandibular premolar teeth with single, straight canals decoronated at cementoenamel junction were divided into five groups (n = 12 each). Group 1 samples served as negative control and remaining four groups root samples were shaped and cleaned using ProTaper rotary files. To simulate immature roots, a #5 Peeso reamer was passed beyond the apex so that apices were enlarged to a diameter of 1.5 mm. Group 2 and 4 samples were filled with 5 mm of MTA or Biodentine apical plug and backfilling with gutta-percha using AH Plus sealer. Group 3 and 5 root samples were completely obturated with MTA and Biodentine, respectively. All the teeth were loaded vertically until fracture, using the universal testing machine.Statistical Analysis:Forces at which fracture of the roots occurred were subjected to statistical analysis using SPSS/PC version 2 software, and the results were analyzed with the one-way analysis of variance and Newman–Keuls multiple post hoc test.Results:Complete root canal obturation with MTA or Biodentine has shown significantly higher fracture resistance (P < 0.05) when compared to apexification with MTA or Biodentine.Conclusion:Obturation of the root canals with bioactive materials has shown highest fracture resistance when compared to apexification groups.