Mineral Trioxide Aggregate Plug Research Articles

Endodontic management of open apex in a tooth using platelet rich plasma mediated regeneration: Case report

Endodontic management of open apex includes conventional treatment method using calcium hydroxide for apexification or use of mineral trioxide aggregate plug. Use of calcium hydroxide for long time causes weakening of dentinal structure which may lead tooth to fracture in later stage. Mineral trioxide aggregate is advantageous as compared to increased number of appointments with calcium hydroxide. Recently, modified concept of regeneration has been suggested as the treatment plan of open apex tooth. Effective disinfection of root canal is of utmost importance for the regeneration of pulp dentin complex. This article presents a case report with endodontic regeneration using platelet rich fibrin for revitalization of immature non vital tooth.

Effects of different calcium-silicate based materials on fracture resistance of immature permanent teeth with replacement root resorption and osteoclastogenesis.

This study evaluated the effects of Biodentine (BD), Bio-C Repair (BCR), and mineral trioxide aggregate (MTA) plug on the fracture resistance of simulated immature teeth with replacement root resorption (RRR) and in vitro-induced osteoclastogenesis. Sixty bovine incisors simulating immature teeth and RRR were divided into 5 groups: BD and BCR groups, with samples completely filled with the respective materials; MTA group, which utilized a 3-mm apical MTA plug; RRR group, which received no root canal filling; and normal periodontal ligament (PL) group, which had no RRR and no root canal filling. All the teeth underwent cycling loading, and compression strength testing was performed using a universal testing machine. RAW 264.7 macrophages were treated with 1:16 extracts of BD, BCR, and MTA containing receptor activator of nuclear factor-kappa B ligand (RANKL) for 5 days. RANKL-induced osteoclast differentiation was assessed by staining with tartrate-resistant acid phosphatase. The fracture load and osteoclast number were analyzed using 1-way ANOVA and Tukey's test (α = 0.05). No significant difference in fracture resistance was observed among the groups (p > 0.05). All materials similarly inhibited osteoclastogenesis (p > 0.05), except for BCR, which led to a lower percentage of osteoclasts than did MTA (p < 0.0001). The treatment options for non-vital immature teeth with RRR did not strengthen the teeth and promoted a similar resistance to fractures in all cases. BD, MTA, and BCR showed inhibitory effects on osteoclast differentiation, with BCR yielding improved results compared to the other materials.

Investigation of the effect of hydrochloric acid with different concentrations on mineral trioxide aggregate plug and dentin

Investigation of the effect of hydrochloric acid with different concentrations on mineral trioxide aggregate plug and dentin

Sealing Ability of Nano-fast Cement vs. Mineral Trioxide Aggregate as Retrograde Apical Plugs: An In-vitro Microleakage Study.

Apical surgery aims to eradicate the apical part of the root and the lesion to enhance the healing. The sealing ability of retrograde filling material is an essential factor affecting the success rate of the surgery. Mineral trioxide aggregate (MTA) is the gold standard of retrograde filling materials, with approved sealing capability and biocompatibility. Newly introduced root repair material with an approved antibacterial effect similar to MTA is Nano-fast cement (NFC) which should be investigated for its sealing ability. This study aimed to evaluate the sealing ability of NFC vs. MTA. Root apices of 48 single-rooted teeth were resected at 90 degrees and were prepared at 3 mm depth. The teeth were randomly divided into 2 experimental groups (n=21), negative control group (n=3), and positive control group (n= 3). MTA and NFC plugs were condensed as retrograde filling material. The samples were evaluated by a modified fluid filtration device for 1 hour. The measurement was conducted at 24 h, 1, and 3 months. Data were analyzed by Friedman Test and Kruskal-Wallis test. According to the results, NFC at 3-months interval showedthe least microleakage, and MTA had the highest at the baseline. However, the results between the two groups were not statistically significant in all intervals. NFC reached the ideal sealing ability within 1 month, which was reached for MTA after 3 months. The results of this in vitro study showed that the microleakage value of NFC is comparable to MTA. In light of current findings, NFC shows characteristics of a suitable calcium silicate-based cement. Further clinical researches are needed to introduce the NFC as retrograde apical plug or for other endodontic applications.

Assessment of bone quality of apical periodontitis treated with MTA plug and regenerative endodontic techniques.

Fractal analysis (FA) is a quantitative, objective and non-invasive method that facilitates the characterisation of the tissue architecture. This study aims to compare the periapical healing at 1-year follow-up by evaluating newly generated trabecular bone with FA after Mineral trioxide aggregate (MTA) plug and regenerative endodontic treatment (RET). A total of 55 asymptomatic teeth with a single-canal, open apex and periapical lesion, treated with MTA plug or RET, were evaluated retrospectively. After considering the inclusion/exclusion criteria, FA was conducted on 30 periapical images using the box-counting method. In both groups, a significant decrease was observed in the periapical lesion size at 1-year follow-up (p < 0.01). However, there was no significant difference between the MTA plug and RET (p > 0.01). Significantly higher fractal dimension values were detected at 1-year follow-up in both MTA plug and RET cases (p < 0.01). However, the difference was not significant between the groups (p > 0.01). Both procedures seem to improve periapical healing with a new resistant bone of similar density and complexity.

Depth of cure of bulk-fill and flowable resin in contact with mineral trioxide aggregate plugs in ex vivo immature teeth

Introducción: Tooth development may be interrupted when the pulp becomes necrotic because of caries, trauma, or anatomical alterations such as dens evaginatus.Objective: To determine the depth of cure and hardness of an injected bulk-fill resin (Sonic Fill™) compared with a flowable resin (Revolution™) in teeth with incomplete apex formation.Material and Methods: Forty recently extracted uniradicular teeth were assigned for the study; 3 mm of the apex was cut to standardize all teeth to 13 mm, then the root canals were instrumented to a size 1.10 mm by using Peeso drills. A 3-mm mineral trioxide aggregate (MTA) plug was placed in the apical third. After etching the root canal walls, an intracanal adhesive system was placed and cured. Then, Sonic Fill™ was injected into the remainder of the root canal of 20 specimens randomly selected and a flowable composite resin (Revolution™) was placed in the others. All specimens were placed in a rectangular, acrylic base and sectioned along the long axis of the tooth. The depth of cure and hardness of the composite resin were evaluated using the Vickers micro-hardness test and compared with Student T test for independent groups.Result: Specimens in the SF group showed significantly (p = 1.6 × 10−6) higher Vickers micro-hardness (24.03±4.09 Kp) I.C.95% [20.88- 27.19] than those in the Revolution™ composite group (11.28±3.19 Kp) I.C.95% [8.82- 13.72].Conclusions: Specimens in the SonicFill™ group showed significantly higher Vickers microhardness than those in the flow able resin group, making the former more suitable for strengthening teeth with immature apexes.

ENDODONTIC MANAGEMENT OF TOOTH WITH OPEN APEX USING MTA AND AN APICAL BARRIER: A CASE REPORT

The completion of root development and closure of the apex occurs up to 3 years after the eruption of the tooth. The treatment of pulpal injury during this period provides a signicant challenge for the clinician. The importance of careful case assessment and accurate pulpal diagnosis in the treatment of immature teeth with pulpal injury cannot be overemphasized. The treatment of choice for necrotic teeth is apexication, which is induction of apical closure to produce more favorable conditions for conventional root canal lling. The most commonly advocated medicament is calcium hydroxide, although recently considerable interest has been expressed in the use of mineral trioxide aggregate (MTA). We report a case series wherein MTA and colla plug were used successfully for one step apexication in teeth with open apex.

Scanning electron microscopic evaluation of the effect of different root-end resection methods in the crack formation in root canals filled with mineral trioxide aggregate or calcium-enriched mixture cement

There is some concern that root resection may alter the surface features and crack formation of the previously set orthograde material. The aim of this in vitro study was to evaluate the crack formation in orthograde mineral trioxide aggregate (MTA) and calcium-enriched mixture (CEM) plugs after root resection.This in vitro study was conducted on 170 extracted human maxillary anterior teeth. The teeth were randomly divided three experimental (n = 50) and control (n = 20) groups. In Group 1, after root canal treatment, half of the roots were cut with a bur, and the other half with an ultrasonic cutter. In Groups 2 and 3, after the 4-mm CEM and MTA plugs were placed and set, the root ends of half of the samples were cut with a bur and the other half by an ultrasonic cutter. The prevalence of cracks in the dentin and orthograde apical plugs of MTA and CEM was then assessed by scanning electron microscopy. Data were analyzed using the McNemar's, Chi-square, and Fisher's exact tests at P ≤ 0.05 level of significance.In general, the prevalence of crack in dentin in Groups 2 and 3 was significantly higher than in the plug (P < 0.05). There was no significant difference in the prevalence of dentin crack in the studied groups (P > 0.05). The prevalence of crack in dentin was lower when the bur was used to cut off the end of the root, although the difference was not significant. The prevalence of crack in the plug was similar in CEM and MTA.Based on the results of this study, the prevalence of crack in dentin is always significantly higher than its prevalence in the plug, and the prevalence of crack in the plug was similar in CEM and MTA; then, when there is an orthograde access to the root canal and surgery is likely in future, MTA and CEM can be placed in an orthograde technique and it just resects the root during surgery.

Apexification in non-vital tooth with open apex: A case report

Apexification is a technique for inducing closure of the non-vital permanent teeth at the apex. In apexification a mineralized barrier is induced with long-term calcium hydroxide (CH) or created artificially with mineral trioxide aggregate (MTA) plug.Method: Two patients presented for evaluation of central incisor with discoloration with mild swelling and a non-traceable sinus tract. Both have a history of trauma. After intraoral examination and radiographic assessment a diagnosis of pulp necrosis with open apex was made. At the initial visit access cavity preparation and biomechanical preparation was done and calcium hydroxide dressing was placed. In the next appointment MTA plug was made and obturation was done after 72 hours and the tooth was build up with composites and a porcelain fused to metal crown was delivered. MTA is used for creating an apical plug, the functional goal of this procedure is to provide a hard tissue barrier that will provide an apical stop which will provide a platform for effective obturation of the canal allowing the patient to maintain the tooth.Conclusion: MTA can be used effectively for creating a hard calcific barrier in cases of open apex. MTA also has low cytotoxic and superior biocompatibility as compared to calcium hydroxide used before.

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.

Prospective cohort study of regenerative potential of non vital immature permanent maxillary central incisors using platelet rich fibrin scaffold

Regenerative endodontic procedures have gained momentum as a treatment modality of young immature permanent teeth. Literature reports reveal that platelet-rich fibrin (PRF) stimulates growth factors and induces regeneration. This study was undertaken to assess the regenerative potential of non-vital immature permanent maxillary central incisors using PRF with a follow-up for 2 yrs. 19 patients in the age group of 9–25 yrs with immature, non-vital permanent maxillary central incisors (n = 23) with/without signs and/or symptoms of periapical pathosis and open apex were included in this study. In the first appointment, access opening, canal disinfection and triple antibiotic paste placement were done. In the subsequent visit, PRF was prepared and placed inside the canal. Access was sealed with Mineral trioxide aggregate plug and composite. The patient was reviewed up to 24 mths. The mean difference was statistically analyzed using Friedman test followed by Dunn post hoc test and adjusted by Bonferroni correction (p < 0.05). As per AAE guidelines, the primary and secondary goals were achieved. A significant (p < 0.001) gradual increase in the root length, thickness of dentinal walls and decrease in apical diameter were observed. Within the limitations of this study, PRF placement was clinically and radiographically effective in inducing regeneration of non-vital immature permanent teeth.

Effects of various thicknesses and levels of mineral trioxide aggregate coronal plugs on nanoleakage and fracture resistance in revascularization: An invitro study.

The aim of this study was to evaluate the effects of mineral trioxide aggregate (MTA) applied at varying levels and thickness in the cervical region of the root on the leakage and fracture resistance of the simulated immature teeth. 3 study groups (n = 16) (Group 1: 2 mm MTA, Group 2: 4 mm MTA, Group 3: 2 mm MTA+2 mm RMGIC below cementoenamel junction) and 2 control groups (Group 4: Complete canal obturation, Group 5: No coronal plug) were used for the study. Nanoleakage was measured using a micro-computed tomography system. For the fracture resistance test, a universal testing machine was used. The amount of silver nitrate penetration decreased while MTA thicknesses increased (P < 0.001). However, the placement of MTA as a thicker layer did not make any additional contribution on the fracture resistance (P > 0.05). The 4-mm coronal MTA plug can be suggested in RETs for its superior sealing and reinforcement abilities.

Presentation and non‐surgical endodontic treatment of two patients with X‐linked hypophosphatemia: a case report

To describe two patients with X-linked hypophosphatemia presenting with spontaneous signs of pulpal necrosis in multiple intact teeth. The presentation and management are discussed, along with the diagnostic and endodontic treatment challenges. Two young male patients with X-linked hypophosphatemia were referred to the Department of Restorative Dentistry at the Edinburgh Dental Institute for management of dental infection. Both patients were referred due to their unusual clinical presentation and abnormal root canal morphology. They subsequently presented on multiple occasions with pain or sinus tracts over a 3- and 5-year period whilst under care. Clinical examination revealed intact teeth with buccal swellings, draining buccal sinuses and negative responses to sensibility testing. Radiographic examination, generally consisting of periapical radiographs, revealed intact teeth with a range of unusual morphological features including large pulp chambers, wide canals, short roots and open apices, all with associated periapical radiolucencies. Due to the unusual morphology, some teeth required apexification with a mineral trioxide aggregate plug. Patient 1 underwent root canal treatment on teeth 21 and 43 over a 3-year period. Patient 2 underwent root canal treatment on 10 permanent teeth over a 5-year period. At follow-up, both patients were asymptomatic and clinically the teeth had no signs of infection or periapical inflammation. Radiographic examination confirmed complete resolution of the apical radiolucencies on 11 out of 12 teeth. Favourable outcomes have been demonstrated up to a follow-up of 4.5-years. Patients with X-linked hypophosphatemia may present with 'spontaneous' signs of pulp necrosis in multiple teeth in the absence of caries and trauma posing a diagnostic challenge. Abnormal morphological features, including wide canals and open apices, may present challenges during endodontic treatment. Outcomes demonstrate that an appropriate root canal treatment protocol, including the application of apexification procedures, may be implemented to successfully manage such cases.

Management of Open Apex - A Case Report

Introduction: Endodontic management of immature permanent teeth is a challenge for both clinicians and researchers. Open apex is an unusual wide apical foramen that results due to multiple reasons such as incomplete development, extensive apical resorption, caries leading to pulpal necrosis or trauma before complete root formation, root-end resection, or due to over instrumentation. Aims: To prevent the risk of subsequent microbial contamination. Case Report: This article is a case report showing the management of open apex with MTA plug and a thermoplasticized Gutta Percha technique for obturation. Discussion: Traditionally, calcium hydroxide was used for inducing the formation of an apical barrier. Conclusion: Currently, biomimetic materials like mineral trioxide aggregate (MTA) and biodentin have shown promising results for apexification procedures.

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.

Effects of Root Maturation and Thickness Variation in Coronal Mineral Trioxide Aggregate Plugs Under Traumatic Load on Stress Distribution in Regenerative Endodontic Procedures: A 3-dimensional Finite Element Analysis Study

IntroductionRegenerative endodontic procedures (REPs) are the best biological-based treatment choice for managing necrotic immature permanent teeth. This study aimed to evaluate the stress distribution of immature maxillary permanent incisors and periodontal tissues under a traumatic load after root maturation achieved by REP with thickness variation in coronal mineral trioxide aggregate (MTA) plugs. MethodsFive different mathematical 3-dimensional finite element analysis models of an immature permanent maxillary incisor were created. These involved immediate postoperative models after REP with varying coronal MTA plug thickness (model 1: 3-mm MTA and model 2: 5-mm MTA), postoperative models after REP with varying coronal MTA plug thickness with 15% volumetric root maturation (model 3: 3-mm MTA and model 4: 5-mm MTA), and a control model (model 5: a mature, healthy maxillary incisor). After the modeling procedures, a traumatic horizontal force load of 400 N was applied, and 3-dimensional finite element analysis was performed. The minimum principal, maximum principal, and von Mises stress criteria were calculated for evaluation. ResultsRegardless of the coronal MTA plug thickness, tensile stress in cervical root surfaces decreased with root maturation after REP. Using the 5-mm MTA plug reduced all types of stress in the middle third of the root. In bone tissue, the difference in MTA thickness did not affect stress values. However, stress decreased in most of the bony surfaces with root maturation after REP. ConclusionsUsing the 5-mm coronal MTA plug may help in providing biomechanical advantages regarding stress transmission. Also, because root maturation after REP provided a more favorable stress distribution as mentioned, regenerative treatments can be recommended for immature permanent maxillary incisors for a good prognosis.

Effect of mineral trioxide aggregate plug location on root development in regenerative endodontic procedure.

This retrospective study investigated the effect of mineral trioxide aggregate (MTA) plug location on treatment outcome and root maturation after regenerative endodontic procedures (REP) in immature permanent teeth. Thirty-three roots (n = 33) in cohort that underwent REP consistently according to AAE guideline were included to trace radiographic changes for the root and canal dimensions. Based on intraoral radiographs, roots were divided into two groups depending on the location of MTA plug within whole root length: coronal group (n = 14), within the upper half; apical group (n = 19), within the lower half. Periapical radiographs were standardized to assess treatment outcomes and root maturation including root development stages and digital measurements on the change ratios of root length, apex width, radiographic root area (RRA), modified RRA (mRRA), and periapical rarefaction area. The data were statistically analysed using the Mann-Whitney test. The patients' average age was 11years and 10months, with no significant between-group difference in sex. Premolars were the most prevalent tooth type (62.1%), followed by incisiors and molars. Pre-existing symptoms and signs subsided within 6months in all cases. The teeth showed similar radiographic root development in both groups (P > 0.05). However, mRRA increase ratio was significantly higher in apical group than that in coronal group at early (< 6months) and late (< 24months) periods of follow-up (P < 0.05). Significant changes of root development stage were observed at early period for apical group and at late period for coronal group (P < 0.05). All the observed cases showed continuing root development after REP. Significant changes in root developments occurred at different follow-up periods according to the location of MTA plugs.

Mineral trioxide aggregate plug and conventional root canal treatment of traumatized maxillary central incisor with an open apex: Three-year follow-up

Traumatic dental injuries may cause the loss of a tooth's pulp vitality before the development of the root has been completed. A 12-year-old boy complained of a broken crown of one of his upper front tooth due to falling down. The tooth had a history of previous trauma 1 year ago. Clinically, the tooth was discolored with complicated crown facture. Intraoral periapical radiograph revealed an open apex of 1 mm in width. Mineral trioxide aggregate (MTA) plug, placed orthogratelly on the apical part, has proven a successful outcome based on a 3-year follow-up. In conclusion, MTA plug is a treatment of choice for cases of small open apex (1-mm diameter or less) of traumatized nonvital permanent teeth.

Regenerative Endodontics: A Paradigm Shift in Clinical Endodontics.

ABSTRACTPreserving the natural dentition in its normal form and function is one of the major goals of endodontic treatment. Re-establishing the lost vitality and development of root maturation in immature permanent teeth with pulp necrosis/apical periodontitis is quiet challenging clinically. The very basis of regenerative endodontics relies on the concept of tissue engineering using stem cells, biomimetic scaffold, and bioactive growth factors to regenerate the pulp tissue damaged by microbial infection, injury, or developmental defects. In clinical endodontics, this approach is referred to as a “paradigm shift.” Even though repair instead of true regeneration is achieved with current protocols, it is hoped that further research in the area of stem-cell-based tissue engineering will allow for true regeneration and improved treatment outcomes. The aim of this review is to discuss about the various aspects of regenerative endodontics, current clinical protocols, and the future of pulp regeneration techniques.

The Apical Extent of Mineral Trioxide Aggregate Apical Barrier Does not Influence the Treatment Outcome in a Nonvital Immature Permanent Anterior Tooth: A Split-Mouth Clinical Study.

Objective:The study aimed to compare treatment outcomes when MTA apical plugs are placed to different apical extents in nonvital immature permanent anterior teeth with an open apex.Methods:Six participants (five male & one female) between the age group of 8-18 years exhibiting bilateral traumatized nonvital immature permanent maxillary anterior teeth (n=12) with non-blunderbuss canal (Cvek’s stage 4) were included. Standardized endodontic procedures were performed, and an inter-appointment calcium hydroxide medicament placed for one week. Based on the apical position of the MTA apical barrier, two study groups were defined. Accordingly, Group I {(n=6) (4mm MTA plug up to the radiographic root end)} and Group II {(n=6) (4 mm MTA plug 2 mm short of the radiographic root-end)}. Teeth were obturated after twenty-four hours with thermoplasticized gutta-percha technique. They were evaluated clinically and radiographically at 12 and 24 months. Radiographs were assessed for periapical healing based on the periapical index (PAI) scores that were dichotomized as score <3 as healed and ≥3 as not healed. The data were compared using Mann Whitney U test, Kruskal Wallis and post hoc analysis.Results:At 24 months, all teeth in Group I and II were healed clinically and radiographically. On inter-group comparison, radiographically, all teeth (n=12) exhibited a PAI score <3 and were categorized as healed (P=1.00).Conclusion:The apical extent of MTA plug does not influence the treatment outcome. The clinician can place MTA apical plug either up to or 2 mm short of the radiographic root-end.