Placement Of Mineral Trioxide Aggregate Research Articles

Super natural power of MTA!! Successful management of badly mutilated young molars, report of two cases with 3 years follow up

Apexification in one visit with Mineral Trioxide Aggregate (MTA) is beneficial in effectively sealing the open apices of young mutilated teeth. Although, placement of MTA through canals is difficult and many a times leads to over extrusion due to wide apex. This case report presents the outcome of extruded MTA during apexification in mandibular young permanent molars in children. On long term follow-up, complete healing of the periapical radiolucency was evident around MTA without any symptoms. MTA apexification in incisors have been found in literature, but very few cases are reported with long term follow up regards to young molars.

Effects of Access Cavity Design and Placement Techniques on Mineral Trioxide Aggregate Obturation Quality in Simulated Immature Teeth: A Micro-Computed Tomography Study.

Background and Objectives: In teeth with open apices, performing single session apexification is a challenging treatment due to the difficulty in handling mineral trioxide aggregate (MTA). Minimally invasive approaches in dentistry have also influenced the cavity designs in endodontics. Until now, different techniques have not been investigated in addition to manual condensation during the process of placing MTA in traditional (TradACs) or conservative (ConsACs) endodontic access cavities. The aim of this in vitro study was to compare and evaluate the obturation quality of MTA apical plugs placed with different techniques in TradACs or ConsACs. Materials and Methods: Sixty upper central teeth were divided into two main groups based on cavity design, and then each main group was further divided into three subgroups according to MTA placement techniques (n = 10): TradAC-manual, TradAC-manual + indirect ultrasonic activation, TradAC-manual + XP-endo Shaper (XPS), ConsAC-manual, ConsAC-manual + indirect ultrasonic activation, and ConsAC-manual + XPS. Subsequently, the porosity percentages in the MTA apical plug were analyzed using micro-computed tomography. The statistical analysis was performed using the Kruskal-Wallis H test and Mann-Whitney U test. Statistical significance was set at p < 0.05. Results: There were differences in volume of porosity percentages (%) according to cavity designs and MTA application techniques (p < 0.05). Except for the XPS group, more porosity was observed in ConsACs compared to TradACs. In TradACs, the significantly lowest open and total porosity was observed in the manual, ultrasonic, and XPS techniques, respectively. In ConsACs, the significantly lowest porosity was observed in the manual, XPS, and ultrasonic techniques, respectively (p < 0.05). Conclusions: In MTA obturation, cavity designs and application techniques had an impact on the MTA porosity. Creating an apical plug in ConsACs may result in more porosity compared to TradACs, especially when manual or indirect ultrasonic activation is preferred. Opting for the manual technique alone may be considered sufficient for controlling porosity for both TradACs and ConsACs.

The Efficacy of Different Laser Applications on Dentin Sealing in Preventing Discoloration Induced by Mineral Trioxide Aggregate.

The aim of this in vitro study was to evaluate the effect of the pre-application of a dentin-bonding agent and the application of different lasers on the prevention of tooth discoloration caused by mineral trioxide aggregate (MTA) in the presence of blood. Sixty extracted human anterior teeth were selected, with root lengths standardized to 10 mm and root canals shaped using Gates-Glidden drills #3 to #5. The samples were divided into six groups (n = 10): Group 1 with no surface treatment and Groups 2 to 6 with Optibond universal adhesive and Neodymium yttrium aluminum garnet (Nd:YAG), Erbium yttrium aluminum garnet (Er:YAG), Erbium-chromium-yttrium-scandium-gallium-garnet (Er:Cr:YSGG), and diode laser applications, respectively. Root canals were filled with fresh human blood, and ProRoot MTA and a collagen barrier were then placed. Color changes were measured with a spectrophotometer at 0, 7, 30, 90, and 180 days post MTA placement. Color differences (∆E) were analyzed using a two-factor mixed-design ANOVA with the Sidak method (p = 0.05). All treatment groups exhibited discoloration above the acceptability threshold. Although all treatment approaches exhibited less color change compared to the control group (p < 0.05), there was no significant difference among them in terms of preventing color change (p > 0.05). It was determined that none of the methods could guarantee 100% prevention of discoloration caused by MTA-blood contact.

Evaluation of pH and Calcium Ion Diffusion from Intracanal MTA and Bioaggregate to Simulated External Resorption Cavities Through Dentinal Tubules

Purpose: This in vitro study compared the effects of mineral trioxide aggregate (MTA), BioAggregate and calcium hydroxide on calcium and hydroxyl ion diffusion through dentinal tubules to the root surfaces without cementum in various root levels. Materials &amp;amp; Methods: The study consisted of 120 mature single-rooted mandibular premolar teeth. The teeth were decoronated and instrumented using Protaper Universal rotary files. To simulate external root resorption, artificial defects were created in cervical-middle-apical thirds of root surfaces. The teeth were divided into four main groups: Control (1), calcium hydroxide (2), MTA (3) and BioAggregate (4). In control group, root canals of specimens left empty. Other root canals of specimens filled with calcium hydroxide, MTA or BioAggregate. Each specimen was immersed in a vial containing 10 mL distilled water. Calcium concentrations and pH of the immersion media was measured at 1, 3, 7, 14, 21 and 28 days. Statistical analysis was accomplished by Kruskal–Wallis H and Mann–Whitney-U tests. Results: This study indicated that intracanal placement of both calcium hydroxide, MTA and BioAggregate resulted in the diffusion of calcium and hydroxyl ions across dentine. The results showed greater calcium and hydroxyl ions released by calcium hydroxide groups than MTA and BioAggregate groups (p&amp;lt;0.05). MTA and BioAggregate groups showed similar properties and there were no differences between these groups in whole study period (p&amp;gt;0.05). Conclusion: MTA and BioAggregate may be preferable for external root resorption cases because of their stimulation of hard tissue formation and ion releasing ability.

Root-end resection with or without retrograde obturation after orthograde filling with two techniques: A micro-CT study.

To evaluate the filling ability of two orthograde obturation techniques followed by the apical resection with or without retrograde obturation through micro-computed tomography (CT). Thirty-two single-rooted permanent teeth were prepared and randomised into four groups (n=8) according to the orthograde obturation technique (single cone technique [SCT] and mineral trioxide aggregate placement) combined or not with retrograde obturation. The volume of voids (VoV) within the entire endodontic space, the apical 3 mm, and 1 mm after root resection was calculated by micro-CT. Statistical analysis showed no significant difference among the groups regarding the total VoV in all root canals, as well as within the apical 1 mm after root resection. The SCT and apical resection without retrograde filling showed significantly better results in terms of VoV at the apical 3 mm after root resection. Within the study limitations, SCT associated with apical resection without retrograde preparation exhibited a similar or less amount of voids than the other groups.

Clinical and radiographic effectiveness of mineral trioxide aggregate (MTA) partial pulpotomy with low power or high power diode laser irradiation in deciduous molars: a randomized clinical trial.

This study investigated the clinical and radiographic effectiveness of MTA partial pulpotomy with low power or high power diode laser irradiation in primary molars. In this randomized single-blind clinical trial, 63 mandibular second molars were assigned into three groups (n = 21). After pulp amputation and achieving hemostasis, MTA was placed over pulp stumps in group 1 (MTA). The patients in groups 2 (LLLT-MTA) and 3 (DL-MTA) underwent low level (660nm, 200 mW) and high power (810nm, 1W) diode laser radiation prior to MTA placement, respectively. The occurrence of clinical failure (spontaneous pain, tenderness upon percussion, swelling, fistula, mobility) and radiographic failure (periodontal ligament widening, external or internal root resorption, periapical or furcal radiolucency) was recorded up to 18months after therapy.MTA and LLLT-MTA groups showed clinical success rate of 100% throughout the experiment. The clinical success rate of DL-MTA group was 95.2%, 95.2%, and 87.5% after 6, 9, and 18months. The radiographic success rates were 90.5%, 90.5%, and 87.5% in the MTA group; 100%, 95.2%, and 88.2% in the LLLT-MTA group, and 85.7%, 76.2%, and 68.7% in the DL-MTA group, at 6-, 9-, and 18-month follow-ups, respectively. No significant differences were found in the frequency of clinical or radiographic failure among the groups at any interval (p > 0.05). MTA partial pulpotomy was a suitable technique for vital pulp therapy in deciduous teeth. The addition of low power or high power diode laser radiation to the procedure did not cause a significant difference in success rate values.

Endodontic management of perforating internal resorption in a mandibular molar using sandwich technique

Internal inflammatory root resorption is an uncommon pathology that can progress to the periradicular vicinity. It is frequently asymptomatic and only discovered during a radiological screening. Appropriate and timely diagnosis is extremely crucial in tackling these cases. A perforating internal resorptive cavity in the distal root of the mandibular first molar was successfully managed using a sandwich concept of sectional apical obturation with gutta-percha and Bioceramic sealer followed by the placement of mineral trioxide aggregate in the resorptive cavity.

Apexification Using Mineral Trioxide Aggregate and Modified Internal Matrix: A Case Report

When pulpal necrosis occurs in immature teeth, one of the treatment alternatives is the creation of an artificial apical barrier through the placement of an apical plug. However, controlling the mineral trioxide aggregate (MTA) during placement has proven difficult. Several studies evaluated the use of resorbable barriers to act as an internal matrix to prevent accidental extrusion of MTA. The aim of this case report was to document the effectiveness of Surgicel as a modified internal matrix for proper placement of MTA during management of immature teeth with necrotic pulp using the apical plug technique. A 12-year-old female patient reported with the chief complaint of a badly mutilated lower right second premolar. The tooth suffered enamel hypoplasia and had a defective coronal structure. It was asymptomatic except for slight tenderness to percussion. Based on the clinical and radiographic findings, a diagnosis of pulpal necrosis with symptomatic apical periodontitis was made. The 3- and 6-month followup showed radiographic evidence of continued root and hard tissue formation. Based on these findings, we infer that Surgicel can be used as a modified internal matrix to prevent extrusion of the MTA into the periapical area and allow for proper MTA placement. Keywords: Apexification; Apical plug; Mineral trioxide aggregate; Calcium hydroxide; Surgicel; Modified internal matrix

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.

Ultrasonic Tips in Surgical and Non Surgical Root Canal Therapy:A Review of Literature

Dentistry has been revolutionized by the development of ultrasonic tips. It gives a minimally invasive approach, and with optimum magnification it can favor a successful conservative treatment. Ultrasonics are ideal for endodontic use and offers many applications and advantages like improved techniques and use of materials, and helps enrich the way endodontics is being practiced beginning from access preparation to re-treatment and also surgical treatment. They offer numerous advantages over conventional methods and a viable option employed by the dentists. Most frequent applications of ultrasonics in endodontics are access refinement, finding calcified canals, and removal of attached pulp stones and intracanal obstructions, increased action of irrigating solutions, condensation of gutta-percha, placement of mineral trioxide aggregate, in surgical endodontics and root canal preparation. Due to its efficiency there is an increased focus on the use and possible consequences of ultrasonics. This review article describes the various uses of ultrasonics in surgical and non surgical root canal treatment in a clinical perspective.

Comparative evaluation of microleakage after root-end resection by erbium, chromium: Yttrium-scandium-gallium-garnet (Er, Cr:YSGG) laser and carbide bur with or without placement of mineral trioxide aggregate: An in vitro study.

Background:Root-end resection followed by retrofilling is one of the prime requisites to avoid apical microleakage.Aim:It comparatively evaluated the microleakage after root-end resection by erbium, chromium:yttrium, scandium, gallium, and garnet laser and carbide bur with or without placement of mineral trioxide aggregate (MTA).Materials and Methods:In this study, 60 maxillary central incisors were decoronated and biomechanically prepared. Out of 60 samples, 48 were included in the experimental group while the rest 12 were in the control group. The samples in the experimental group were obturated, whereas the samples in the control group were not obturated. The experimental group samples were divided into two: one group resected with the laser and the other half resected with carbide bur. These groups were further subdivided into two – one group retrofilled with MTA and the other half without MTA. The control group had both laser- and carbide bur-resected samples with positive and negative controls. All the samples were dyed, decalcified, and cleared. Digital photograph of each sample was taken, and the area of dye penetration was measured with the help of ImageJ software.Statistical Analysis:Analysis of variance and Tukey's test were done.Results:The highest microleakage was seen in carbide without MTA and the least was seen with laser with MTA.Conclusion:Laser-resected MTA-retrofilled samples showed minimum leakage.

Root lengthening with apical closure in two maxillary immature permanent central incisors after placement of mineral trioxide aggregate (MTA) as an apical plug

Necrosis of permanent immature teeth is a common reason for consultation in paediatric dentistry. Apexification is a therapeutic procedure aiming to create an apical calcified barrier in open apex teeth. Two cases are presented in which apexification were completed on immature permanent traumatised incisors using a mineral trioxide aggregate (MTA) plug. At 2 and 5years showed apical closure and radicular elongation beyond the MTA plug. Unexpectedly, a regeneration of mineral tissues beyond the MTA plug occurred which is an uncommon outcome.

Partial Pulpotomy in Mature Permanent Teeth with Clinical Signs Indicative of Irreversible Pulpitis: A Randomized Clinical Trial

IntroductionThis study aimed to assess the outcome of partial pulpotomy using mineral trioxide aggregate (MTA) compared with calcium hydroxide (CH) in mature cariously exposed permanent molars. MethodsFifty permanent molar teeth with carious exposures in 50 patients >20 years old were included. Preoperative pulpal and periapical diagnosis was established based on a history of presenting pain, results of cold testing, and radiographic findings. After informed consent, the tooth was anesthetized, isolated via a dental dam, and disinfected with 5% sodium hypochlorite before caries excavation. Partial pulpotomy was performed by amputating 2 mm of the exposed pulp, hemostasis was achieved, and the tooth was randomly assigned for the placement of either white MTA (White ProRoot; Dentsply, Tulsa, OK) or CH (Dycal; Dentsply Caulk, Milford, DE) as the pulpotomy agent. Postoperative periapical radiographs were taken after placement of the permanent restoration. Clinical and radiographic evaluation was completed after 6 months and 1 and 2 years postoperatively. Statistical analysis was performed using the Fisher exact test. ResultsClinical signs and symptoms suggestive of irreversible pulpitis were established in all teeth. Immediate failure occurred in 4 teeth. At 1 year, MTA showed a higher tendency toward success compared with the CH group, and the difference was statistically significant after 2 years (83% vs 55%, P = .052 at 1 year; 85% vs 43%, P = .006 at 2 years). Sex did not have a statistically significant effect on the outcome. ConclusionsMTA partial pulpotomy sustained a good success rate over the 2-year follow-up in mature permanent teeth clinically diagnosed with irreversible pulpitis. More than half of the CH cases failed within 2 years.

Fracture resistance of immature teeth filled with mineral trioxide aggregate, bioaggregate, and biodentine

Objective:The purpose of this study was to evaluate fracture resistance of teeth with immature apices treated with coronal placement of mineral trioxide aggregate (MTA), bioaggregate (BA), and Biodentine.Materials and Methods:Forty-one freshly extracted, single-rooted human premolar teeth were used for the study. At first, the root length was standardized to 9 mm. The crown-down technique was used for the preparation of the root canals using the rotary ProTaper system (Dentsply Maillefer, Ballaigues, Switzerland) of F3 (30). Peeso reamer no. 6 was stepped out from the apex to simulate an incompletely formed root. The prepared roots were randomly assigned to one control (n = 5) and three experimental (n = 12) groups, as described below. Group 1: White MTA (Angelus, Londrina, Brazil) was prepared as per the manufacturer's instructions and compacted into the root canal using MAP system (Dentsply Maillefer, Ballaigues, Switzerland) and condensed by pluggers (Angelus, Londrina, Brazil). Group 2: The canals were filled with DiaRoot-BA (DiaDent Group International, Canada). Group 3: Biodentine (Septodont, Saint Maur des Fosses, France) solution was mixed with the capsule powder and condensed using pluggers. Instron was used to determine the maximum horizontal load to fracture the tooth, placing the tip 3 mm incisal to the cementoenamel junction. Mean values of the fracture strength were compared by ANOVA followed by a post hoc test. P < 0.05 was considered statistically significant.Results:No significant difference was observed among the MTA, BA, and biodentine experimental groups.Conclusion:All the three materials tested, may be used as effective strengthening agents for immature teeth.

The Treatment of Immature Teeth With Periapical Lesions Using Ca(OH)2 and MTA: A Case Report

Introduction: One-step apexification using mineral trioxide aggregate (MTA) has been reported as an alternative treatment modality with more benefits than the use of long-term calcium hydroxide (CaOH) for teeth with an open apex. However, the orthograde placement of MTA is a challenging procedure in terms of length control, especially in teeth with a wide-open apex. Therefore, we took advantage of the desirable properties of Ca(OH)2 in the formation of apical barriers in order to control the length of MTA during placement. Case Presentation: We would like to report the successful treatment of tooth 8 (in a 10-year-old girl) with an open apex and periapical lesions. In this case, we first used calcium hydroxide to form the primary apical barrier for six months and then we placed an MTA plug. Conclusions: Based on evidence, both MTA and Ca(OH)2 can be used for the endodontic treatment of non-vital immature teeth. In this case, we took advantage of special properties of MTA and Ca(OH)2 in apexification.

Comparison of Mechanical and Indirect Ultrasonic Placement Technique on Mineral Trioxide Aggregate Retrofill Density in Simulated Root-end Surgery

IntroductionThe objective of this study was to evaluate the density of mineral trioxide aggregate (MTA) root-end filling placed by either manual condensation or manual condensation with indirect ultrasonic activation under simulated root-end surgery conditions in vitro. MethodsExtracted human molar teeth were obtained and sectioned to provide single-rooted samples (n = 50). Roots were instrumented to a size of 40 with a .04 taper and obturated with a warm vertical technique. The coronal end of each root was embedded in resin. A root-end resection and root-end preparation were completed on each root. Samples were randomly assigned to receive root-end fillings with ProRoot MTA (Dentsply, Tulsa, OK) by 1 of 2 techniques: manual condensation alone (group M, n = 25) or manual condensation with indirect ultrasonic activation (group U, n = 25). MTA was placed incrementally to the level of the root end using the enumerated technique. Samples were weighed immediately before and after filling placement. MTA was removed from all samples so as not to change the root-end preparation, rinsed, and dried. Each sample then underwent MTA placement by the opposite technique, and weight was again measured immediately before and after MTA placement. MTA filling weights for each technique were analyzed statistically using a technique for repeated measures analysis. Statistical analysis was conducted to account for any carryover or order effects. ResultsAfter adjustment for carryover effects, it was found that regardless of the order of placement, the mean fill weight of MTA produced by the indirect ultrasonic method was on average 4.42 mg heavier than that produced by manual condensation alone. This result was statistically significant (P < .0003). ConclusionsUnder simulated root-end surgery conditions, indirect ultrasonic condensation of MTA root-end fillings was shown to produce a filling that was significantly denser than MTA placed by manual condensation alone.

Absorbable Suture as an Apical Matrix in Single Visit Apexification with Mineral Trioxide Aggregate.

Several procedures have been recommended to induce the root end barrier formation in teeth with open apices. Conventional treatment for such cases will require many appointments with an average duration of 12.9 months. During this period, the root canal is susceptible to reinfection from around the provisional restoration, which may promote apical periodontitis and arrest of apical repair. Mineral trioxide aggregate (MTA) has been successfully used for one visit apexification wherein the root canal can be obturated within 24 hours after placement of MTA. Using a matrix prior to the placement of MTA avoids its extrusion, reduces leakage in the sealing material, and allows favorable response of the periapical tissues. This report presents a case of apexification where an absorbable suture was used as an apical matrix. Use of an absorbable suture circumvents all the problems associated with other conventional materials. Conclusion. Placement of the matrix made from the suture material is predictable and is easily positioned at the apex and the length can be adjusted as required. 10-month follow-up of the case shows resorbed matrix and bone healing in the periapical region. The patient was asymptomatic during the whole follow-up period and tooth exhibited mobility within physiologic limits and was functioning normally.

The Effect of Mineral Trioxide Aggregate on the Periapical Tissues after Unintentional Extrusion beyond the Apical Foramen.

Introduction. Single-step apexification procedures using mineral trioxide aggregate (MTA) have been reported as favorable treatment options for teeth with an open apex, posing greater benefits compared to the other available medicaments. However, controlled apical placement of MTA is a challenging procedure to perform using orthograde approach. This case series describes the outcome of the unintentional extrusion of MTA into periradicular tissues during apexification, in three separate cases. Methods. Three adult patients reported to the Department of Conservative Dentistry and Endodontics for the management of maxillary incisors with open apices. After isolation, conventional access, and cleaning and shaping procedures, one-step MTA apexification was performed. On subsequent radiographs, a considerable amount of MTA was seen to be extruded in all the three cases. Results. During follow-up examination the teeth were seen to be asymptomatic in all cases and radiographically demonstrated repair of the periapical lesion. Conclusion. The results of these cases suggest that extrusion of MTA into the periapical tissues does not cause any detrimental effect, which could be attributed to the biologic properties of MTA.

Management of a Traumatized Open Apex Tooth with a Combination of Mineral Trioxide Aggregate Apical Plug and Platelet-rich Fibrin Apical Matrix

ABSTRACTThe absence of a natural apical constriction in permanent tooth makes endodontic treatment a challenge. Traditionally, calcium hydroxide was used for inducing the formation of an apical barrier. Currently, mineral trioxide aggregate (MTA) has shown promising results for apexification procedures. In an open apex, it is imperative to limit the MTA placement within the confines of the root canal for predictable healing. The placement of an internal matrix may limit the extrusion to some extent. Many materials can be used as internal matrix such as collagen membrane, calcium sulphate, hydroxyapatite, freeze dried bone, and platelet-rich fibrin (PRF) among others. This case report presents a successful demonstration of the management of an open apex using MTA placed over an internal apical matrix of PRF.How to cite this articlePawar RB, Margsahayam SV, Shenoy VU, Shaikh SAH. Management of a Traumatized Open Apex Tooth with a Combination of Mineral Trioxide Aggregate Apical Plug and Platelet-rich Fibrin Apical Matrix. J Contemp Dent 2016;6(1):57-62.

Treatment Outcome of Mineral Trioxide Aggregate: Repair of Root Perforations—Long-term Results

IntroductionThis historical cohort study follows on a previously reported trial, with the aim of assessing the outcome for teeth with root perforations managed by the orthograde placement of mineral trioxide aggregate (MTA) and identifying potential outcome factors for such treatment with a larger sample size and longer follow-up periods than in the first phase of the project. MethodsThe treatment outcomes of 64 root perforations repaired between 2000 and 2012 with MTA were investigated. The root perforations were located in different areas of the root. Calibrated examiners assessed clinical and radiographic outcomes by using standardized follow-up protocols 12–107 months after treatment (median, 27.5 months). Preoperative, intraoperative, and postoperative information was evaluated. The outcomes were dichotomized as healed or diseased. ResultsOf the 64 teeth examined (85% recall rate), 86% were healed. The univariate analyses (χ2 tests) identified 2 potential prognostic factors, experience of the treatment providers (odds ratio, 2.14; 95% confidence interval, 0.39–11.74; P < .01) and placement of a post after treatment (odds ratio, 0.06; 95% confidence interval, 0.01–0.27; P < .01). In the multivariate stepwise logistic Cox regression, none of the potential prognostic factors displayed a significant effect on the outcome at the 5% level. ConclusionsMTA appears to have good long-term sealing ability for root perforations regardless of the location. The results of this historical cohort study confirm the results of the first phase of this project.