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Drilling without MTA. What to do?

Professor of Endodontics

Drilling without MTA. What should I do? Did a perforation occur during access surgery and you're not an endodontic specialist or don't have MTA? The following is a guide to immediate endodontic perforation with temporary resolution with calcium hydroxide P.A., until a second session, when it can be treated definitively or the case referred to another colleague.

In: Zanini. APPLICATION OF BIODENTINE, MTA AND CALCIUM HYDROXIDE IN DIRECT PULP CAPPING.

  1. Introduction
    In 1989 Stanley discovered more extensive regenerative capacities of the pulp
    than had previously been assumed. He suggested preserving the tooth's pulp tissue in
    various treatments unless in the presence of a diagnosis of irreversible pulpitis.
    For some time, pulpotomy was considered the best treatment for exposed
    pulp, because it was thought that regeneration of the pulp, once exposed, was impossible.
    The aim of vital pulp therapy is to preserve the pulp tissue by removing contaminated
    tissue and promoting the formation of a mineralized tissue barrier, bridging
    dentin .
    The dental pulp has a natural potential for tissue regeneration, which leads to the
    formation of reparative dentin. It has been well documented that the dental pulp has
    the ability to form a hard tissue barrier following the application of a
    direct pulp capping or pulpotomy treatment.
    During reparative dentinogenesis, at the site of exposure, the original odontoblasts are
    destroyed and replaced by new differentiated odontoblast-like cells.
    This process of pulp tissue regeneration involves the migration of stem cells to
    the injured site and subsequent aproliferation and differentiation into
    odontoblast-like cells.
    Maintaining pulp vitality upon pulp exposure is one of the greatest challenges for a
    dentist. Pulp tissue exposure to the external environment can occur due to iatrogenic
    causes, via instrumentation, caries or dental trauma.
    If pulp exposure occurs before complete caries removal, it is considered
    caries exposure. If pulp exposure occurs during the preparation of a cavity
    without caries, this is called mechanical exposure. Mechanical exposures are
    usually a consequence of tooth preparation. Pulp exposure can result from
    trauma when the coronal part of the tooth is impacted. In the event of exposure of the
    vital pulp, direct pulp capping, pulpotomy or polpectomy may be the
    treatment options.
    The most widely used material for direct pulp capping was calcium hydroxide,
    introduced to dentistry in 1921 and considered the "gold standard" of direct pulp capping materials
    for several decades.
    New materials have been tested over the last two decades as alternatives to calcium hydroxide
    . Recently, mineral trioxide aggregate has become an alternative (5).
    However, mineral trioxide aggregate is difficult to handle due to its long
    setting time, cost and potential pigmentation of teeth and soft tissues (5,8).
    To overcome some of these limitations, other bioactive tricalcium silicate cements
    have been introduced to the market, such as Biodentine.

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