MTA apical plug in a tooth with incomplete rhizogenesis.
Patient, 11 years old, referred for treatment following an emergency endodontic procedure.
Radiographic examination showed an image of probable incomplete root formation in the distal root.
During treatment, a 35.04 cone was secured in the mesial canals, but in the distal canal, it was very difficult to fit a gutta-percha cone.
An MTA Repair plug of around 4mm was then placed in an MTA holder and seated with a file wrapped in absorbent cotton. Above this, conventional filling was carried out with gutta percha and Bio C Sealer cement.
Case carried out by student Luciane Felício, specializing in Endodontics at Chibebe Cursos, Taubaté.
In: Castro et al. Evaluation of the use of MTA as an apical plug in teeth with open apices. Rev. bras. odontol., Rio de Janeiro, v. 68, n. 1, p. 59-63, jan./jun. 2011
Introduction
Conventional endodontic filling techniques rely on the presence of a constriction at the apical level of the canal, so the absence of an apical constriction due to incomplete root development presents a management challenge. Filling the root of a wide canal with an open apical foramen carries the risk of extrusion of obturating material, which can compromise the long-term outcome of the treatment. To avoid extrusion, compaction can be minimized, resulting in inadequate adaptation and sealing. Most endodontic failures occur as a result of leakage of irritating substances present in root canals into the periradicular tissues, so a repair material must provide a satisfactory seal for the root canal with an open apex.
One of the most important criteria for an ideal endodontic material is its sealing capacity and marginal adaptation. Of the options currently available for treating root canals with an open apex, the use of calcium hydroxide dressing to induce an apical hard tissue barrier (apicification) is characterized as a traditional treatment. This technique was first introduced by KAISER (18) and later popularized by FRANK (12). Despite its high success rate, there are several disadvantages to this technique. This procedure usually requires several visits to the dentist over a period of 5-20 months and during this time, the tooth is only temporarily restored, making it more susceptible to coronal infiltration. There is also a higher cost of treatment and a risk that the patient may fail to keep up with the necessary visits. In addition, prolonged exposure to calcium hydroxide can adversely affect the mechanical properties of root dentin, making it more susceptible to fracture. The fragility and porosity of the calcified apical barrier formed in this technique results in the possible apical extrusion of gutta-percha during treatment.
The induction of artificial apical barriers with different materials has been suggested as an alternative to the traditional use of calcium hydroxide (7). One of these alternatives for inducing apicification is to seal the open apical foramen with a Mineral Trioxide Aggregate (MTA) apical plug (28). The popularity of MTA as an artificial apical barrier can be attributed to several factors. This procedure can be completed in one or two treatment sessions, creating an apical stop at the open end of the canal, making it possible to restore the tooth within a short space of time with a restoration adapted to the crown, making it significantly stronger than unrestored crowns, reducing the possibility of coronal fracture. Unlike the prolonged use of calcium hydroxide in immature roots, the prolonged filling of roots with MTA does not reduce their resistance to fracture. Induced apicification with MTA can also result in improved hard tissue apical barrier strength and satisfactory sealing properties. This process will only be successful if the root canal space is closed, preventing the entry of new bacteria, burying remaining microorganisms and preventing their survival by obstructing the supply of nutrients. MTA also provides an effective seal in dentin and cementum and promotes biological repair and regeneration of the periodontal ligament.
MTA not only fulfills the ideal requirement of being bacteriostatic, it can also have bactericidal properties. The release of hydroxyl ions, a high pH sustained for prolonged periods and the formation of an interstitial mineralized layer can provide a challenging environment for bacteria to survive. These antibacterial properties can be a potent inhibitor of bacterial growth against species such as Streptococcus faecalis, a microorganism prevalent in root canal failures. In addition, Candida Albicans, commonly present in refractory endodontic disease, is susceptible to the antifungal activity of MTA.
molar furcation perforation
