The incidence of asymptomatic pulp necrosis of teeth following crown preparation is noteworthy. The presence of preoperative caries, restorations or crowns of experimental teeth correlated with a significantly higher incidence of pulp necrosis. Electric pulp testing remains a useful diagnostic instrument for determining the pulp condition.
Mineral trioxide aggregate (MTA) has been proposed as one of the materials which can be used in a one-visit apexification technique. Recently conventional grey MTA has been replaced by a new white MTA formula. The aim of this study was to compare the root canal adaptation of white MTA to that of grey MTA when used as an apical barrier in teeth with open apices. We also examined whether a previous calcium hydroxide intracanal medication affects MTA's sealing ability and investigated the ability to remove calcium hydroxide from the root canal walls. Forty-nine teeth were prepared in a manner to simulate a divergent open apex of immature teeth. Four teeth were used in a preliminary experiment to demonstrate the inefficacy of calcium hydroxide removal from the canal walls in teeth with open apices. Four groups of 10 teeth each were created: groups A and B were treated with calcium hydroxide intracanal medication and then received an apical plug of grey and white MTA respectively. Groups C and D received an apical plug of grey and white MTA respectively without previous intracanal medication. Four teeth served as negative and one as a positive control. The marginal adaptation and sealing ability of the apical barrier were tested by means of a dye tracer (basic fuchsine) after longitudinal sectioning. It was found that MTA apical barrier resisted displacement during gutta-percha condensation. Calcium hydroxide pretreatment, adversely affected white MTA sealing ability (P < 0.05).
Root-end resected teeth with persistent apical periodontitis are usually retreated surgically or a combination of non-surgical and surgical retreatment is employed. However, patients are sometimes unwilling to be subjected to a second surgical procedure. The apical barrier technique that is used for apical closure of immature teeth with necrotic pulps may be an alternative to non-surgically retreat a failed apicoectomy. Mineral trioxide aggregate (MTA) has become the material of choice in such cases because of its excellent biocompatibility, sealing ability and osseoinductive properties. This case report describes the non-surgical retreatment of a failed apicoectomy with no attempt at retrofilling of a maxillary central incisor. White MTA was used to induce apical closure of the wide resected apical area. Four-year follow-up examination revealed an asymptomatic, fully functional tooth with a satisfactory healing of the apical lesion. White MTA apical barrier may constitute a reliable and efficient technique to non-surgically retreat teeth with failed root-end resection. The predictability of such a treatment is of great benefit for the patient who is unwilling to be submitted to a second surgical procedure.
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