Non-surgical retreatment of a failed apicoectomy without retrofilling using white mineral trioxide aggregate as an apical barrier

Abstract

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.

Nonsurgical endodontic management of mandibular first premolar with incomplete root‐end resection

“…Some of the patients are reluctant to be subjected to another surgical procedure. Undoubtedly, the second attempt of apical surgery may cause discomfort to the patient and may result in further scarring, bone loss, and compromising the crown‐to‐root ratio 19,21 . In the present case, a 2‐year follow‐up period was adopted, as most of the apical periodontist cases healed within this period 32 .…”

Mineral trioxide aggregate apical plug method for the treatment of nonvital immature permanent molars

“…Calcium hydroxide remains the most used remedy in the treatment of immature permanent teeth due to its low cost and ability to induce the formation of an apical barrier (15,16). Cell migration, differentiation and production of organic matrix consisting of cementum or osteodentine determine the outcome of the apexification procedure (17).…”

Retrospective Evaluation of Root End Resection without Retrograde Filling

“…It was reported that healing after apicoectomy made by conventional methods is not related with retrograde filling (15,27). Stefopoulos et al (28) reported that root end resection completed with MTA and without retrograde filling presents apical sealing. Reported reviews claiming retrograde filling's necessity advocated that horizontal accessory canals in the posterior dentition cannot be eliminated with conventional methods, remaining pulpal tissue can lead to relapse of infection, and periapical environment cannot be protected without retrograde filling (8,24).…”