Apical Barrier Formation After Incomplete Orthograde MTA Apical Plug Placement in Teeth with Open Apex - Report of Two Cases

Abstract

Two cases are reported in which incomplete placement of 4 mm mineral trioxide aggregate (MTA) plug was performed unintentionally at the apical third of permanent immature teeth with open apex and apical periodontitis. As confirmed radiographically, there were gaps between MTA and dentinal walls along the MTA-dentin interface. After setting of MTA was confirmed, endodontic treatment was completed and access was sealed with composite resin. At 6 to 16 months follow-up examinations, formation of dentin in contact with the MTA surface, as well as apical closure and periapical healing were identified radiographically for both cases. The results of these cases showed that apical barrier formation and complete periapical healing is possible despite the incomplete apical placement of the MTA plug. This might be due to the biological properties of the MTA. Even so, an incomplete three-dimensional placement of the filling material is not advocated.

Mineral Trioxide Aggregate for Intruded Teeth with Incomplete Apex Formation

“…Several studies have reported that MTA yielded a significantly higher frequency of mineralized bridge formation, thicker and less porous dentin, and less periapical inflammation than calcium hydroxide 5,6) . It has also been reported that MTA induces migration and proliferation of osteogenic and odontoblastic cells, which, in turn, promotes mineralized tissue deposition, reducing inflammation in its site of action 4,6,8) . Such a protocol, combining the use of these two biomaterials (calcium hydroxide and MTA) in treating teeth with incomplete root formation, has been reported to offer favorable outcomes [1][2][3] , and the present results support the findings of these earlier studies.…”

“…It is a calcium silicatebased cement composed of a mineral powder of hydrophilic particles which sets in the presence of moisture 6) . Several studies have reported that MTA stimulates the deposition of hard tissue, inducing apical formation, particularly in dental traumatology cases 8,13) . Due to its low toxicity and pH of 12.5, MTA has satisfactory biological properties and stimulates tissue repair 6,8,13) .…”

“…Several studies have reported that MTA stimulates the deposition of hard tissue, inducing apical formation, particularly in dental traumatology cases 8,13) . Due to its low toxicity and pH of 12.5, MTA has satisfactory biological properties and stimulates tissue repair 6,8,13) . It is also capable of inducing the formation of a hard tissue apical barrier, and provides better sealing than other materials used for surgical or non-surgical purposes 8,[12][13][14] .…”

“…Due to its low toxicity and pH of 12.5, MTA has satisfactory biological properties and stimulates tissue repair 6,8,13) . It is also capable of inducing the formation of a hard tissue apical barrier, and provides better sealing than other materials used for surgical or non-surgical purposes 8,[12][13][14] . The objective of this case report is to describe and discuss the endodontic management of traumatic intrusive luxation of maxillary permanent central incisors with incomplete root formation using MTA as an apical plug to induce apexification.…”

Orthograde Apical Application of an MTA Plug in a Tooth without Constriction - A Case Report

“…MTA is a bioactive material that is mainly composed of tricalcium and silicate. Scientific investigations have shown that MTA can release various ions thatconduct and induct hard-tissue formation 4,17 .MTA presents some advantages,including its physical characteristics thatguarantee expansion during the attachment, which favors sealing, and the biological properties ofcalcium hydroxide 3,24 . MTA forms calcium oxide when in contact with water, which then, when in contact with tissue fluids, forms calcium hydroxide and triggers the same repair process in the tissue 11 .Some recentstudies have reported on the success of MTA as a root apical barrier, with rates ranging from 76.5% to 91% 10,20 .…”