Effect of MTA versus CEM apical plugs on fracture resistance of endodontically treated simulated immature teeth restored with cast metal posts: an in-vitro study

Abstract

Background Endodontically treated immature teeth which are restored with cast metal posts are of the most susceptible teeth to fracture. An apical plug is usually used as root end filling in order to seal the wide apical foramen. The current study was performed to evaluate the effect of different apical plug materials (MTA and Calcium enriched mixture cement) at varied thicknesses on fracture resistance of teeth restored with cast metal posts. Methods A total of 40 extracted intact single-rooted human mandibular premolars (removed for orthodontic reasons) were used in the study. The coronal part of each tooth was removed and root canal preparation was performed. A size 4 Gates Glidden drill was used to enlarge the canal and was passed through the apical foramen in order to simulate an immature apex. Samples were randomly divided into 5 groups (n = 8) according to apical plug (control group: No plug, group MTA5: 5 mm MTA plug, group CEM5: 5 mm CEM plug, group MTA3: 3 mm MTA plug, group CEM3: 3 mm CEM plug). Post-space preparations were performed and cast metal post-and-cores were fabricated and cemented. Fracture resistance was assessed using a universal testing machine. Fracture thresholds were recorded and data were analyzed using One-way ANOVA and Dunnett’s T3 tests with significance level at P value < 0.05. Results The analysis showed a significant difference of fracture resistance between groups (P value < 0.05). The mean fracture resistance of samples in control group was significantly lower than MTA5 (P value = 0.003). There was no significant difference between other groups (P value > 0.05). Conclusions Within the limits of this study, the evidence indicated that placement of a 5 mm MTA apical plug increased the fracture resistance in simulated immature teeth which are restored with cast metal posts, compared to control group (gutta-percha and sealer). While the results were not as promising for a 3 mm MTA apical plug or either 3 or 5 mm CEM apical plug.

Fracture Resistance of Molars With Simulated Strip Perforation Repaired With Different Calcium Silicate-Based Cements

“…Moreover, the findings of the current study ensured that MTA had a superior mean of fracture resistance compared with CEM (1025.20 N and 794.40 N, respectively) in terms of SP repairing. A similar result was found in the study of Grayli et al [ 34 ].…”

Clinical applications of calcium silicate‐based materials: a narrative review

“…In this treatment, the most important risk factor in prognosis is the susceptibility of teeth to fracture due to thin dentine walls. According to laboratory studies, an apical barrier with CSCs increases the fracture resistance and reduces the stresses within the root compared with root filling with gutta‐percha and sealer, 70 filling with Ca(OH) 2 , 71 or no treatment 72 . To increase the fracture resistance of immature teeth, one study recommended the filling of the entire canal with CSCs, 73 while another study suggested using MTA as an apical plug rather than in the entire root canal 74 .…”

Comparison of the Effects of TheraCal LC and Mineral Trioxide Aggregate on Direct Pulp Capping (DPC) Based on Histological Findings

“…MTA is one of the most critical materials used in dentistry, and today, it is used in many clinical and laboratory applications based on many studies, it has been considered the ideal and reference material (Gold Standard) [ 3 ]. Moreover, it showed an increase in fracture resistance when applied to simulated immature teeth [ 4 ]. It is composed of vital active silicate cement, which has been shown to be effective as a DPC material in both humans and experimental animals [ 5 ].…”