Clinical results with two different methods of root-end preparation and filling in apical surgery: mineral trioxide aggregate and adhesive resin composite

INTRODUCTION: The aim of apical surgery is to hermetically seal the root canal system after root-end resection, thereby enabling periradicular healing. The objective of this nonrandomized prospective clinical study was to report results of 2 different root-end preparation and filling methods, ie, mineral trioxide aggregate (MTA) and an adhesive resin composite (Retroplast). METHODS: The study included 353 consecutive cases with endodontic lesions limited to the periapical area. Root-end cavities were prepared with sonic microtips and filled with MTA (n = 178), or alternatively, a shallow concavity was prepared in the cut root face, with subsequent placement of an adhesive resin composite (Retroplast) (n = 175). Patients were recalled after 1 year. Cases were defined as healed when no clinical signs or symptoms were present and radiographs demonstrated complete or incomplete (scar tissue) healing of previous radiolucencies. RESULTS: The overall rate of healed cases was 85.5%. MTA-treated teeth demonstrated a significantly (P = .003) higher rate of healed cases (91.3%) compared with Retroplast-treated teeth (79.5%). Within the MTA group, 89.5%-100% of cases were classified as healed, depending on the type of treated tooth. In contrast, more variable rates ranging from 66.7%-100% were found in the Retroplast group. In particular, mandibular premolars and molars demonstrated considerably lower rates of healed cases when treated with Retroplast. CONCLUSIONS: MTA can be recommended for root-end filling in apical surgery, irrespective of the type of treated tooth. Retroplast should be used with caution for root-end sealing in apical surgery of mandibular premolars and molars.

5-year results comparing mineral trioxide aggregate and adhesive resin composite for root-end sealing in apical surgery

INTRODUCTION Recent meta-analyses of the outcome of apical surgery using modern techniques including microsurgical principles and high-power magnification have yielded higher rates of healing. However, the information is mainly based on 1- to 2-year follow-up data. The present prospective study was designed to re-examine a large sample of teeth treated with apical surgery after 5 years. METHODS Patients were recalled 5 years after apical surgery, and treated teeth were classified as healed or not healed based on clinical and radiographic examination. (The latter was performed independently by 3 observers). Two different methods of root-end preparation and filling (primary study parameters) were to be compared (mineral trioxide aggregate [MTA] vs adhesive resin composite [COMP]) without randomization. RESULTS A total of 271 patients and teeth from a 1-year follow-up sample of 339 could be re-examined after 5 years (dropout rate = 20.1%). The overall rate of healed cases was 84.5% with a significant difference (P = .0003) when comparing MTA (92.5%) and COMP (76.6%). The evaluation of secondary study parameters yielded no significant difference for healing outcome when comparing subcategories (ie, sex, age, type of tooth treated, post/screw, type of surgery). CONCLUSIONS The results from this prospective nonrandomized clinical study with a 5-year follow-up of 271 teeth indicate that MTA exhibited a higher healing rate than COMP in the longitudinal prognosis of root-end sealing.

Clinical and radiographic evaluation of pulpotomies employing calcium hydroxide and trioxide mineral aggregate

This study utilized clinical and radiographic examinations to compare the effectiveness of calcium hydroxide paste and mineral trioxide aggregate (MTA) for pulpotomies of primary molars in children. Ninety primary molars that showed clinical and radiographic indications for pulpotomy treatment were selected. The pulpotomies were performed in two sessions, using a corticosteroid/ antibiotic solution as therapeutic dressing. The sample was divided into two groups of 45 teeth, in which the pulpal remains were protected with either calcium hydroxide paste (Group 1) or MTA (Group 2). Radiographs were taken immediately and at 3-, 6-, and 12-month follow-up appointments. Three teeth in Group 1 failed after three months, while two cases failed after six months and one more failed at one year. Two failures were found in Group 2 at the 12-month follow-up. These results indicate that both materials may be utilized for pulpotomies in primary teeth.

Testes de biocompatibilidade in vitro de duas formas comerciais do agregado de trióxido mineral

Recently, regular and white mineral trioxide aggregate (MTA) are being used in Dentistry as retrofilling materials. Genotoxicity and cytotoxicity tests form an important part of cancer research and risk assessment of potential carcinogens. Thus, the goal of this study was to examine the genotoxicity and cytotoxicity of regular and white MTA in vitro by the single cell gel (comet) assay and trypan blue exclusion test, respectively. Mouse lymphoma cells were exposed to two presentation forms of MTA at final concentrations ranging from 1 to 1,000 μg/mL for 3 h at 37°C. The results showed that both compounds tested did not produce genotoxic effects at all concentrations evaluated. Likewise, no statistically significant differences (p > 0.05) were observed in cytotoxicity. Taken together, our results suggest that regular and white MTA are not genotoxins and are not able to interfere in cellular viability as assessed by single cell gel (comet) assay and trypan blue assay, respectively.

Atividade antibacteriana e citotoxicidade do agregado de trióxido mineral associado a diferentes concentrações de clorexidina

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Avaliação histomorfológica da resposta da polpa de dentes de cães submetida ao capeamento com sistema adesivo, cimento de hidróxido de cálcio e dois tipos de agregado de trióxido mineral

Pós-graduação em Odontologia - FOA

Adaptação marginal do agregado de trióxido mineral com e sem cloreto de cálcio em retrocavidades

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Avaliação de propriedades físico-químicas e antimicrobianas sobre Enterococcus faecalis do mineral trióxido agregado associado a óleo de melaleuca ou farnesol

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Avaliação de propriedades físico-químicas e antimicrobianas sobre Enterococcus faecalis do mineral trióxido agregado associado a óleo de melaleuca ou farnesol

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Periapical tissue reactions to calcium hydroxide and MTA after external root resorption as a sequela of delayed tooth replantation

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Influence of a Parafunctional Oral Habit on Root Fracture Development After Trauma to an Immature Tooth

Root fractures in immature teeth are rare because the resilience of the alveolar bone is more favorable to the occurrence of luxation. This article reports a case of traumatic injury in an immature permanent tooth that progressed to root fracture, having a parafunctional oral habit as the possible modifying factor of case evolution. A 12-year-old boy presented for treatment complaining of a defective restoration and mild pain on the maxillary right central incisor. The patient had a history of crown fracture in this tooth due to trauma 2 years before. The clinical examination showed healthy gingival tissues and no abnormal tooth mobility, whereas radiographic projections revealed healthy periradicular tissues, incomplete root formation, and no visible root fracture. As pulp necrosis was diagnosed, calcium hydroxide therapy was started for canal disinfection and subsequent obturation. However, after 4 weeks of treatment, a horizontal fracture line was observed radiographically in the root's middle third. The patient denied a new traumatic injury, but revealed the habit of chewing on a pencil. Refraining from the deleterious oral habit was strongly advised, and root canal filling with mineral trioxide aggregate was performed to treat the root fracture. After 4 years of follow-up, the tooth has normal function and no abnormal mobility. Images suggestive of remodeling at the apical end of the coronal segment and replacement resorption of the apical segment are seen radiographically. This case demonstrates the need of following cases of dental trauma and the possible influence of parafunctional oral habits as modifying factors of case progression.

Evaluation of subcutaneous and alveolar implantation surgical sites in the study of the biological properties of root-end filling endodontic materials

Objective: The aim of this study was to compare two methodologies used in the evaluation of tissue response to root-end filling materials in rats. Material and Methods: Forty rats were divided into 4 groups: in Groups I and II (control groups), empty polyethylene tubes were implanted in the extraction site and in the subcutaneous tissue, respectively; in Groups III and IV, polyethylene tubes filled with ProRoot MTA were implanted in the extraction site and in the subcutaneous tissue, respectively. The animals were killed 7 and 30 days after tube implantation, and the hemi-maxillas and the capsular subcutaneous tissue, both with the tubes, were removed. Specimens were processed and evaluated histomorphologicaly under light microscopy. The scores obtained were analyzed statistically by the Kruskal-Wallis test (p<0.05). Results: There were no statistically significant differences between the implantation methods (p=0.78033, p=0.72039). It was observed that the 30-day groups presented a more mature healing process due to smaller number of inflammatory cells. Conclusions: The present study showed no differences in tissue responses as far as the implantation site and the studied period were concerned. Alveolar socket implantation methodology represents an interesting method in the study of the biological properties of root-end filling endodontic materials due to the opportunity to evaluate bone tissue response.

Rat tissue reaction to MTA FILLAPEX (R)

The aim of this study was to evaluate the rat subcutaneous tissue reaction to implanted polyethylene tubes filled with mineral trioxide aggregate (MTA) FILLAPEX (R) compared to the reaction to tubes filled with Sealapex (R) or Angelus MTA (R). These materials were placed in polyethylene tubes and implanted into the dorsal connective tissue of Wistar rats for 7, 15, 30, 60, and 90 days. The specimens were stained with hematoxylin and eosin or Von Kossa or left unstained for examination under polarized light. Qualitative and quantitative evaluations of the reaction were performed. All materials caused moderate reactions after 7 days, which decreased with time. The reactions were moderate and similar to that evoked by the control and Sealapex (R) on the 15th day. MTA FILLAPEX (R) and Angelus MTA caused mild reactions beginning after 15 days. Mineralization and granulation birefringent to polarized light were observed with all materials. It was concluded that MTA FILLAPEX (R) was biocompatible and stimulated mineralization.

Histologic evaluation of the use of membrane, bone graft, and MTA in apical surgery

The aim of this study was to evaluate the periapical healing after the use of membrane, bone graft, and mineral trioxide aggregate (MTA) in apical surgery of dogs' teeth. Apical lesions were induced in 48 roots of 6 dogs after coronal access and pulpal removal. Apical surgery consisted of osteotomy with trephine bur for the standardization of the critical surgical cavities, followed by apicoectomy, curettage, preparation of the root-end cavities with the aid of the ultrasonic device, and retrofilling with MTA. The surgical sites were divided into: group 1-filled with blood; group 2-filled with blood and recovered with membrane; group 3-filled with bone graft; and group 4-filled with bone graft and recovered with membrane. The results showed that the inflammatory infiltrate, the periapical healing process, and the behavior of MTA was the same in all groups, including the mineralization stimulation. It was concluded that the use of membranes and bone graft materials isolated or associated in apical surgery did not alter the periapical healing process after the root-end filling with MTA. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109: 309-314)