Setting of mineral trioxide aggregate (MTA) is affected by various factors. The purpose of this in vitro study was to evaluate the influence of root canal wall thickness on mechanical properties of MTA along the whole apical plug. Bovine bone mold tubes with internal diameter of 2 mm, height of 5 mm, and wall thickness of 0.8 mm, 1.2 mm, and 1.6 mm were filled with 3 mm ProRoot MTA and were kept in 37 °C and relative humidity of 100% for 7 days. The indentation hardness and reduced modulus of elasticity were measured in a large overview matrix and detailed matrix placed 1.5 mm from simulated apical foramen in order to obtain particularized information about gradient of altering mechanical properties. The uppermost layer of material in contact with simulated apical foramen had reduced mechanical properties irrespective of root canal wall thickness. The most distinct decrease of microhardness (32%) and reduced modulus of elasticity (27%) in interfacial layer were present in specimen with thinnest root canal wall. This effect could be observed in detailed measurement up to 190 µm in material. The interfacial layer of MTA, which was in contact during setting with root canal wall thinner than 1.2 mm, had reduced mechanical properties.

The complicated crown-root fracture of young permanent teeth is an uncommon traumatic dental injury that is usually treated in a complex way and is demanding not only for the dentist but even for the treated child. In this case report, we present the conservative treatment of a maxillary central incisor in a 10-year-old boy after a traumatic dental injury. Treatment included partial pulpotomy and adhesive fragment reattachment after reflection of the mucoperiosteal flap. The patient was fully asymptomatic at 24-month follow-up, with an aesthetically acceptable outcome. Vital pulp therapy and adhesive fragment reattachment can be a viable treatment option for complicated crown-root fractures, especially when treating immature permanent teeth.

Regenerative endodontic procedure (REP) is a progressive treatment modality for immature permanent teeth with necrotic pulp. The ambiguousness about the predictability of REP outcome in relation to complete disinfection of the root canal system and the occurrence of discoloration still exists. The aim of this retrospective study was to analyze two treatment protocols on clinical success rate, radiographic root development and the occurrence of discoloration. Eighteen patients were treated by a single operator by either treatment protocol according to the American Association of Endodontists (AAEP, n = 9) or a modified protocol (MP, n = 9) with the use of 5% sodium hypochlorite and sandblasting. Patients were followed up after 3, 6, 9, 12, 18 and 24 months and clinical success, radiographic root development and the occurrence of discoloration were assessed. The clinical success of MP was significantly higher in two years follow-up (p = 0.015), but the change in radiographic root area was higher for AAEP (p = 0.017) and the occurrence of discoloration was higher in AAEP (p = 0.029). The use of 5% sodium hypochlorite for a longer period of time leads to a higher success rate. The sandblasting of the access cavity reduces the occurrence of discoloration.