Mineral trioxide aggregate apical plug method for the treatment of nonvital immature permanent maxillary incisors: Three case reports

Abstract

Treatment of nonvital immature permanent teeth with calcium-hydroxide is associated with some difficulties such as weakened tooth fracture, root canal reinfection and long treatment time. Mineral trioxide aggregate (MTA) apical plug method is an alternative treatment option for open apices, and has gained popularity in the recent times. In this case report, we have attempted to present successful treatment of three maxillary incisors with open apices and periapical lesions with MTA. After preparing the access cavity, the working length was determined. The root canals were irrigated with 2.5% Sodium hypochlorite (NaOCl) and disinfected with calcium-hydroxide for two weeks. MTA was then placed in the apical 3 millimeters of the root canal. The remaining part of the root canal was filled with gutta-percha and the coronal restoration was finished with composite resin. After six months the radiographic examination showed a decrease of periapical lesions. At a 1-year and 18-months follow up, radiological and clinical successful healing of the incisor teeth was seen. MTA seems as an effective material for the apical plug method for the treatment of nonvital immature permanent teeth with open apices.

The Management of Crown Fracture of Immature Teeth by MTA and Calcium Hydroxide: Case Reports

“…Despite the higher success rate of apical barrier formation using Ca(OH) 2 , it still has its inherent clinical problems, like the possibility of cervical root fracture of the weakened teeth because of the desiccating properties of high pH Ca(OH) 2 ,failure to control infection, multiple appointments, which complicated the treatment, the nature of barrier which might be porous or sometimes contains soft tissues [13,14,20,29,31,35,36]. The presence of Ca(OH) 2 paste in the root for more than 30 days, and the long-term treatment procedures raise the tooth susceptibility to fracture [15,35,36].…”

“…In cases where the initial treatment of the injured tooth included long-term apexification with Ca(OH) 2 showing no apical stop 3 years later, by replacing it with MTA at the 12 months follow up the tooth was asymptomatic and showed repair of the radiolucent apical lesion [39]. The treatment with Ca(OH) 2 is time consuming, ranging from 3 to 21 months, dependent on the diameter of open apex, the rate of tooth displacement and the tooth repositioning method after luxation injury [35]. Lemon advocated the use of a matrix when the perforation diameter is larger than 1 mm to avoid extrusion of the sealing material [28].…”

“…The presence of Ca(OH) 2 paste in the root for more than 30 days, and the long-term treatment procedures raise the tooth susceptibility to fracture [15,35,36]. Disadvantages of Ca(OH) 2 can be the variability of treatment time, unpredictability of apical closure, high rate of cervical root fracture, difficulties with patient follow-up and delayed treatment [37].…”

Mineral Trioxide Aggregate Apexification followed by Fiber Post reinforced and customized with Ribbond Material in Fractured Immature Maxillary Central Incisor

“…4 For single-visit apexification, nowadays MTA is a good option because of its less cytotoxicity, biocompatibility, bioremineralization abilities, osteoconductive properties, and hydrophilic nature. 5,7 Moreover, MTA manipulation is difficult due to which its placement in the apical area is a difficult procedure. To avoid extrusion of MTA, a matrix can be used in apexification procedures.…”

Interaction of backfilling techniques and MTA plugs with additives: Fracture strength and adaptation analyses

“…This treatment technique has been accomplished in several case reports by placing MTA plugs with a thickness of 3-5 mm and obturating the remaining root canal portion with cold lateral or warm vertical compaction techniques [16][17][18][19] . Both obturation techniques may create different stresses and wedging effects inside the root canal system 20,21) , thus may affect the marginal adaptation of apical plugs and also the fracture resistance of endodontically treated immature teeth.…”