Root Reconstructed with Mineral Trioxide Aggregate and Guided Tissue Regeneration in Apical Surgery: A 5-year Follow-up

Abstract

Apical surgery should be considered as the last treatment option and employed when conventional endodontic treatment does not provide the expected result. In teeth undergoing apical surgery, the type of retrograde filling material is one of the factors interfering with the repair of periapical tissues. The material in intimate contact with the periapical tissues plays a fundamental role in the repair process. Several materials have been studied and indicated for use in apical surgery procedures, but the mineral trioxide aggregate (MTA) is still the most frequently used one. Guided tissue regeneration (GTR) techniques have been proposed as an adjunct to apical surgery to enhance bone healing. Here is reported a clinical case in which apical surgery was performed in conjunction with MTA-based root reconstruction of the maxillary right second incisor. After the apical surgery, a root-end cavity was prepared at the vestibular face of the involved tooth and filled with MTA. A bovine bone graft and a cortical collagen membrane were placed on the bone defect. After 5 years, clinical and radiographic assessments showed that the treatment was successful. It may be concluded that MTA presents favorable characteristics in adverse conditions and can be used in conjunction with GTR in cases involving root reconstruction.

Apical surgery failures: Extraction or re-surgery? Report of five cases

“… 1 , 2 Endodontic treatment may need to be renewed in cases of failure; however, when non-surgical treatment is inadequate, apical surgery (AS) is the only choice. 3 - 5 AS is an endodontic surgical procedure which is performed by following steps such as root canal treatment, resection of the apical part of the root, preparation of adequate root-end filing and curettage of the periapical inflammation or necrotic tissue rigorously. 4 In this surgical treatment, root-end filling plays a crucial role in providing an efficient apical obturation because the most common cause of failures in the apical surgery is inadequate obturation between the root canal system and peri-radicular tissues.…”

“… 4 In this surgical treatment, root-end filling plays a crucial role in providing an efficient apical obturation because the most common cause of failures in the apical surgery is inadequate obturation between the root canal system and peri-radicular tissues. 3 , 6 In cases of apical surgery failure, apical re-surgery (AR) seems a viable alternative. 2 , 7 …”

“…It has also been reported that the use of guided tissue regeneration (GTR) has advantages such as promoting bone healing and increasing the success rate in AS; therefore, GTR and biomaterials can be applied in ASs. 1 , 3 , 5 …”

The use of a biocompatible cement in endodontic surgery. A randomized clinical trial 1

“…The development of biocompatible cements made this surgical treatment a viable alternative for the preservation of the tooth as a functional unit [3][4][5][6] . Root-end filling materials are required to provide hermetic sealing and to be biocompatible and a precursor for carbonateapatite formation, which promotes biomineralization, resulting in periodontal ligament at the bone-cement-dentin interface [7][8][9] .…”

Mineral trioxide aggregate induces osteoblastogenesis via Atf6

“…Mineral trioxide aggregate (MTA), which is a bioactive inorganic compound consisting of calcium silicate, calcium aluminate, calcium aluminoferrite, calcium sulfate, and bismuth oxide, has been clinically used for not only retrograde filling and apexification but also repair of accidental root perforations (Parirokh and Torabinejad, 2010, Bernabé et al, 2013). Several studies have postulated microleakage of MTA from the root in endodontic treatment (Lawley et al, 2004, Yazdizadeh et al, 2013) and the other reported induction and/or acceleration of bone repair of MTA in vivo (Qin et al, 2010, Wu et al, 2013).…”