Endo Tribune Asia Pacific Edition

Endo TribuneAsia Pacific Edition | 12/201520 TRENDS&APPLICATIONS Mineral trioxide aggregate (MTA) is an endodontic sealer that emerged on the market in 1998. Through provenscientificresultsithasbecame the true miracle of endodontics. An excellentsealingmaterial,itprovides settingexpansionandintegrityofthe seal owing to low solubility, tissue biocompatibility and high biological regeneration. The release of calcium ionsprovidesantibacterialactivity.Its radiopacity is excellent,and it can be usedforthermalcondensationowing toitsmeltingpoint of150°C. MTA also has good capacity for adhesion to dentine, making it re- sistant to the forces of displace- ment, and greater sealing power than other cements when tested to assessthequantityofbacterialinfil- tration. It is indicated for treatment of perforations in the furcation re- gion, of internal resorption, and of root perforations via surgery when it is impossible to treat the perfora- tion via the canal or treatment has been unsuccessful; for use in para- endodonticsurgeryasaretro-filling material; and for direct pulpal pro- tection, pulpotomy, apexogenesis andapexification. Literature review MTA is a biocompatible material with numerous clinical applica- tions in endodontics. It was first used experimentally by Lee and Monsef.1 However, approval of its use in humans by the American Dental Federation was not granted until 1998.2 It is composed primarily of tri- calcium silicate, tricalcium alumi- nate, tricalcium oxide and silicate oxide, as well as a small quantity of other mineral oxides and the ad- dition of bismuth oxide, which is responsible for the material’s ra- diopacity. The principal molecules present in MTA are calcium and phosphorus ions, which are also the main components of dental tissue, giving MTA excellent bio- compatibilitywhenincontactwith cells and tissue.3 MTA has been investigated as an alternative material in endodon- tics and can be used in retro-filling of root canals. Although the retro- filling material is very important, good sealing of the suitable apex is made for this purpose. According toAssisetal.,manytechniquesand instruments have been recom- mended for carrying out apical preparations.4 Both brands of MTA have been significantly evaluated and no other material has shown more progressive results.5 According to Pozza et al., the use of MTA in cav- ity walls, unlike other materials, achieves the best seal against infil- trations.6 Different materials have been used to seal the paths con- nectingtherootcanalandthepara- endodontic tissue. However, none of them have achieved results as promisingasthoseofMTA,andvar- ious studies have proven that MTA is the best on the market today.7 According to Leal, MTA cement has effective sealing capacity.8 According to Bernabé et al., con- ventional endodontic treatment is not able to resolve some cases and para-endodontic surgery is required to obtain a good result.9 The filling material used must not be toxic or mutagenic, and has to be biocompatible and insoluble. The material used in retro-filling distinguishes a good para-endo- donticsurgeryfromabadone.MTA achievesthebestresultspecifically for sealing between the tooth and external surface. Endodontic treatment has be- come more practical owing to the newmethodsandtechniques,with the emergence of materials with excellent physical and biological properties. The literature deals with various materials used in retro-filling, but generally speak- ing these materials do not have all the requisite properties to be able to remain in the cavity, such as biocompatibility, radiopacity, in- solubility in periapical fluids, easy compounding, non-staining of the periradicular tissue, good adap- tation and sealing capacity.10 An ideal material to replace amalgam should offer adhesion, promote hermetic sealing, be biocompati- ble, be radiopaque, be easy to compound and provide for an en- vironment favourable for tissue regeneration.11 According to Hellwig et al., para- endodontic surgeries expose and remove dental apices, promote retro-cavitations along the axis of the root canals, and retro-fill them with materials that promote their sealing.11 Para-endodontic surgery is an excellent option for conser- vative treatment of teeth with chronic periapical lesions, and treatment by the conventional method is impractical in some cases.12 According to Jacobovitz et al., treatmentofinflammatoryresorp- tionmustbedirectedatcombating endodontic infection.13 In certain cases,clinicalresolutionusingcon- ventional endodontic treatment can become unfeasible owing to the difficulties of performing in- strumentation and adequate fill- Use of mineral trioxide aggregate in endodontic retro-ﬁlling By Fernanda Maria Klimpel,Brazil 10 11 12 7 8 9 4 5 6 Figs. 4 & 5: Instruments for endodontic retro-ﬁlling.—Fig. 6: Supra-periosteal anaesthesia.—Figs. 7 & 8: Detachment of the ﬂap.—Fig. 9: Cutting of the root apex with a high-rotation drill.—Fig.10: Mini-handpiece for preparation of the apex.—Fig.11: MTA restorative material (liquid and powder).—Fig.12: Compounded MTA. “Both brands of MTA have been signiﬁcantly evaluated and no other material has shown more progressive results.” 1 2 3 Fig. 1: Panoramic radiograph.—Fig. 2: Periapical radiograph of the apex showing the presence of a ﬁstula.—Fig. 3: Periapical radiograph of the endodontic retreatment. 101112 789 456 123

Endo Tribune Asia Pacific Edition

Pages Overview