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ePaper created 2016-03-31, 16:35:38 | version 1.38.0
| case report use of MTA 32 roots1 2016 and retro-fill them with materials that promote their sealing.11 Para-endodonticsurgeryisanexcellentop tionforconservative treatment ofteethwith chronic periapicallesions,andtreatmentbytheconventional method is impractical in some cases.12 According to Jacobovitz et al., treatment of in flammatory resorption must be directed at combat ing endodontic infection.13 In certain cases, clinical resolution using conventional endodontic treat ment can become unfeasible owing to the difficul ties of performing instrumentation and adequate filling of the apical region. In these situations, alter native techniques for preparation of the root canal andfillingmaybenecessary,inadditiontotheuseof supplementary surgical treatment. Some cases may be treated with the use of a laser, but this does not change the pattern of microfiltration of retro-fill ings with MTA.14 Para-endodontic surgeries have various procedural methods that aim to resolve failures or accidents that occur in conventional endodontic treatment.15 According to Girardi et al., apicectomy is a method of para-endodontic surgery that entails the separation of the apical portion from the root.16 It is performed when there is no regression of the apical lesion after the alternatives of conventional endodontic therapy have been exhausted in an at tempt to eliminate the apical micro-organisms and their toxic products. The use of a high-quality retro-filling material is indispensable; if an inferior quality material is used, an increase in apical infiltration may occur, since the dentinal tubules are more exposed by certain cutting anglesandpermeabilityishenceincreased,andthisis importantatthetimeofapplyingthefillingmaterial.17 According to Oliveira et al., in an apicectomy with retro-fillingusingMTAandmonitoringafterfiveyears, it was observed that teeth with a persistent periapical fistula, after having undergone a suitable endodontic treatment, the surgical retreatment with retro-filling may be an efficient option in the resolution of the in fection and repair of the periapical tissue.18 TheliteratureconfirmsthatMTApresentsexcellent physical, chemical and biological properties, which justify it as the material of choice in the treatment of radicular resorption. It is a material that, compared with other restorative materials, has less microleak age and is capable of inducing the formation of min eralised tissue, such as bone, dentine and cementum, owing to it reaching a pH plateau of around 12.5 in 3 hours. According to Costa et al., who analysed the clinical application of MTA in relation to radicular re sorption,incasesinwhichradicularresorptionismin imal, the canal is filled with calcium hydroxide to stimulate the repair, closing the access cavity with zinc oxide and eugenol.19 Fig.10: Mini-handpiece for preparation of the apex. Fig.11: MTA restorative material (liquid and powder). Fig.12: Compounded MTA. Fig.13: Removal of the extra pre-existing cones. Fig.14: Placement of the MTA material. Fig.10 Fig.11 Fig.12 Fig.13 Fig.14