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ePaper created 2016-03-31, 16:35:38 | version 1.38.0
use of MTA case report | 33roots1 2016 Among the various advantages of MTA is minimal radiopacity, which has proven to be an important criterion and contributes to it being considered the best choice by the dental surgeon in relation to bio materials to be used in para-endodontic surgery.20 According to Barros and Araújo Filho, MTA has been used successfully in filling the apical space of the root canal. In addition to its excellent sealing capacity, it is biocompatible with the periradicular tissue, and induces the formation of cementoblasts and osteoblasts.21 Clinical case This case illustrates the use of MTA for sealing the root perforation and the effectiveness of the retro- filling material after apicectomy (additional surgery; Figs. 1–17). A 51-year-old patient presented to the Universidade Tuiuti do Paraná dental clinic (Brazil) complaining about a gap in the gingiva above tooth #11, from which a large quantity of purulent dis charge was draining. In the radiographic examina tion,anextensiveradiolucentareawasfound,indica tingafistula(periapicallesion)involvingtheperiapical region of the tooth in question. During the endodontic treatment, the secretion into the tooth could not be controlled. Even 23 days after treatment, with changes to the intra-canal medication, the fistula returned and the exudate drainage via the canal persisted. Definitive sealing of the root perforation was then opted for, utilising MTAandcontinuingwithchangesofcalciumhydrox ide in the root canal. Owing to the persistence of the exudate via the canal, it was decided to perform end odontic filling, followed by supplementary surgical treatment (apicectomy) with retro-filling with MTA, conserving the tooth structure as much as possible. Thesurgerywasperformedunderlocalanaesthetic with an infraorbital nerve block and supplementary infiltrativeanaesthesiaattheapexofthetooth,aswell as a nasopalatine nerve block. The anaesthesia used was 3 % mepivacaine with 1:1,000,000 adrenaline. The incision was made with a #15 scalpel blade andaflapwasraised.Theosteotomywasperformed withahigh-rotationdrillofthe700seriesinorderto gain access to the periapical region. The lesion was curetted with a short curette. An apicectomy was performed with the drill and 2 mm of the apex was removed. The cavity for retro-filling was prepared with a spherical drill under constant irrigation with saline solution, and then the retro-filling with MTA was performed. After condensation of the material in the cavity, the excess was removed with a peri odontal curette. Finally, the flap was repositioned and then sutured. One 750 mg pill of acetaminophen every 6 hours for two days was prescribed. In the seven-day post operative control period, the patient had no symp toms incompatible with the surgery performed and the healing appeared normal. These circumstances held for the full monitoring period, over the course ofayear,astheradiographoneyearaftertreatment establishednewboneformationintheregion,prov ingthesuccessofthecase.Attheendofthesurgical treatment, the patient was referred for prosthetic treatment. Conclusion Accordingtothemethodologyusedinthiscaseand considering its results, it can be concluded that the MTAmaterialusedwasefficientintheformationofa newmineralisedtissuebarrier,completelysealingthe apical portion of the canal._ The author would like to thank Prof. Luciano Loureiro de Meloforhisadvisesandhelpwiththisarticle,andProf.Yas- mineMendesPupoforthephotographs. about Dr Fernanda Maria Klimpel is working as a dentist in Brazil. Fig.15: Condensation of the MTA in the canal. Fig.16: Suturing with 4-0 silk thread. Fig.17: Final radiograph of the apicectomy. Fig.15 Fig.16 Fig.17