Dental Tribune Asia Pacific Edition No.4, 2017

16 TRENDS & APPLICATIONS Dental Tribune Asia Paciﬁ c Edition | 4/2017 Discussion Previous clinical studies in humans have demonstrated that an apical barrier of MTA can be used with success in the tech- nique of apexiﬁ cation of teeth AD 6a & b with open apices. El-Meligy and Avery ran a clinical trial compar- ing the use of calcium hydroxide and MTA in 30 teeth of 15 patients who had lost pulp vitality through caries or trauma.9 The conventional technique of apexi- ﬁ cation with calcium hydroxide was performed in one tooth, whereas the barrier technique with MTA was applied to the other tooth in the same patient. The teeth were then followed up for three, six and 12 months. Two of the teeth ﬁ lled using calcium hydroxide failed, while none of the teeth ﬁ lled with MTA showed clinical or radiographic signs of pathology. Simon et al. carried out a prospective clinical trial in 57 teeth of 50 patients with open apices treated with MTA plugs and deﬁ nitive ﬁ lling of the canal and observed success in 81 % of the cases.16 6c In this case report, the use of a modiﬁ ed MTA (MTA–bioceram- ic-based high-plasticity reparative cement) achieved a good clinical result over the short follow-up pe- riod. Comparison of CBCT images just after placement of the MTA Figs. 6a & b: MTA REPAIR HP. (a) Cap- sule containing the powder. (b) Vial containing the liquid. Fig. 6c : The material after proper manipulation. barrier and after a nine-month pe- riod demonstrated bone forma- tion and apical closure by hard tis- sue. It should be noted that a radio- lucent area too could be seen at this time. Such a healing pattern could be classiﬁ ed as incomplete healing, according to Molven et al.24 From a clinical perspective, the handling and placement of the MTA REPAIR HP was easier than with the conventional MTA. According to the manufacturer, the difference between MTA REPAIR HP and the original An- gelus MTA is the replacement of distilled water with a liquid that contains water and another or- ganic plasticiser that gives the new product high plasticity25 (Fig. 6). The manufacturer claim that the new MTA does not pro- mote dental discoloration could not be studied in this case, since the material was placed in the apical portion of the canal. The importance of case re- ports is the demonstration of what is possible in our patients using scientiﬁ c clinical treatment protocols. Reports from clinical practitioners have played impor- tant roles in the ﬁ eld of dentistry, but should be validated through proper laboratory and clinical re- search studies. In conclusion, the clinical protocol using the new MTA REPAIR HP, as described in this case report, enabled the suc- cessful apexiﬁ cation of a central incisor in a young patient. Editorial note: This article ﬁ rst appeared in the Endodontic Practice US magazine (Vol. 9, No. 2). Reprinted with permission. A list of references is available from the publisher. Endodontist Dr Mario Luis Zuolo from São Paulo in Brazil is an internationally prominent spea- ker in the spe- cialty. He can be contacted at mlzuolo@uol. com.br. de Dr Arthur Zuolo Siqueira runs a private practice in São Paulo and is Adjunct Pro- fessor of Endo- dontics at the Associação Paulista de Cirurgiões Dentistas, the São Paulo association of dental surgeons. He can be contacted at artz@msn.com.

Dental Tribune Asia Pacific Edition No.4, 2017

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