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ePaper created 2017-06-21, 10:00:36 | version 1.38.0
| case report use of MTA Management of a non-vital central incisor with an open apex Using a novel MTA-based repair material in a young patient Authors: Drs Mario Luis Zuolo & Arthur de Siqueira Zuolo, Brazil Fig. 1 Fig. 2 Fig. 3a Fig. 3b Fig. 1: Initial radiograph showing tooth #11 with an open apex and a periradicular lesion. Fig. 2: A radiograph after the first appointment with calcium hydrox- ide-based paste in the canal. Figs. 3a & b: Radiographs during obturation. The position of the apical barrier is indicated by arrows (a). Final obturation and restoration (b). The treatment of immature necrotic teeth with non- vital pulps and open apices often presents a challenge to the clinician. Cleaning and shaping the thin canal walls, controlling the infection, and performing satis- factory sealing of the apex are sometimes not possi- ble.1 In most cases, the treatment involves the induc- tion of apical closure by apexification procedures to allow more favourable conditions for the conven- tional treatment.2 Traditionally, calcium hydroxide has been the ma- terial of choice used to induce the formation of an apical hard tissue barrier before placing the perma- nent filling.3 Although many studies have reported favourable outcomes when this treatment is used,4–7 disadvantages have also been reported. The use of calcium hydroxide apical barriers has been associated with some problems, such as unpredictability of api- cal closure,8 risk of reinfection due to leakage of the provisional filling9 and risk of root fracture as a result of the long-term application of calcium hydroxide.10, 11 Furthermore, poor patient compliance has a negative influence on the prognosis of conventional apexifica- tion procedures.12 With the advent of the mineral trioxide aggregate (MTA), a calcium silicate-based, biocompatible, non- absorbable material, another treatment option was proposed.13 This material has the ability to set in a short period and in the presence of moisture. It solidifies into a hard structure in less than three hours.14 This prop- erty, along with its capability of inducing cementum- like hard tissue when used in the periradicular tissue,15 allows its use in the immediate obturation of an open apex.16–18 Several studies show that apexification with MTA has a high success rate with fewer visits and less time to completion.18–21 Also, in a study that compared clin- ical and radiographic results of apexification with MTA or calcium hydroxide, all of the cases sealed with MTA healed, whereas in the calcium hydroxide cases, two out of 15 did not heal.9 However, MTA has some disadvantages too. Because of its consistency, its ma- nipulation and placement in the site of repair can be challenging.22 Additionally, its use can cause discolor- ation of the tooth, and it should be used with caution in aesthetic zones.23 A novel material, MTA REPAIR HP (high plasticity; Angelus), was recently introduced with the intention of improving some of those char- acteristics.24 This new formula retains all the chemical and biological properties of the original MTA; how- ever, it changes its physical properties of manipula- tion, resulting in greater plasticity, thereby facilitat- 22 roots 2 2017