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ePaper created 2017-06-21, 10:00:36 | version 1.38.0
use of MTA case report | ing handling and insertion. Additionally, its formula uses a different radiopacifier (calcium tungstate), which does not cause staining of the root or dental crown, according to the manufacturer.24 In this case report, we present the clinical identification, diagno- sis and management of a non-vital central incisor with an open apex, treated using MTA REPAIR HP. Case report A 12-year-old male patient with a non-contributory medical history presented for examination with the chief complaint of pain in tooth #11. Clinical examina- tion found that the tooth had been restored with a temporary filling and responded with pain to percus- sion and palpation and presented with a discrete oedema in the area. There was no probing defect or si- nus tract stoma. According to the patient, root canal therapy had been started in the tooth approximately 12 months before. In the radiographic examination, a radiopaque material inside the canal a few millimetres short of the apex could be observed. Also, on the radi- ograph, it could be seen that the apex was not com- pletely formed and presented with a periapical lesion (Fig. 1). A clinical diagnosis of a pulpless tooth with unsatisfactory previously initiated therapy and symp- tomatic periapical periodontitis was established. The treatment plan was to first perform the clean- ing and shaping of the canal and to place a calcium hydroxide dressing. Then, after one to two weeks, with the regression of the symptoms, we would recreate an apical barrier with a new MTA-based material, obtu- rate the tooth and restore it. The treatment plan was presented to the patient’s parents, who agreed to it. After the consent form had been signed, 1.8 ml of local anaesthetic (2 % lidocaine with adrenaline 1:100,000) was administered, the restorative material was removed, and endodontic access corrected. After rubber dam isolation, the material inside the canal was removed under thorough irrigation using a 2.5 % sodium hypochlorite solution (Fórmula & Ação) and a CPR-7 ultrasonic tip (Obtura Spartan Endodontics). Fig. 4a Fig. 4b Figs. 4a & b: CBCT images. Axial view just after MTA REPAIR HP placement (a). Axial view at the nine-month follow-up. The bone formation, including the cortical plate, can be observed (b). Figs. 5a & b: CBCT images. Sagittal view just after MTA REPAIR HP placement (a). Sagittal view at the nine-month follow-up. Reformulation of the cortical plate is visible, as well as partial apical closure (b). After the removal of the material from the canal, #2 and #3 Largo burs were used to prepare the first two- thirds of the canal. Then, the apical foramen was lo- cated with the aid of an apex locator (RAYPEX, VDW), and the working length was established at 0.0 and confirmed with a radiograph. Instrumentation pro- ceeded using stainless steel K-type hand files in a crown-down technique until a #80 hand file achieved the working length. Between each file change, copi- ous irrigation with 2.5 % sodium hypochlorite solu- tion was performed (approximately 100 ml through- out the entire treatment). During the procedure, passive ultrasonic irrigation was performed for one minute several times to ensure complete removal of the old material and to maximise the irrigation technique. After the completion of in- strumentation, the canal was irrigated with 5 ml of 17 % EDTA (Fórmula & Ação) for three minutes and a final rinse with 5 ml of saline solution. A calcium hydroxide- based paste was placed in the canal as an inter-appointment dressing, and the tooth was tem- porarily restored (Fig. 2). After ten days, the patient came to the clinic for conclusion of treatment. The tooth was asymptomatic, and the area was no longer Fig. 5a Fig. 5b roots 2 2017 23