Mineral Trioxide Aggregate (MTA) and its Uses		What's New

Mineral Trioxide Aggregate (MTA) and its Uses CLINICAL CASES A 42 year-old female presented for evaluation of an endodontically treated primary retained molar. Although the tooth was asymptomatic, a sinus tract was present. Radiographic evaluation revealed radiolucencies related to all the roots (Fig. #5). Figure 5 This radiograph shows the complexity of this case. In addition to poorly sealed canals, we can the shortness of the roots. Radiolucencies are also present. Severe apical resorption was detected, further jeopardizing the prognosis of this tooth. At the initial appointment it was decided to remove the old filling material from within the canals and to clean and shape them with the use of hand files and Sodium Hypochlorite. Once the canals were cleansed, they were filled with a Calcium Hydroxide paste in order to promote bone healing. At the six-month period it was established that an apical stop was present and the decision was made to seal the canals with MTA as opposed to gutta- percha. This decision was dictated by the unusual internal anatomy of the very short canals, and to also take advantage of the biocompatibility of this material over potentially large areas of exposure due to the severe apical and lateral resorptive processes. A waiting period of six months was given to ascertain proper healing before the placement of the final restoration. At this time the radiograph revealed excellent bone fill in close apposition to the root system and the MTA (Fig. #6). Figure 6  A six month follow-up radiograph reveals complete healing of the bone. Note that the canals were sealed with MTA alone! A 52 year-old male was referred to our office for treatment regarding a first lower molar. This tooth had been endodontically treated and crown-lengthening procedures had been recently performed. The patient had mild discomfort associated with this tooth. Clinical examination revealed a sinus tract located in the lingual aspect. Radiographically, a radiolucency was noted in the furcation area (Fig. #7). Figure 7  This preoperatory radiograph shows a radiolucency involving the furcation area of the first lower molar. It was decided at the time to proceed with retreatment of the root canal system. The patient was informed of the possibilities of a vertical fracture, the presence of a large lateral canal, or a furcal and or strip perforation. With the use of the Surgical Operating Microscope, a strip perforation was located in the distal aspect of the mesio-lingual canal. Bleeding was controlled using a paste made with anesthetic solution and Calcium Hydroxide. After five minutes, this paste was washed out and the perforation was sealed with MTA.The remainder of the canal was obturated with thermoplastic gutta-percha utilizing the Obtura system (Fig. #8). Figure 8  Postoperatory radiograph showing the placement of MTA in the perforation of the mesial root. The access opening was bonded and the patient was instructed to return to the office a month later. At this time, the patient demonstrated no symptoms and the sinus tract was no longer present (Fig. #9). Figure 9  This picture reveals healing of the sinus tract and normal probing readings of the furcation area only one month after the treatment with MTA. A six-month check radiograph revealed significant healing in the furcation area (Fig. #10). Figure 10  A six month radiograph showing significant healing of the preexisting lesion in the furca. In addition to being used as a root-end filling material, procedural mistakes such as furcal, strip and apical perforations can be consistently repaired with MTA. Mineral Trioxide Aggregate is relatively easy to use and its long-term prognosis has been proven to be excellent! In summary, MTA promises to be one of the most versatile materials of this century! References Germain L., Mineral Trioxide Aggregate: A New Material for the New Millennium.Dentistry Today. 1999; 18:66-71. Torabinejad M, Hong C, Pitt Ford T. Tissue Reaction to Implanted Supereba and Mineral Trioxide Aggregate in Mandibles of Guinea Pigs: A Preliminary Report. J Endo. 1995; 21:569-571. Torabinejad M, Hong C, Pitt Ford T. Cytotoxicity of Four Root End Filling Materials. J Endo. 1995; 21:489-492. Torabinejad M, Pitt Ford T, Abedi H. Tissue Reaction to Implanted Potential Root-end Filling Materials in the Tibia and Mandible of Guinea Pigs. J Endo. 1998; 24:468-471. Torabinejad M, Watson T, Pitt Ford T. The Sealing Ability of a Mineral Trioxide Aggregate as a Retrograde Root Filling Material. J Endo. 1993; 19:591-595. Holland... Reaction of Rat Connective Tissue to Implanted Dentin Tubes Filled with MTA or Calcium Hydroxide. J Endo. 1999; 25:161-166. Nakata T, Bae K, Baumgartner J. Perforation Repair Comparing Mineral Trioxide Aggregate and Amalgam using an Anaerobic Bacterial Leakage Model. J Endo. 1998; 24:184-186. Hong C, McKendry D, Pitt Ford T. Healing of Furcal Lesions Repaired by Amalgam or Mineral Trioxide Aggregate (abstract 37). J Endo. 1994; 20:197. Dr. Nahmias currently maintains a private practice specializing in endodontics in Oakville, Ontario. He is also the creator of www.endoweb.com an endodontic electronic magazine. He can be reached at nahmiasoffice@endoweb.com.     Dr. Bery maintains a private practice in endodontics in Chicago, Illinois.

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