Surgical endodontics
John Dudley Langdon, Mohan Francis Patel, Robert Andrew Ord, Peter Brennan in Operative Oral and Maxillofacial Surgery, 2017
The apex of the tooth is resected, perpendicular to the long axis of the tooth to minimize the number of exposed dentinal tubules. Dentinal tubules allow communication between untreated contaminated areas of the root canal system and the peri-apical tissues. The level of the resection should be sufficient to remove the portion of the root canal system identified pre-operatively as potentially harbouring micro-organisms, usually 3–4 mm. It is not necessary to resect the root at the base of the cavity as this will expose a larger dentinal surface and reduce the remaining root length for restoration and stability. The orthograde root filling will usually be exposed by the resection. If mineral trioxide aggregate (MTA) has been used for the orthograde filling, no root-end preparation is necessary (Figure 8.2).
Dentin-Pulp Complex Regeneration
Vincenzo Guarino, Marco Antonio Alvarez-Pérez in Current Advances in Oral and Craniofacial Tissue Engineering, 2020
Another type of apexification named ‘apical MTA plug’ was described using Mineral Trioxide Aggregate (MTA). MTA is a repair material made of fine hydrophilic particles of tri/dicalcium silicate, tricalcium aluminate, tricalcium oxide and silicate oxide (Parirokh and Torabinejad 2010). MTA is placed into the root canal space and acts as a mechanical barrier to prevent coronal leakage and penetration of microorganisms. Some disadvantages of this material are difficulty to manipulate, the possibility of tooth discoloration and difficulty to remove from the root canal However, neither calcium hydroxide nor MTA barrier technique allow further root growth in length, maturation of the apex or root wall thickening. New calcium silicate-based materials have recently been developed with the purpose of improving clinical use and overcoming MTA limits BiodentineTM is a bioceramic made of tricalcium silicate, dicalcium silicate, zirconium oxide, calcium carbonate, calcium oxide and iron oxide. It is mixed with a hydrosoluble polymer and calcium chloride to decrease the setting time (Rajasekharan et al. 2014). This biomaterial has shown reduced setting time with interesting physical and biological properties as a dentine restorative material (Koubi et al. 2013; Topçuoglu and Topçuoğlu 2016).
Antibacterial, pH Neutralizing, and Remineralizing Fillers in Polymeric Restorative Materials
Mary Anne S. Melo in Designing Bioactive Polymeric Materials for Restorative Dentistry, 2020
Mineral trioxide aggregate (MTA) has been introduced to overcome the drawbacks of calcium hydroxide. Human studies in primary teeth did not reveal any significant difference between calcium hydroxide and MTA (Schwendicke et al. 2016). Higher success rate than calcium hydroxide in reducing dental pulp inflammation and enhancing dentin bridge formation (Li et al. 2015; Zhu et al. 2015). The mechanism of action of MTA is believed to be similar to that found with calcium hydroxide with a greater sealing ability observed with the use of MTA (Fridland and Rosado 2003, 2005). However, using a layer of glass ionomer or RMGI is suggested after applying calcium hydroxide or MTA to enhance the sealing and protect the capping materials during the restoration placement (Hilton 2009).
The effects of mineral trioxide aggregate on osteo/odontogenic potential of mesenchymal stem cells: a comprehensive and systematic literature review
Published in Biomaterial Investigations in Dentistry, 2020
Danial Babaki, Sanam Yaghoubi, Maryam M. Matin
Based on laboratory and clinical studies, mineral trioxide aggregate (MTA) overcame the drawbacks of many conventional substances, and it has been considered as a suitable surrogate in the clinical practice [1–3]. Chemical assessments have shown that in contrast to Portland Cement, MTA contains smaller pieces and fewer harmful heavy metals [4–7]. Hence, it has received much attention as an ideal dental material for various endodontic uses, including pulp capping, pulpotomy, root perforation treatment, and root canal filling [1,8,9]. Several investigators have evaluated the physical properties of MTA, and although physical characteristics can be influenced by methods of placement and environmental conditions, MTA exhibits favorable sealing ability, solubility and compressive strength [10–12]. MTA setting is initiated in the existence of moisture. In the course of hardening, a release of calcium hydroxide and a rise in pH could be detected. Bismuth was reported as another crucial component in this mixture whose solubility increases in acidic conditions, similar to inflammatory environments, and accordingly the precipitation rate of calcium hydroxide in hydrated MTA increases [2,7,13]. Among various MTA types, several studies focused on gray (GMTA) and white (WMTA) forms of this material. The results revealed lower level of hydroxyapatite formation within hydrated WMTA. On the other hand, more silica, calcium, and phosphorus were present in WMTA [13–15].
Orthodontic management of a non-vital immature tooth treated with regenerative endodontics: a case report
Published in Journal of Orthodontics, 2018
Zynab Jawad, Claire Bates, Mandeep Duggal, Hani Nazzal
Traditionally, calcium hydroxide apexification has been used in managing these teeth, however, the long-term use of calcium hydroxide has been shown to result in denaturation of dentinal portions and reduction in dentine modulus of elasticity leading to cervical root fractures (Cvek 1992; Al-Jundi 2004; Twati et al. 2009). The use of Mineral Trioxide Aggregate (MTA) in creating a physical barrier against which root canals can be obturated is currently considered the gold standard in managing these teeth (Chala et al. 2011), however, despite the good success in the short to medium terms, currently there are no long-term data on the success of this technique (Chala et al. 2011; Nazzal and Duggal 2017; Tong et al. 2017). Both these techniques have a fundamental problem in that although they allow root canal obturation, they do not contribute to any quantitative or qualitative increase in root dimensions, therefore, they are mainly useful in those teeth with a minimum of half root length formation (Nazzal and Duggal 2017). Non-vital immature teeth with less than half root length formation pose a huge challenge with very poor short and long-term prognosis (Nazzal and Duggal 2017).
Efficacy of cavity liners with/without atmospheric cold helium plasma jet for dentin remineralization
Published in Biomaterial Investigations in Dentistry, 2020
Hamid Kermanshah, Reza Saeedi, Elham Ahmadi, Ladan Ranjbar Omrani
In deep caries with the risk of pulp exposure, indirect pulp capping is a minimally invasive procedure, in which, infected carious tissue is removed, affected dentin is preserved and the tooth is restored with suitable restorative materials [4,5]. This procedure is performed aiming to be enhanced by the use of ion-releasing cavity liners [6]. The key to success in this approach is to use remineralizing agents during indirect pulp capping [7]. Dentin remineralization is more complex than enamel remineralization due to the presence of higher amounts of organic matrix [7]. The remineralization process occurs by the growth of the remaining hydroxyapatite crystals in the affected dentin [7]. Bioactive materials are applied close to the pulp or over the pulpal exposure site as liners for induction and progression of remineralization. These liners release calcium and hydroxyl ions that induce remineralization [8]. Calcium hydroxide (CH), mineral trioxide aggregate (MTA), and Biodentine are among the commonly used bioactive materials [9].
Related Knowledge Centers
- Apexification
- Root Canal Treatment
- Calcium Sulfate
- Tooth Resorption
- Pulp Capping
- Alite
- Calcium Silicate
- Tricalcium Aluminate
- Bismuth(Iii) Oxide
- Zeolite