CASE REPORTCASE REPORTCASE REPORTCASE REPORT

60 ARCHIVES OF DENTAL AND MEDICAL RESEARCH

Clinical Applications oCases Ghanshyam Patel1, Dipti ChoksiSanju Patel1

1Post graduate student, Department of Conservative Dentistry & Endodontics, Faculty of Dental ScienceNadiad; 2Professor and Head, Department of Conservative Dentistry & Endodontics, Faculty of Dental ScienceNadiad; 3Professor, Department of Conservative Dentistry & End4Senior lecturer, Department of Conservative Dentistry & Endodontics, Faculty of Dental Science Address for Correspondence: Dr. Ghanshyam Patel, Department of Conservative Dentistry & EndodonNadiad, India. ABSTRACT: The greatest threats to teeth are dental caries and traumatic injuries. The primary goal of all restorative treatment is to maintain vitality of pulp. If pulpal exposure occurs, then vital pulp done to preserve pulp vitality. Historically, calcium hydroxide has been the material of choice for vital pulp procedures. As of late, an option material called mineral trioxide total (MTA) has exhibited the capacity to prompt hard-tissue development in pulpal tissue. This article portrays the clinical and radiographic result of cases including the utilization of MTA in furcal perforation repair, closure of open apex and direct pulp capping. Keywords: Closure of open apex, D

INTRODUCTION A perfect endodontic repair material should seal the pathways of correspondence between the the root canal system and its surrounding tissues. It should be noncarcinogenic, nontoxic, biocompatible, insoluble in tissue fluids, and dimensionally stable.previous materials did not have these all characteristics, MTA is being used in a wide range of clinical treatments such as a perforation repair material, as a rootfilling material and as a pulp capping agent during vital pulp therapy and2 excellent sealing ability and promoted osteoblast activity3. It is less cytotoxic had an antimicrobial effect.4,5 In this article three cases of furcal perforation repair, closure of open apex and direct pulp capping by using MTA are shown. CASE REPORT CASE 1 :- Furcal Perforation repair using MTA A 34-yr-old female patient reported to the Department, with the chief complain of pain in her lower right back region of the jaw since

ARCHIVES OF DENTAL AND MEDICAL RESEARCH Vol 3 Issue 1

Clinical Applications of Mineral Trioxide Aggregate: Report o

Dipti Choksi2, Barkha Idnani3, Nirav Parmar

student, Department of Conservative Dentistry & Endodontics, Faculty of Dental ScienceProfessor and Head, Department of Conservative Dentistry & Endodontics, Faculty of Dental ScienceProfessor, Department of Conservative Dentistry & Endodontics, Faculty of Dental Science

Senior lecturer, Department of Conservative Dentistry & Endodontics, Faculty of Dental Science

Department of Conservative Dentistry & Endodontics, Faculty of Dental Science,

The greatest threats to teeth are dental caries and traumatic injuries. The primary goal of all restorative treatment is to maintain vitality of pulp. If pulpal exposure occurs, then vital pulp done to preserve pulp vitality. Historically, calcium hydroxide has been the material of choice for vital pulp procedures. As of late, an option material called mineral trioxide total (MTA) has exhibited the

ue development in pulpal tissue. This article portrays the clinical and radiographic result of cases including the utilization of MTA in furcal perforation repair, closure of open apex and direct pulp capping.

open apex, Direct pulp capping, MTA, Perforation repair.

A perfect endodontic repair material should seal the pathways of correspondence between the the root canal system and its surrounding

be noncarcinogenic, nontoxic, biocompatible, insoluble in tissue

.1 Because any previous materials did not have these all characteristics, MTA is being used in a wide range of clinical treatments such as a

material, as a root-end filling material and as a pulp capping agent

MTA showed excellent sealing ability and promoted

. It is less cytotoxic had an

f furcal perforation repair, closure of open apex and direct pulp capping by using MTA are shown.

Furcal Perforation repair using

old female patient reported to the Department, with the chief complain of pain in her lower right back region of the jaw since

one month. On clinical examination a deep carious lesion was found in relation to 46. Radiographic examination reveled exocclusal caries involving pulp and furcal area.(Figure 1)

Figure 1: Radiograph showing furcation involvement in 46

Vitality test showed negative response with both thermal tests and Electric pulp tester. The diagnosis was necrosis of the tooth and involvement of furcal area because of deep carious lesion. On first appointment tooth was isolated with rubber dam. The carremoved, and Perforation was confirmed clinically with probe. Canals were cleaned and shaped with ProTaper files up to the F1ProTaper and patient was recalled after three days. On second appointment tooth was asymptomatic canals were obturated & same day the perforation was sealed with

AODMR

ral Trioxide Aggregate: Report of Three

Nirav Parmar4, Ajaz Goplani1,

student, Department of Conservative Dentistry & Endodontics, Faculty of Dental Science-Professor and Head, Department of Conservative Dentistry & Endodontics, Faculty of Dental Science-

odontics, Faculty of Dental Science-Nadiad, Senior lecturer, Department of Conservative Dentistry & Endodontics, Faculty of Dental Science-Nadiad

tics, Faculty of Dental Science,

The greatest threats to teeth are dental caries and traumatic injuries. The primary goal of all restorative treatment is to maintain vitality of pulp. If pulpal exposure occurs, then vital pulp procedure should be done to preserve pulp vitality. Historically, calcium hydroxide has been the material of choice for vital pulp procedures. As of late, an option material called mineral trioxide total (MTA) has exhibited the

ue development in pulpal tissue. This article portrays the clinical and radiographic result of cases including the utilization of MTA in furcal perforation repair, closure of

one month. On clinical examination a deep carious lesion was found in relation to 46. Radiographic examination reveled extensive

ing pulp and furcal

Figure 1: Radiograph showing furcation involvement in 46

Vitality test showed negative response with both thermal tests and Electric pulp tester. The diagnosis was necrosis of the tooth and involvement of furcal area because of deep carious lesion. On first appointment tooth was isolated with rubber dam. The caries was removed, and Perforation was confirmed clinically with probe. Canals were cleaned and shaped with ProTaper files up to the F1-ProTaper and patient was recalled after three days. On second appointment tooth was asymptomatic canals were obturated & on same day the perforation was sealed with

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61 ARCHIVES OF DENTAL AND MEDICAL RESEARCH

MTA (Angelus, Londrina, Brazil) mixed with sterile saline, as suggested by the manufacturer. The MTA was covered with a cotton pellet moistened with distilled water and Cavit temporary restoration material. After2 days the cavity was sealed with composite restoration.(Figure 2)

Figure 2: Radiograph showing furcation repair with MTA in 46

CASE 2 :- Direct pulp capping with MTAA 26-year-old female patient reported to the department with complains of sensitivitysweet and cold in lower left back side region of jaw. Clinical examination revealed gross occlusal caries on her lower left first molar. Normal response seen with pulp vitality test. Radiographic examination revealed caries near to the distal pulp horn and no evidence ofperiradicular pathology.(Figure 3)

Figure 3: Radiograph showing carious involvement of distal pulp horn in involvement in 36

The diagnosis was made reversible pulpitis. The treatment plan was made Vital pulp therapy with mineral trioxide aggregate. Following administration of local anaesthesia the tooth was isolated with rubber dam. Caries removal was performed using a round burAfter removal of caries, exposure of pulp horns with moderate bleeding was observed. A cotton pellet moistened with saline was applied with pressure to the exposed pulp to achieve hemostasis. After that sodium hypochlorite was used to disinfect the surgiexposure and the dentin. Mineral trioxide aggregate (Angelus, Londrina, Brazil) was

Clinical Applications of Mineral Trioxide Aggregate

ARCHIVES OF DENTAL AND MEDICAL RESEARCH Vol 3 Issue 1

MTA (Angelus, Londrina, Brazil) mixed with sterile saline, as suggested by the manufacturer. The MTA was covered with a cotton pellet moistened with distilled water and Cavit temporary restoration material. After

with composite

Figure 2: Radiograph showing furcation repair with MTA in 46

Direct pulp capping with MTA old female patient reported to the

department with complains of sensitivity to sweet and cold in lower left back side region of jaw. Clinical examination revealed gross occlusal caries on her lower left first molar. Normal response seen with pulp vitality test. Radiographic examination revealed caries near

and no evidence of periradicular pathology.(Figure 3)

Figure 3: Radiograph showing carious involvement of distal

pulp horn in involvement in 36

The diagnosis was made reversible pulpitis. The treatment plan was made Vital pulp therapy with mineral trioxide aggregate. Following administration of local anaesthesia the tooth was isolated with rubber dam. Caries removal was performed using a round bur. After removal of caries, exposure of pulp horns with moderate bleeding was observed. A cotton pellet moistened with saline was applied with pressure to the exposed pulp to achieve hemostasis. After that sodium hypochlorite was used to disinfect the surgical exposure and the dentin. Mineral trioxide aggregate (Angelus, Londrina, Brazil) was

mixed according to the manufacturer’s instructions and placed over the exposure. A moist cotton pellet with saline was placed over the MTA and the rest of the cavity warestored with temporary filling material (Cavit, 3M). The patient was scheduled after 5 days for follow-up and the patient was asymptomatic so composite restplaced over MTA.(Figure

Figure 4: Radiograph showing direct pulp capping with MT36

CASE 3:- NONSURGICAL ROOT CANAL TREATMENT USING MTA AS AN APICAL BARRIER A 36 year old male patient The patient reported to the department of Conservative Dentistry and with the chief complaint of Broken upper anterior teeth. The patient reported that trauma had occurred about 15 years back. The root canal treatment had been started in both upper anteriors before about 2 years but patient failed to continue with further appointments. Clinical examination revealed that Crown fracture in relation toright central incisor with discoloration and access openings with respect to maxillary right central and lateral incisors. Radiographic examination revealed immature right central and lateral incisors with open apices and a radiolucent area in proxapices.(Figure 5)

Figure 5: Radiograph showing immature 11 & 12 with open apices

ral Trioxide Aggregate

mixed according to the manufacturer’s instructions and placed over the exposure. A moist cotton pellet with saline was placed over the MTA and the rest of the cavity was restored with temporary filling material (Cavit, 3M). The patient was scheduled after 5 days

up and the patient was asymptomatic so composite restoration was placed over MTA.(Figure 4)

Figure 4: Radiograph showing direct pulp capping with MTA in

NONSURGICAL ROOT CANAL TREATMENT USING MTA AS AN

A 36 year old male patient The patient reported to the department of Conservative Dentistry and with the chief complaint of Broken upper anterior teeth. The patient

that trauma had occurred about 15 years back. The root canal treatment had been started in both upper anteriors before about 2 years but patient failed to continue with further appointments. Clinical examination revealed that Crown fracture in relation to maxillary right central incisor with discoloration and access openings with respect to maxillary right central and lateral incisors. Radiographic examination revealed immature right central and lateral incisors with open apices and a

proximity of the root

Figure 5: Radiograph showing immature 11 & 12 with open

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62 ARCHIVES OF DENTAL AND MEDICAL RESEARCH

The diagnosis made was of chronic periapical abscess and immature open apex with relation to maxillary right central and lateral incisors. Treatment plan included artificial apical barrier formation using MTA(Angelus, Londrina, Brazil) plug in both maxillary right central and lateral incisors (Figure by obturation using thermoplastisized gutta percha.(Figure 7)

Figure 6: Radiograph showing MTA apical plug in 11 & 12

Figure 7: Radiograph showing obturation using thermoplastisized guttapercha

DISCUSSION MTA was developed by Dr Torabinejad at Loma Linda University in 1993trioxide aggregate consists Tricalcium silicate, Dicalcium silicate, Tricalcium aluminate, Tetracalcium aluminoferrite.6 Radioopacifier Bismuth oxide free crystalline silica that is in the form of insoluble residue.6 MTA are available in market that are grey mineral trioxide aggregate (GMTA) and white mineral trioxide aggregate (WMTA). The white mineral trioxide aggregate lacks the aluminoferrite phase that causes the grey color to grey mineral trioxide aggregatehave shown that mineral trioxide aggregate

Clinical Applications of Mineral Trioxide Aggregate

ARCHIVES OF DENTAL AND MEDICAL RESEARCH Vol 3 Issue 1

The diagnosis made was of chronic periapical abscess and immature open apex with relation to maxillary right central and lateral incisors.

an included artificial apical barrier formation using MTA(Angelus, Londrina, Brazil) plug in both maxillary right entral and lateral incisors (Figure 6) followed

plastisized gutta

showing MTA apical plug in 11 & 12

Radiograph showing obturation using

guttapercha

MTA was developed by Dr Torabinejad at Loma Linda University in 1993.3 Mineral trioxide aggregate consists Tricalcium silicate, Dicalcium silicate, Tricalcium aluminate,

Radioopacifier Bismuth oxide free crystalline silica that is in

Two types of in market that are grey

mineral trioxide aggregate (GMTA) and white mineral trioxide aggregate (WMTA). The white mineral trioxide aggregate lacks the aluminoferrite phase that causes the grey color to grey mineral trioxide aggregate.7 Studies

hat mineral trioxide aggregate

stimulate cytokine release from bone indicating that it useful in promoting hard tissue formation. MTA is advantageous in its ability to effectively seal the tooth material interface to prevent bacterial penetration and to it has good biocompatibilitycalcium hydroxide, which deteriorates over period of time and gradually disintegrates thereby leaving space for potential microleakage. MTA does not appear to change overtime. Therefore, it preserves the protecticover for developing reparative dentin and prevents bacterial invasion of the pulp. To save the vitality of pulp tissue and prevent pathological changes in the periradicular tissues, mechanical and carious pulp exposures without signs of irreversible pusealed7. Furthermore, pathways of communications between the root canal system and the periodontium like iatrogenic perforations should be sealed with restorative materials that prevent bacterial leakage.Schwartz RS, Mauger M, Clement DJ, William A discussed various uses of mineral trioxide aggregate10 like used in both surgical and non-surgical applications including direct pulp capping, root-end fillings, apexification and perforation repairs in roots or in furcations.11,14 Previously mabeen used to seal the communication between root canal system and the surrounding as well as the periradicular tissues. The main disadvantage of these materials are microleakage, varying degrees of toxicity and sensitivity to the presence Recently, MTA has been investigateg as a potential material to seal the pathways of communication between root canal system and the external tooth surfaceused as a pulp capping material, for closure of open apex, repair of root and furcation perforation and as a barrier in treatment of internal bleaching of endodontically treated teeth.13,17

CONCLUSION Mineral trioxide total is new material different energizing potential outcomes for

ral Trioxide Aggregate

stimulate cytokine release from bone indicating that it useful in promoting hard tissue formation. MTA is advantageous in its ability to effectively seal the tooth material interface to prevent bacterial penetration and

has good biocompatibility.8 In contrast to calcium hydroxide, which deteriorates over period of time and gradually disintegrates thereby leaving space for potential microleakage. MTA does not appear to change overtime. Therefore, it preserves the protective cover for developing reparative dentin and prevents bacterial invasion of the pulp. To save the vitality of pulp tissue and prevent pathological changes in the periradicular tissues, mechanical and carious pulp exposures without signs of irreversible pulpitis must be

. Furthermore, pathways of communications between the root canal system and the periodontium like iatrogenic perforations should be sealed with restorative materials that prevent bacterial leakage.9 Schwartz RS, Mauger M, Clement DJ, William A discussed various uses of mineral

like used in both surgical surgical applications including direct

end fillings, apexification and perforation repairs in roots or in

Previously many materials have been used to seal the communication between root canal system and the surrounding as well as the periradicular tissues. The main disadvantage of these materials are microleakage, varying degrees of toxicity and

of moisture.12,15

Recently, MTA has been investigateg as a potential material to seal the pathways of communication between root canal system and the external tooth surface.16 MTA has been used as a pulp capping material, for closure of open apex, repair of root and furcation perforation and as a barrier in treatment of internal bleaching of endodontically treated

Mineral trioxide total is new material that has different energizing potential outcomes for

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pulpal therapy. Certainly mineral trioxide aggregate can not be utilize to spare each tooth with pulpal involvement, however it is very useful and advance pulp medicament to add to a clinician armamentarium. So MTA is an ideal material with predictable sealability, good biocompatibility and increased moisture sensitivity. REFERENCES 1. Camilleri J, Pitt Ford TR. Mineral trioxide aggregate: a review of the constituentsand biological properties of the material. Int Endod J 2006;39:747-54. 2. Roberts HW, Toth JM, Berzins DW, Charlton DG. Mineral trioxide aggregate material use in endodontic treatment: a review of the literature. Dent Mater 2008;24:149-64. 3. Monisha R, Manish R. MTA as A Revolution in Endodontics-A Review. IOSR Journal of Dental and Medical Sciences 2013;9(2):18-21. 4. Nekoofar MH, Oloomi K, Sheykhrezae MS, Tabor R, Stone DF. An evaluation of the effect of blood and human serum on the surface microhardness and surface microstructure of MTA. International Endodontic Journal 2010;43:849-57. 5. Badr AE. Marginal adaptation and cytotoxicity of bone cement compared with amalgam and MTA as root-end filling materials. Journal of Endod 2010;36(6):1056-60. 6. Torabinejad M, Chivian N. Clinical applications of mineral trioxide aggregate. J Endod 1999;25(3):197-205. 7. Hegde R, Battepati PM. Clinical Applications of Mineral Trioxide Aggregate: Report of Four Cases. Int J Clin Pediatr Dent 2010;3(1):43-50. 8. Kettering JD, Torabinejad M. Microbiology and immunology. In: Cohen S, Burns RC, editors. Pathways of the pulp. 6th ed. St. Louis, MO: Mosby; 1999. pp. 363–376. 9. Torabinejad M, Hong CU, McDonald F, Pitt Ford TR. Physical and chemical properties of a new root-end filling material. J Endod 1995;21(7):349–53.

10. Schwartz RS, Mauger M, Clement DJ, William A 3rd. Mineral trioxide aggregate: a new material for endodontics. J Am Dent Assoc 1999;130(7):967-75. 11. Islam I, Chng HK, Yap AU. Comparison of the physical and mechanical properties of MTA and portland cement. J Endod 2006;32(3):193-7. 12. Ribeiro DA, Sugui MM, Matsumoto MA, Duarte MA, Marques ME, Salvadori DM. Genotoxicity and cytotoxicity of mineral trioxide aggregate and regular and white Portland cements on Chinese hamster ovary (CHO) cells in vitro. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101(2):258-61. 13. Castellucci A. The use of mineral trioxide aggregate in clinical and surgical endodontics. Dent Today 2003;22(3):74-81. 14. Mineral Trioxide Aggregate: A Comprehensive Literature Review—Part III: Clinical Applications, Drawbacks, and Mechanism of Action. Masoud Parirokh, DMD, MS,* and Mahmoud Torabinejad, DMD, MSD, PhD. j.joen.2009.09.009. 15. Shah D, Manwar NU, Chandak M, Pattanaik N. Repair of Furcal Perforation with Mineral Trioxide Aggregate: Case Report. IOSR Journal of Dental and Medical Sciences 2013;9(4):66-9. 16. Muhamad A, Abdulgani A, Abdulgani M, Ayah J. Open Apex with Mineral Trioxide Aggregate- Case Report. IOSR Journal of Dental and Medical Sciences 2016;15 (10):81-7. 17. Vats A, Vats AS. Direct Pulp Capping With MTA - A Case Report. National Journal of Medical and Dental Research 2014;2(2):74-80.

How to cite this article: Patel G, Choksi D, Idnani B, Parmar N, Goplani A, Patel S. Clinical Applications of Mineral Trioxide Aggregate: Report of Three Cases. Arch of Dent and Med Res 2017;3(1):60-3.