MTA apical plug in second lower molar
In case of large foramen the traditional techniques with gutta-percha and cement are less efficient in term of sealing , for this reason the use of different techniques are nowadays the gold standard when we have to face resorbed apexes , zipped apexes or big foramen
Female 63 yrs old , the patient has been referred to the office for a problem on distal root in second lower molar , the patient has pain during the chewing and radiographically is evident an overfilling due to a wrong obturation technique .
Two different operative options , endodontic surgery or non surgical retreatment , but in this case we preferred the retreatment option for the unfavorable anatomy and the difficulty in the surgical access even in presence of materials beyond the apex .
In the CBCT the anatomy situation is clear , it’s possible to see the relationships between the apex and the mandibular nerve as well as the materials over the apex.
CBCT cross sections
Green Arrows show the overextended material in two different CBCT views
We removed the big screw post thanks to the a special screw driver and after that all the cement using ultrasonic tips , in the previous treatment the colleague used thermafil technique and part of the core is out of the apex .
After the disassembling we can see the cement in the canal and the plastic core that occlude the space
When the disassembling has been completed , the canal shaped and cleaned , we positioned a collagen matrix beyond the foramen to obtain a better control during the apical plug .
MAP SYSTEM , MTA and PLANO
the cement must be mixed correctly with the right powder liquid ratio
MTA mixed and ready to use
The MAP-ONE bring the MTA in the apical one third
Using the MAP-ONE it’s easy to bring the MTA in the apical one third , subsequently the material is pushed and adapted gently to the foramen, using a paper point .
Post-op xray , the plug is perfectly positioned , no overfilling and the obturation is tridimensional
With MAP system it's possible to obtain a MTA block, 5 mm leght ideal to do apical plug
To obtain a perfect adaptation of the cement in the apical one third is necessary bring the right amount of material in the apex and at the right level , that’s why the use of MAP-ONE is mandatory
Torabinejad M, Parirokh M, Dummer PMH. Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview - part II: other clinical applications and complications. Int Endod J. 2018 Mar;51(3):284-317.
Parirokh M, Torabinejad M, Dummer PMH. Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview - part I: vital pulp therapy. Int Endod J. 2018 Feb;51(2):177-205.