MTA apical plug
MTA has several desirable properties that makes it an excellent choice for apical plug formation .
Firstly , biocompatibility to the surrounding tissues . This is crucial for achieving successful healing .
Secondly , MTA has sealing capability when properly placed and condensed , it creates a tight seal , prevent the ingress of bacteria and contamination of the root canal system .
Moreover MTA has a bioactive nature . It can stimulate the deposition of mineralised tissue , aiding in the regeneration of the periapical area and formation of apical barrier.
MTA has been shown to be a very effective root filling material for sealing immature root canals with open apices that could otherwise impose technical challenges in obtaining adequate obturation .
MTA has ability to facilitate periradicular healing by inducing hard tissue formation. But in some cases with wide open apices , adequate condensation of MTA is difficult to achieve as the material may get extruded beyond the apex . Therefore an apical matrix is used for the controlled placement of MTA to a desired level . Various biocompatible materials have been tried as apical matrix .
Therefore , present case reports highlight the nonsurgical retreatment of upper central incisor with open apex and large periapical radiolucencies using collagen sponge , acts as a scaffold to prevent MTA extrusion .
A 42 year male patient reported with chief complaint of a discoloured right central incisor . History revealed that the tooth previously root canal treated before 8 years .
Radiographic examination revealed an apical resorption and wide open apex with large radiolucent area in proximity of the apex of the tooth .
Isolation with rubber dam and access opening was done under local anaesthesia .
During gutta percha removal one of the accessory gutta percha was extruded beyond the apex .
The canal was cleaned and over extruded gutta percha removed.
By curving H file at the end (like small hook ) , then going beyond the apex and slightly rotated to catch the extruded gutta percha.
Periapical radiograph was taken to determine the working length .the root canal was lightly cleaned with hand file under irrigation with 5.25% NaOCl . The root canal was then dried with sterile paper points . Calcium hydroxide was placed in the root canal , and the patient was recalled after two weeks.
Two week later , the tooth was again isolated under rubber dam , the calcium hydroxide was removed by hand instrumentation , and irrigation was done with 5.25% NaOCl and EDTA17% , the root canal was dried with paper points.
Collagen sponge used to act as artificial barrier , then MTA placed in the canal by MAP one then condensed by large pepper point .
The remains part of the canal was filled by injectable gutta percha .
A 8 months follow-up revealed healing and bone formation .
The major problem in cases of a wide open apex is the need to limit the material , thus avoiding the extrusion of a large amount of material into the periodontal tissue .
Using a matrix avoids the extrusion of the material into the periodontal tissues , reduces leakage in the sealing material and allows favorable response of the periodontal tissues .
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