Fig. 1

Pre op xray shows root resorption and necrosis with an apical lesion. Diastema and tooth discoloration represented additional problems to manage.

Procedural sequence:

  1. access cavity
  2. Disinfection protocol
  3. Resorbable matrix placed beyond the apex
  4. MTA apical plug
Fig. 2

A 4 mm thick MTA apical plug was placed.

Taking an intra operative X-ray is suggested for an ideal control of the material.

Fig. 3

In the following appointment guttapercha back filling and direct composite restoration were made by Dr Stefano Bertoni. The second x ray shows the healing after 6 months.

Fig. 4

Direct composite restoration (curtesy of Dr S. Bertoni)


Sometimes the most complicated clinical cases can be managed in an easy and conservative way. MTA is sometimes considered as obsolete, but clinical practice instead demonstrates the opposite. Absence of discoloration, high apical sealing ability and long term stability are the main benefits of this material.


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Torabinejad M, Chivian N. Clinical application of mineral trioxide aggregate; J Endod 1999;25:197-205.

Koh ET, McDonald F, Pitt Ford TR, Torabinejad M. Cellular response to Mineral Trioxide aggregate. J Endod 1998;24:543 ^ 7.

Torabinejad M, Smith PW, KatteringJD, Pitt FordTR. Comparative investigation of marginal adaptation of MineralTrioxide Aggregate and other commonly used root-end filling materials. J Endod 1995;21:295^9.