Endodontic treatment with MTA apical plugs: a case report

Apexification with calcium hydroxide is associated with certain difficulties, such as the very long treatment time required, the possibility of tooth fracture, and incomplete calcification of the bridge. Use of an apical plug is an alternative treatment for open apices, and this has gained popularity in recent years, employing mineral trioxide aggregate (MTA) for optimal results. Here we report the successful treatment of two maxillary central incisors that had open apices and periapical lesions using MTA apical plugs after the root canals had been debrided and rinsed with 2.5% NaOCl. Calcium hydroxide paste was then placed in the canals for 1 week, before the apical portion of the canals (5 mm) was filled with the MTA plug. The remaining portion of the root canal was then sealed with a post and crown. After 6 months of follow-up, the clinical and radiographic appearance of the teeth showed a decrease of the periapical lesions. At 2 years, although the left post had been lost and the periapical lesion of the left central incisor had subsequently deteriorated, the right central incisor had healed successfully. Considering the importance of a coronal seal, the use of MTA for apical plugging appears to be a valid option.     

Endodontic management of immature teeth with spontaneous apical closure and periapical lesions: case series and review of the literature

Spontaneous apical closure in non‐vital immature teeth has been rarely encountered and outcome of non‐surgical endodontic treatment of related teeth associated with periapical lesions has not yet been adequately elucidated. The aim of this article was to report endodontic management of spontaneous apical closure of infected untreated immature teeth with periapical lesions and to review previously proposed mechanisms for the development of spontaneous hard tissue barrier. Three patients were referred at different time intervals to the endodontic clinic for treatment of their maxillary anterior incisors with acute or chronic apical periodontitis . Dental histories indicated that related teeth had been subjected to trauma approximately 12–18 years previously. Radiographically, the involved teeth exhibited incomplete root formation with spontaneous apical closure and were associated with an apical radiolucency. After biomechanical preparation, calcium hydroxide paste was applied and was changed once or twice within 3 months. All canals were then filled with gutta‐percha and AH Plus and the follow‐up period was 16–50 months; both clinical and radiographic examinations revealed adequate function, the absence of clinical symptoms and significant healing of the periapical radiolucency.     

根尖大面积病变手术治疗的临床疗效观察

目的评估根尖手术治疗大面积根尖病变患牙的疗效。方法选择存在大面积根尖病变的59例患者（59处根尖病变,91颗患牙）为研究对象,根尖病变范围6~21 mm,在根管治疗后进行根尖手术。术后1、3、6、9、12、24个月复诊,对患牙及根尖病变进行临床及影像学评估,综合二者结果进行疗效评估,并对可能影响其术后疗效的各种因素进行统计学分析。结果59例患者中52例（88.1%）被评估为成功,6例（10.2%）被评估为失败,1例（1.7%）被评估为有效。老年组患者的成功率（63.6%）明显比青年组（87.5%）和中青年组（95.0%）低,具有统计学差异（P=0.037,P=0.017）;磨牙的成功率（75.0%）比前牙（92.6%）和前磨牙（90.0%）均低,具有统计学差异（P=0.041,P=0.047）;性别、根尖病变侵及牙齿数量、根尖病变范围等因素对成功率的影响未见统计学差异（P>0.05）。结论对于存在大面积根尖病变的患牙,根管治疗后配合根尖手术治疗是一项可选择的治疗方式。     

MTA根尖屏障术治疗年轻恒牙根尖周炎的临床疗效及满意度评价

目的:比较MTA根尖屏障术和Vitapex根尖诱导成形术对年轻恒牙根尖周炎的临床疗效,并进行患者满意度评价.方法:将75例年轻恒牙根尖周炎患者随机分为对照组(n=37)和实验组(n=38),对照组患者行Vitapex根尖诱导成形术,实验组患者行MTA根尖屏障术,比较2组患者在3、6、9个月及1年复查时的临床疗效,以及接受治疗的平均次数和平均周期,并对2组患者在就医环境、医护服务、后期保健指导、治疗费用、治疗周期及治疗效果等6个方面进行满意度评价.采用SPSS19.0软件包对2组患者的临床疗效、治疗次数和周期以及满意度等指标进行统计学分析.结果:在3个月和6个月复查时,实验组的临床疗效优于对照组,但组间差异不显著(P＞0.05);在9个月和1年复查时,实验组的总有效率显著高于对照组(78.38％:94.74％,P=0.037;75.68％:97.37％,P=0.006).实验组的治疗次数和治疗周期均显著低于对照组(P均＜0.05),分别为(3.24±0.39)次、(0.68±0.23)个月和(7.78±0.65)次、(8.24±2.95)个月.2组患者对就医环境、医护服务、后期保健指导及治疗周期的满意率无显著差异(P＞0.05),但在治疗费用和治疗效果2个调查项目上,实验组患者的满意率显著高于对照组(P均＜0.05).结论:MTA根尖屏障术较使用Vitapex根尖诱导成形术临床疗效更优、治疗次数更少、治疗周期更短、患者满意度更高,适合在临床上推广应用.     

Inadvertent MTA extrusion in an immature traumatized permanent incisor

This report describes the 24-month clinical and radiographic outcome of an unintentionally extruded mineral trioxide aggregate (MTA) apical plug. A 9 year old boy presented with a previously traumatized, immature central incisor; associated with a large periradicular lesion. During placement of MTA in the treatment of wide open apex, the material was inadvertently extruded into the periapical region upon a sudden movement of the child. No intervention was made, except for obturation of the remaining root canal two weeks later. The radiographic follow up at 12 and 24 months confirmed successful management through the non surgical approach, as evidenced by advanced healing of the periapical lesion and regeneration of the periradicular tissue in the absence of clinical symptoms.     

Periodontal healing in teeth with periapical lesions

Abstract The purpose of the present investigation was to compare clinical periodontal healing in periodontally involved teeth with and without pulpal pathosis. The investigation was conducted as a retrospective study on a consecutive referral population. The periapical conditions in endodontically involved single-rooted teeth from a selected patient sample were evaluated and correlated with their periodontal healing pattern. Multiple regression analysis of the registered variables showed that initial mean pocket depth and time elapsed after treatment significantly influenced change in pocket-depth. Non-surgical treatment of periodontal pockets exceeding 2.5 mm in teeth with horizontal marginal defects, over the observation period, showed significantly reduced mean pocket depth reduction in teeth with periapical pathology compared to teeth without periapical pathology. It was, furthermore, evident that proximal restorations, abutments for fixed bridges and root fillings with and without dowels did not significantly influence pocket depth reduction in the present material. It was concluded, based on the present results, that a root-canal infection, evident as a periapical radiolucency, if left untreated may in the long term perspective result in retarded or impaired periodontal healing following periodontal therapy and, consequently, should be given appropriate consideration when coordinating endodontic therapy and periodontal treatment.     

Endodontic treatment of teeth associated with a large periapical lesion

AIM: To report the healing of a large periapical lesion following non-surgical root canal treatment. SUMMARY: A 12-year-old male with a large periapical lesion around the apices of his mandibular incisors is described. The lesion formed after trauma to the mandibular anterior teeth 5 years previously. During root canal treatment, chlorhexidine gluconate was used for irrigation, and calcium hydroxide was used both for the intracanal dressing and as a base of the root canal sealer. Periapical healing was observed 3 months after obturation and continued at the 12-month review. Key learning points Root canal treatment, including the use of chlorhexidine gluconate and calcium hydroxide for infection control, led to substantial healing of a large periapical lesion. This report confirms that large periapical lesions can respond favourably to non-surgical treatment.     

Scanning electron microscopy of bacteria in the apical part of root canals in permanent teeth with periapical lesions

Abstract The most apical 2 mm of the root canals of periapically diseased roots were examined for microorganisms by scanning electron microscopy (SEM). Bacteria in this area were observed in 10 out of 12 (83.3%) cases. The two remaining cases exhibited bacteria more coronally, with tissue remnants between the bacterial front and the apical foramen. Rod-shaped bacteria dominated, but filaments, spirochetes and cocci were also seen. Cocci and rods sometimes formed micro-colonies. Occasionally, cocci were seen attached to filaments forming “corn-cob”-like structures. Deposits resembling bacterial plaque were also found inside the root canal. SEM is useful for studying microbial topography of the apical root canal.     

MTA应用于显微根尖手术治疗慢性根尖周炎的效果观察

目的 观察三氧化矿物凝聚体(mineral trioxide aggregate,MTA)应用于显微根尖手术治疗慢性根尖周炎的效果.方法 无法行常规根管再治疗的慢性根尖周炎患者64例91颗患牙,随机分为观察组和对照组.观察组患者32例48颗,行显微根尖手术,应用MTA进行倒充填治疗.对照组患者32例43颗,行传统外科根尖手术联合银汞合金充填治疗.术后每隔3个月定期复诊,随访12个月,通过临床和X线检查评估根尖周病损愈合情况,进行疗效判定.结果 观察组痊愈27颗,改善17颗,成功率91.67%(44/48);对照组痊愈19颗,改善12颗,成功率72.09%(31/43).观察组治疗成功率明显高于对照组(x2=5.997,P=0.014).结论 MTA应用于显微根尖手术治疗慢性根尖周炎效果满意.     

Revascularization of immature permanent teeth with apical periodontitis

The aim of this minireview was to identify and review the scientific evidence regarding regenerative endodontic protocols claiming to revascularize permanent immature teeth with apical periodontitis. The literature was identified using the PubMed/MEDLINE, Scopus, Scirus, EMBASE and Cochrane databases up to February 2013. Studies were selected independently by two different researchers (kappa index: 0.88), based on established inclusion/exclusion criteria. The methodological quality of the reviewed papers was classified as high, medium or low (HQ, MQ, LQ). The search strategy identified 285 titles. Nine studies, both human and animal based, were selected after application of the criteria (LQ:5; MQ:4). In most of these studies (seven of nine), the revascularization protocol included a triple antibiotic combination as canal disinfectant for a period of 1–4 weeks after blood clot formation (LQ:5; MQ:4), although there is no clear consensus about the treatment protocol. Two studies reported tooth discoloration after the revascularization process (LQ:2), and only three (LQ:1; MQ:2) reported a success rate of 54.9% in dogs and 73.6% and 80% in humans, respectively. Revascularization of immature permanent teeth with apical periodontitis is possible and preferable to apexification. Nevertheless, there is a widespread lack of randomized clinical trials and blinded measures. In addition, the small sample sizes that are common in these studies as well as the generally low quality of the analysed publications require the results to be viewed with caution. There is a high risk of bias, with a low quality of available information, for developing clinical guidelines for regenerative endodontic protocols; rigorous randomized clinical trials are therefore needed.     

Scanning electron microscopy of bacteria in the apical part of root canals in permanent teeth with periapical lesions.

The most apical 2 mm of the root canals of periapically diseased roots were examined for microorganisms by scanning electron microscopy (SEM). Bacteria in this area were observed in 10 out of 12 (83.3%) cases. The two remaining cases exhibited bacteria more coronally, with tissue remnants between the bacterial front and the apical foramen. Rod-shaped bacteria dominated, but filaments, spirochetes and cocci were also seen. Cocci and rods sometimes formed micro-colonies. Occasionally, cocci were seen attached to filaments forming "corn-cob"-like structures. Deposits resembling bacterial plaque were also found inside the root canal. SEM is useful for studying microbial topography of the apical root canal.     

Treatment of extraoral sinus tracts from traumatized teeth with apical periodontitis

Abstract When a draining lesion is encountered on the skin of the face, an endodontic origin should always be considered in differential diagnosis. Non-surgical endodontic therapy, sometimes complimented by surgery, or extraction are the choices for the treatment of these cases. Three cases of extraoral sinus tract on the chin caused by necrotic pulp of traumatized lowrer anterior teeth are presented. A paste consisting of calcium hydroxide and barium sulfate powder mixed with glycerin was used. Usage of calcium hydroxide paste was advocated for rapid and successful treatment of extraoral lesions communicating with necrotic teeth.     

Regenerative treatment of an immature, traumatized tooth with apical periodontitis: report of a case

This case report describes the treatment of a necrotic immature permanent central incisor with complete crown fracture, suspected root fracture, and sinus tract, which was not treated with conventional apexification techniques. Instead, a regenerative approach based on the trauma literature's methods for revascularization was provided. The root canal was gently debrided of necrotic tissue with a sharp spoon excavator and irrigated for only one third of its length with NaOCl and then medicated with calcium hydroxide. After 15 days the sinus tract had healed, and the tooth was asymptomatic. The tooth was accessed, calcium hydroxide was removed, bleeding was stimulated to form an intracanal blood clot, and mineral trioxide aggregate was placed coronally to the blood clot. After 8 months, a coronal calcified barrier was radiographically evident and accompanied with progressive thickening of the root wall and apical closure. Two and a half years after treatment was initiated, the tooth remained asymptomatic, and the sinus tract had not reappeared. The progressive increase in the thickness of the dentinal walls and subsequent apical development suggest that appropriate biologic responses can occur with this type of treatment of the necrotic immature permanent tooth with sinus tract.     

年轻恒前牙感染根管内血管再生的动物实验研究

目的通过建立根尖周炎模型观察年轻恒前牙根管内血管再生的组织学状况。方法选择4个半月龄杂种犬1只,建立上颌未发育完成的恒前牙根尖周炎模型,将6颗上颌恒前牙随机分组,对照组3颗采用根尖诱导成形术,实验组3颗采用根管内血管再生术。将术后1、4、8周的X线片分别与术前X线片进行对比,观察牙根继续发育及根尖炎症的愈合情况。术后8周处死动物,利用苏木精-伊红（HE）染色观察根尖闭合情况及根管内容物的构成。结果X线观察,术后1、4周,2组牙根的根尖孔大小及根尖透射区范围未见明显改变。术后8周,实验组根尖透射区范围缩窄较明显,并出现根尖孔缩窄的趋势,但管壁厚度无明显变化;而对照组根尖透射区变化不一。组织学检查,实验组管腔内可见肉芽组织,其中包含有大量的不规则的类牙本质、类牙骨质和类骨质样钙化物,钙化物以根尖部和管腔内侧壁尤为明显。对照组管腔未见软组织,根尖部有少量的硬组织沉积。结论血管再生术可促使年轻无髓恒前牙的慢性根尖周炎症消退,根管内再生的肉芽组织中有硬组织沉积。     

Pulp revascularization of immature dog teeth with apical periodontitis

This study examined the ability of a collagen solution to aid revascularization of necrotic-infected root canals in immature dog teeth. Sixty immature teeth from 6 dogs were infected, disinfected, and randomized into experimental groups: 1: no further treatment; 2: blood in canal; 3: collagen solution in canal, 4: collagen solution + blood, and 5: negative controls (left for natural development). Uncorrected chi-square analysis of radiographic results showed no statistical differences (p >or= 0.05) between experimental groups regarding healing of radiolucencies but a borderline statistical difference (p = 0.058) for group 1 versus group 4 for radicular thickening. Group 2 showed significantly more apical closure than group 1 (p = 0.03) and a borderline statistical difference (p = 0.051) for group 3 versus group 1. Uncorrected chi-square analysis revealed that there were no statistical differences between experimental groups for histological results. However, some roots in each of groups 1 to 4 (previously infected) showed positive histologic outcomes (thickened walls in 43.9%, apical closure in 54.9%, and new luminal tissue in 29.3%). Revascularization of disinfected immature dog root canal systems is possible.     

血管再生治疗犬年轻恒牙根尖周炎的实验研究

目的：比较血管再生和根尖诱导成形术治疗犬年轻恒牙根尖周炎的效果。方法：选用3只5-6个月犬的30颗双根前磨牙,建立根尖周炎模型,三联抗生素糊剂消毒后,随机分为三组,即血管再生组、根尖诱导组和空白对照组。于术后4周、8周、12周分别拍摄X线片,比较根尖愈合情况。术后12周处死动物,常规制作组织切片,观察管腔内再生组织的成分以及根尖硬组织形成情况。结果：①X线观察：三组均可看到根尖闭合影像,两实验组的根尖闭合率优于对照组（P〈0．05）,实验组之间差异无统计学意义（P〉0．05）。②组织形态学观察：血管再生组和对照组有类似于牙骨质样组织（管内牙骨质）从根尖孔向内延伸,在管壁沉积,管腔内出现骨样组织（管内骨组织）,共同促使牙根伸长和管壁增厚,且血管再生组的两种组织发生率优于对照组（P〈0．05）,根尖诱导组未见此两种组织。结论：血管再生在管壁增厚和牙根伸长等方面优于根尖诱导成形术。