Use of Mineral Trioxide Aggregate in the Treatment of Horizontal Root Fractures with a 5-Year Follow-up: Report of a Case

Differences in Healing of a Horizontal Root Fracture as Seen on Conventional Periapical Radiography and Cone-Beam Computed Tomography

Different locations and healing patterns of horizontal root fractures bear different prognoses. Conventional periapical radiographs have been routinely used for the evaluation of the locations and healing of horizontal root fractures, with the limitation of presenting two-dimensional images. The three-dimensional imaging technology, cone-beam computed tomography (CBCT), has recently gained interest in dental traumatology, in particular for locating and diagnosing root fractures. However, the assessment of healing patterns of horizontal root fracture using CBCT compared to conventional radiographs has not been established. This case report describes the different healing patterns evaluated by two-dimensional radiographs and CBCT of a horizontally root-fractured maxillary right central incisor treated with mineral trioxide aggregate (MTA) with a two-year follow-up. The findings suggest that the healing patterns of horizontal root fractures seen on conventional radiographs and CBCT may be different.

Healing of Horizontal Intra-alveolar Root Fractures after Endodontic Treatment with Mineral Trioxide Aggregate

INTRODUCTION

The purpose of this retrospective study was to evaluate the healing type and assess the outcome of horizontal intra-alveolar root fractures after endodontic treatment with mineral trioxide aggregate (MTA) as filling material.

METHODS

The clinical database of the Department of Conservative Dentistry at Yonsei University Dental Hospital, Seoul, Korea, was searched for patients with histories of intra-alveolar root fractures and endodontic treatments with MTA between October 2005 and September 2014. Radiographic healing at the fracture line was evaluated independently by 2 examiners and was classified into 4 types according to Andreasen and Hjørting-Hansen.

RESULTS

Of the 22 root-fractured teeth that received endodontic treatment with MTA, 19 cases participated in the follow-up after a period of at least 3 months. Seventeen of the 19 teeth (89.5%) exhibited healing of the root fractures. For each healing type, 7 teeth (36.8%) showed healing with calcified tissue, 8 teeth (42.1%) showed interposition of connective tissue, 2 teeth (10.5%) showed interposition of connective tissue and bone, and 2 teeth (10.5%) showed interposition of granulation tissue without healing.

CONCLUSIONS

Within the limitations of this study, intra-alveolar root fractures showed satisfactory healing outcomes after endodontic treatment with MTA. MTA could be considered to be suitable filling material for the endodontic treatment of horizontal intra-alveolar root fractures.

Multidisciplinary approach for the treatment of horizontal root-fractured maxillary anterior teeth

Dental trauma can lead to a wide range of injuries of which crown and root fractures are examples. Crown-root fractures often need complex treatment planning. This case report describes the use of MTA in the multidisciplinary management of a patient with a horizontally fractured central incisor and luxation in a different central incisor. A 42-year-old female patient presented within 1 h of receiving direct trauma to her maxillary area. Clinical examination revealed that the right and left maxillary central incisors presented mobility and sensitivity to percussion and palpation but no sensitivity to thermal stimulations. Occlusal displacement with extrusion in the left maxillary central incisor and luxation in the right maxillary central incisor was observed. Radiographic examination revealed horizontal root fracture at the apical third of the left maxillary central incisor. Root fracture in the right maxillary incisor was not observed. Endodontic and aesthetic restorative treatments were completed. MTA showed a good long-term outcome when used in root-fractured and luxated teeth. In addition, composite resin restoration provided satisfactory aesthetic results even after 15 months.

Effect of dentin bonding agent on the prevention of tooth discoloration produced by mineral trioxide aggregate

Objective. Determination of the effect of dentin bonding agent (DBA) on the prevention of tooth discoloration produced by mineral trioxide aggregate (MTA). Methods. 50 teeth were endodontically treated and after removal of 3 mm of obturating materials were divided into five groups. In white MTA (WMTA) and grey MTA (GMTA) groups, these materials were placed in root canal below the orifice. In DBA + WMTA and DBA + GMTA groups, DBAs were applied in the access cavity. Then, 3 mm of WMTA and GMTA was placed. The last 10 teeth served as control. All of teeth were restored and color measurement was recorded for each specimen at this time and 6 months later. Results. The mean tooth discoloration in WMTA and GMTA groups was significantly more than DBA + WMTA and DBA + GMTA groups, respectively. There was no significant difference between DBA + WMTA and DBA + GMTA groups and control group. Conclusion. Application of DBA before MTA may prevent tooth discoloration.

Will mineral trioxide aggregate replace calcium hydroxide in treating pulpal and periodontal healing complications subsequent to dental trauma? A review

Mineral trioxide aggregate (MTA) has over the last two decades begun to take the place of calcium hydroxide (CH) in the treatment of a variety of pulpal and periodontal healing complications following dental trauma. These conditions include teeth with: (i) exposed pulps, (ii) immature roots and pulp necrosis, (iii) root fractures and pulp necrosis located in the coronal part of the pulps, and (iv) external infection-related (inflammatory) root resorption. The main reasons for replacing CH with MTA in these situations have generally been the delayed effect when using CH to induce hard tissues, the quality of such induced hard tissues, and finally the dentin weakening effect of CH, which in some instances lead to cervical root fractures in immature teeth. MTA appears, from a relatively few clinical studies, to overcome these shortcomings of CH. The lack of long-term clinical studies, however, may warrant a certain reservation in an unrestricted replacement of CH with MTA. A definite need for randomized clinical studies comparing CH and MTA in trauma healing situations is urgently needed.

"MTA"-an Hydraulic Silicate Cement: review update and setting reaction

OBJECTIVES

To review the current status and understanding of Portland cement-like endodontic materials commonly referred to by the trade designation "MTA" (alias "Mineral Trioxide Aggregate"), and to present an outline setting reaction scheme, hitherto unattempted.

METHOD

The literature was searched using on-line tools, overlapping an earlier substantial review to pick up any omissions, including that in respect of ordinary Portland cement (OPC), with which MTA shares much. The search was conducted for the period January 2005 to December 2009 using 'MTA', 'GMTA', 'WMTA', and 'mineral AND trioxide AND aggregate' as keywords, with various on-line search engines including ScienceDirect (http://www.sciencedirect.com), SAGE Journals Online (http://online.sagepub.com), Wiley Online Library (http://onlinelibrary.wiley.com), SciELO Scientific electronic library online (http://www.scielo.br/scielo.php), JSTOR (http://www.jstor.org), and Scopus (http://www.scopus.com). References of articles found were cross-checked where appropriate for missed publications. Manufacturers' and related websites were searched with Google Search (http://www.google.com.hk).

RESULTS

A generic name for this class of materials, Hydraulic Silicate Cement (HSC), is proposed, and an outline reaction scheme has been deduced. HSC has distinct advantages apparent, including sealing, sterilizing, mineralizing, dentinogenic and osteogenic capacities, which research continues to demonstrate. However, ad hoc modifications have little supporting justification.

SIGNIFICANCE

While HSC has a definite place in dentistry, with few of the drawbacks associated with other materials, some improvements in handling and other properties are highly desirable, as are studies of the mechanisms of the several beneficial physiological effects. Reference to the extensive, but complex, literature on OPC may provide the necessary insight.

An evaluation of the effect of blood and human serum on the surface microhardness and surface microstructure of mineral trioxide aggregate

AIM

Short-term and long-term evaluation of the effect of whole human blood or serum contamination on the surface microhardness value and microstructure of white and grey mineral trioxide aggregate (MTA).

METHODOLOGY

Three groups of 10 samples for each type of MTA were prepared. The first group was mixed with and exposed to fresh whole human blood. The second and third groups were mixed with distilled water and exposed to fresh whole human blood or human serum, respectively. The control group samples were mixed with and exposed to distilled water. During preparation, 1 g of MTA was triturated with 0.33 g of the selected liquid using an amalgamator and placed inside borosilicate cylindrical moulds. The samples were treated with ultrasonic energy. Vickers surface microhardness values were compared after 4 and 180 days. Scanning electron microscopy (SEM) analysis was performed after 4 days.

RESULTS

White MTA had a greater microhardness value than grey MTA in all groups. There was a significant difference between the control and the experimental groups (P < 0.00001). There was no significant difference between the microhardness values obtained after 4 and 180 days, apart from grey MTA mixed with blood or exposed to serum (P < 0.00001). SEM analysis showed the contaminated samples were devoid of acicular crystals that were prominent in the control groups.

CONCLUSION

Blood contamination had a detrimental effect on the surface microhardness of MTA in the short and long term. If blood or serum contamination is unavoidable under clinical conditions, it might be preferable to use white MTA.

Treatment of horizontal root fractures using a triple antibiotic paste and mineral trioxide aggregate: a case report

This case report describes the treatment of a horizontal root fracture in a maxillary central incisor (tooth #8) using a triple antibiotic paste and mineral trioxide aggregate. A nonsurgical endodontic treatment was performed to a coronal root canal fragment of tooth #8. During the treatment procedure, 1% sodium hypochlorite solution was used for irrigation and a triple antibiotic paste was used as an intracanal medicament. The coronal part of the canal was obturated with mineral trioxide aggregate totally. At follow-up examination after 12 months, the tooth was asymptomatic and radiographically showed repair of the fracture region. Healing was achieved without any need for further interventions.

Effect of acid-etching procedure on selected physical properties of mineral trioxide aggregate

AIM

To evaluate the effect of acid-etch procedures on the compressive strength and surface microhardness of tooth-coloured mineral trioxide aggregate (MTA).

METHODOLOGY

White ProRoot MTA (Dentsply Tulsa Dental) was mixed and packed into cylindrical tubes of 4 mm in diameter and 6 mm in height. Three groups, each of 15 specimens were subjected to an acid-etch procedure either 4, 24 or 96 h after mixing. The compressive strength was measured and compared with unetched control groups. Differences between groups were analysed using the Kruskall-Wallis test. A further batch of cylindrical specimens of 6 mm in diameter and 12 mm in height were prepared for testing surface microhardness. Three groups of 15 specimens were subjected to the acid-etch procedure at either 4, 24 or 96 h following mixing. Data were subjected to one-way anova. Changes in the surface microstructure before and after the acid-etch procedures were analysed using a scanning electron microscope (SEM).

RESULTS

There was a general trend for the compressive strength and surface microhardness of specimens to increase with time. In terms of compressive strength, the increase was significant between 4 h and the other time periods for both experimental and control groups (P < 0.0001); however, there was no significant difference between 24 and 96 h. The increase in surface microhardness was significant between 4, 24 and 96 h (P < 0.0001). In addition, there was a significant difference between experimental and control groups at all time periods (P < 0.0001). SEM examination revealed morphological differences between the intact and the etched MTA surfaces.

CONCLUSIONS

Acid-etch procedures affected the compressive strength and surface microhardness of ProRoot MTA. This indicates that it may be better to postpone restorative procedures for at least 96 h after mixing MTA. Etching created surface changes that might have the potential to enhance bonding of resinous materials.