A Prospective Clinical Study of Mineral Trioxide Aggregate for Partial Pulpotomy in Cariously Exposed Permanent TeethKefah Mahmood Barrieshi-Nusair, BDS, MS andMuawia Abdulla Qudeimat, BDS, MDent, Sci, FRCD(C) JOE — Volume 32, Number 8, August 2006

Abstract: The aim of this study was to evaluate the success of using gray mineral trioxide aggregate (MTA) for partial pulpotomy in cariously exposed young permanent first molars. Thirty-one first permanent molars of 23 patients with a carious exposure were treated using a partial pulpotomy technique. The age of the patients ranged from 7.2 to 13.1 yr with an average of 10 yr. Clinical and radiographic examination revealed a pulpal response within normal limits and normal appearance of the periradicular area respectively. A diagnosis of reversible pulpitis and normal periapex was established. After isolation, caries removal and carious exposure, the exposed pulp tissue was removed with a diamond bur to a depth of 2 to 4 mm. After hemostasis, 2 to 4 mm of

gray MTA paste was placed against the fresh wound. The floor of the cavity was covered with a base of glass ionomer. The teeth were restored with amalgam or stainless steel crowns. Teeth were reviewed radiographically and clinically at 3, 6, 12, and 24 month intervals. Twenty-two of the treated teeth did not show any clinical or radiographic signs of failure during the follow-up evaluation period. Six teeth did not respond to vitality testing at the final follow-up period; however, no radiographic signs of failure or clinical symptoms were detected. Gray MTA was a suitable dressing agent for parital pulpotomy in cariously exposed young first permanent molars.

http://youtu.be/VUfRt8GNhKA

To know that we know what we know, and that we do not know what we do not know, that is true knowledge.

Henry DavidThoreau

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Abstract: This in vitro study evaluated the seal created by varying depths of mineral trioxide aggregate (MTA) plugs placed in an orthograde fashion in five groups of 10teeth. One group received a 2 mm thick orthograde apical plug of MTA, the second group a 5 mm apical MTA plug, and the third group a 2 mm apical MTA plug with a second 2 mm increment, 24 h later. The remaining portion of the canal in these groups was left unfilled. Group four received a 2 mmMTA plug that set for 24 h and the canal was then back-filled with guttapercha and eugenol based sealer. Group five was a positive control without an MTA plug. The apical seal was tested using a bacterial leakage model of Actinomyces viscosus. Results showed a statistically significant difference in only the 5 mm apical plug, which completely prevented bacterial leakage. (page 3 figure)

Abstract: The purpose of this study was to evaluate whether intracoronal delivery of an apical barrier of mineral trioxide aggregate (MTA) placed ultrasonically, non-ultrasonically, or ultrasonically with the addition of an intracanal composite resin provided a better seal against bacterial leakage. A second purpose was to determine whether intracanal composite resin or gutta-percha and sealer placed against an apical barrier of MTA provided greater resistance to root fracture.In a standardized in vitro open apex model, MTA was placed as an apical barrier at a thickness of 4 mm, with and without ultrasonic vibration.The barriers were challenged with bacteria exposure within a leakage model, and fracture resistance was assessed with increasing forces applied via an Instron machine. After 45 days, the addition of ultrasonicssignificantly improved the MTA seal, compared with the non-ultrasonics treatment (Kruskal Wallis non-

parametric ANOVA with Dunn multiple comparison test p < 0.05). Bacterial leakage occurred in 6 (33%) of 18 in the non-ultrasonic MTA group, 2 (11%) of 18 in the ultrasonic MTA group, and 1 (6%) of 18 in the ultrasonic MTA-composite group. There were no significant differences at 90 days. A 4-mm thickness of MTA followed with an intracanal composite resin demonstrated a significantly greater resistance to root fracture than MTA followed with gutta-percha and sealer (one-way ANOVA with Newman-Keuls multiple comparison test, p < 0.01). The MTA–gutta-percha group was not significantly different than the MTA unrestored positive control.http://youtu.be/Q0LmbvAIKHE

Abstract This study evaluated the histo-morphologic response of human dental pulps capped with mineral trioxide aggregate (MTA) and Ca(OH)2 cement (CH). Pulp exposureswere performed on the occlusal floor of 40 human permanent premolars. After that, the pulp was capped either with CH or MTA and restored with composite resin. After 30 and 60 days, teeth were extracted and processed for histologic exam and categorized in a histologic score system. The data were subjected to Kruskal-Wallis and Conover tests ( .05). All groupsperformed well in terms of hard tissue bridge formation, inflammatory response, and other pulpal findings. However, a lower response of CH30 was observed for the dentin bridge formation, when compared with MTA30 and MTA60 groups. Although the pulp healing with calcium hydroxide was slower than that of MTA,both materials were successful for pulp capping in human teeth.

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In-Vitro Evaluation of Microleakage of an Orthograde Apical Plug of Mineral Trioxide Aggregate in Permanent Teeth with Simulated Immature ApicesAhmed Al-Kahtani, BDS, MS, Sandra Shostad, DMD, MS, Robert Schifferle, DDS, PhD, andSatish Bhambhani, BDS, DDS, MS JOE — Volume 31, Number 2, February 2005

Evaluation of Ultrasonically Placed MTA and Fracture Resistance with Intracanal Composite Resin in a Model of ApexificationG.Robert Lawley, DDS, William G.Schindler, DDS, MS, William A.Walker III, DDS, MS and David Kolodrubetz, PhDJOE - Volume 30, Number 2, March 2004

Evaluation of Mineral Trioxide Aggregate and Calcium Hydroxide Cement as Pulp-capping Agents in Human TeethMaria de Lourdes R. Accorinte, DDS, MS, PhD, Roberto Holland, DDS, MS, PhD, Alessandra Reis, DDS, PhD, Marcelo C. Bortoluzzi, DDS, PhD, Sueli S. Murata, DDS, MS, PhD, Eloy Dezan, Jr, DDS, MS, PhD, Valdir Souza, DDS, MS, PhD, and Loguercio Dourado Alessandro, PhDJOE Volume 34, Number 1, January 2008

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Abstract: Pulp necrosis in immature teeth subsequent to caries has a major impact on long-term tooth retention. The aim of vital pulp therapy is to maintain pulp viability by eliminating bacteria from the dentin-pulp complex and to establish an environment in which apexogenesis canoccur. A complicating factor in treating immature teeth is the difficulty predicting the degree of pulpal damage. The ability of the clinician to manage the health of the remaining pulpal tissue during the procedure is paramount. Currently, the best method appears to be the ability to control pulpal hemorrhage by using sodium hypochlorite. Mineral trioxide aggregate (MTA) currently is the optimum material for use in vital pulp therapy. Compared with the traditional material of calcium hydroxide, it has superior long-term sealing ability and stimulates a higher quality and greater amount of reparative dentin. In the medium-term clinical assessment, it has demonstrated a high success rate. Thus, MTA is a good substitute for calcium hydroxide in vital pulp procedures.

Abstract: The purpose of this retrospective study was to evaluate the clinical outcomes of ProRoot mineral trioxide aggregate used as an artificial apical barrier in teeth with immature apices. Twenty teeth from 19 patients were included in this study. A healed diagnosis was based on periapical index scores of 1 or 2 and no clinical signs or symptoms at recall examinations. Eighty-five percent (17/20) of these teeth were healed, and improvements in periapical index scores at recall appointments were shown to be statistically significant (P .001, Wilcoxon signed-rank test). Chi-square test indicated that age, gender, primary treatment versus retreatment, presence of preoperative lesion, and differences in recall times did not significantly influence healing outcome. Overall, these results indicated that the mineral trioxide aggregate apical barrier technique is a successful method for obturating teeth with immature apices.

http://youtu.be/D8FeuGcKcpo

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Directions and Treatment Perspectives—Permanent TeethDavid E. Witherspoon, BDS, MSJOE — Volume 34, Number 7S, July 2008

Clinical Outcomes of Artificial Root-end Barriers with Mineral Trioxide Aggregate in Teeth with Immature ApicesDavid T. Holden, DMD, Scott A. Schwartz, DDS, Timothy C. Kirkpatrick, DDS, and William G. Schindler, DDS, MSJOE—Volume 34, Number 7, July 2008

Results showed a statistically significant difference in only the 5 mm apical plug, which completely prevented bacterial leakage.

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Abstract: This study is a retrospective analysis of the outcome of initial nonsurgical root canal treatment of teeth with open apices, obturated with mineral trioxide aggregate when no apical barrier existed. One hundred sixteen patients from a single private endodontic office were treated between 1999 and 2006. Treatments on 144 teeth were completed either in one (92/144) or two visits with an interim calcium hydroxide interappointment medication (52/144). Fifty-four percent (78/144) of the teeth were available for recall (60.3% one visit and 39.7% two visits). The maximum time to recall was 4.87 years. The mean time to recall was 19.4 months. Of the cases recalled for period of 1 year or longer, 93.5% of teeth treated in 1 visit healed, and 90.5% of teeth treated in 2 visits healed.

AbstractIntroduction: Teeth with open apical foramina present a challenge during root canal treatment, and little is known about the clinical outcome of treatment in such teeth. This retrospective study assessed healing of teeth with open apices managed by the placement of

mineral trioxide aggregate apical plugs. Methods: Seventy-two patients with 78 teeth with apical resorption or excessive apical enlargement, treated between 2000 and 2006, were contacted for follow-up examination 12 to 68 months after treatment (median 30.9 months). Treatments were provided by supervised undergraduate students (27%), general dentists (32%), or dentists who had focused on endodontics (41%). The outcome based on clinical and radiographic criteria was assessed by calibrated examiners and dichotomized as ‘‘healed’’ or ‘‘disease.’’ Results: Of 56 teeth examined (72% recall), 84% were healed. Teeth without or with preoperativeperiapical radiolucency had a healed rate of100% and 78%, respectively. None of the variables analyzed had a significant effect on the outcome. Conclusion: The results supported the management of open apical foramina with mineral trioxide aggregate apical plugs.

AbstractIntroduction: Several case reports on endodontic regeneration involving immature permanent teeth have recently been published. These case series have used varying treatments to achieve endodontic regeneration including triple antibiotic paste, Ca(OH)2, and

formocresol. However, no study has analyzed the overall results. Methods: In this retrospective study, we collected radiographs from 54 published and unpublished endo-dontic regenerative cases and 40 control cases (20 apexification and 20 nonsurgical root canal treatments) and used a geometrical imaging program, NIH ImageJ with TurboReg plug-in, to minimize potential differences in angulations between the preoperative

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Mineral Trioxide AggregateDavid E. Witherspoon, BDSc, MS, Joel C. Small, DDS, John D. Regan, BDS, MS and Martha Nunn, DDS, PhD JOE — Volume 34, Number 10, October 2008

Mineral Trioxide Aggregate Apical Plugs in Teeth with Open Apical Foramina: A Retrospective Analysis of Treatment OutcomeJohannes Mente, DMD, Nathalie Hage, Thorsten Pfefferle, DMD, Martin Jean Koch, MD, DMD, PhD, Jens Dreyhaupt, DSc, Hans Joerg Staehle, MD, DMD, PhD and Shimon Friedman, DMD JOE — Volume 35, Number 10, October 2009

A Retrospective Evaluation of Radiographic Outcomes in Immature Teeth With Necrotic Root Canal Systems Treated With Regenerative Endodontic ProceduresRaison Bose, DDS, Pirkka Nummikoski, DDS, MS and Kenneth Hargreaves, DDS, PhD JOE — Volume 35, Number 10, October 2009

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and recall images and to calculate continued development of root length and dentin wall thickness. Results: The comparison to the 2 control groups provided a validation test for this method. Forty-eight of the 54 regenerativecases (89%) had radiographs of sufficientlysimilar orientation to permit analysis. The resultsshowed regenerative endodontic treatment with triple antibiotic paste (P < .001) and Ca(OH)2 (P < .001) produced significantly greater increases in root length than either the MTA apexification or NSRCT control groups. The triple antibiotic paste produced significantly greater differences in root wall thickness than either the Ca(OH)2 or formocresol groups (P < .05 for both). The position of Ca(OH)2 also influenced the outcome. When Ca(OH)2 was radiographically restricted to the coronal half of the root canal system, it produced better results than when it was placed beyond the coronal half. Conclusions: Ca(OH)2 and triple antibiotic paste when used as an intracanal medicament in immature necrotic teeth can help promote further development of the pulp dentin complex. (see images below)

Occurrence of Cervical Invasive Root Resorption in First and Second Molar Teeth of Orthodontic Patients Eight Years after Bracket RemovalRaison Bose, DDS, Pirkka Nummikoski, DDS, MS and Kenneth Hargreaves, DDS, PhD JOE — Volume 35, Number 10, October 2009

(A) Preoperative radiograph of tooth #20 with an open apex and a diagnosis of pulpal necrosis with apical periodontitis (6). (B) Recall radiograph at 10 months. Notice change in the angulations between (A) and (B). (C) Preoperative radio-graph after image correction with the TurboReg plug-in application of NIHImage J. (D) Recall radiograph used as the source image to define the modeling function used on the pre-operative (target) image. Note the final degree of parallelismof tooth #20 between the modified pre-operative and recall radiographs.

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Introduction: The occurrence and potential orthodontic causes of cervical invasive root resorption (CIRR) are unknown. We aimed to identify the occurrence of CIRR in molar teeth of orthodontic patients treated with fixed appliances. Methods: All patients invited for final orthodontic recall between November 2009 and March 2011 were included. From 175 patients, 108 (46 men/ 62 women; mean age, 25+/- 5 years; mean time after bracket removal, 8 +/- 2 years) were available. The first and second molar teeth (N = 858) of these patients were investigated for clinical and radiographic signs of CIRR. Patients identified with such signs were asked to have limited-volume cone-beam computed tomography scans performed. Results: No clinical signs of CIRR were detected. CIRR could not be ruled out on bite-wing radiographs in 18 patients. CIRR was thus identified in 1 patient in whom a second maxillary molar was affected. All first molars had been extracted in this patient, and the second molars had been moved mesially over a long distance. The 3 other second molars showed surface resorption. Conclusions: CIRR in molar teeth of orthodontic patients have a low mid-term occurrence (0.9%; 95% confidence interval, 0.2%–5.2%). Long movement distances and/or long treatment duration may be related to the development of these lesions.