MTA apexification in a traumatic lesion: a case report

Introduction: Mineral trioxide aggregate is a recently introduced dental material. It may be used to seal perforations, make retrograde fillings in root-end resections, seal open apices or cap vital pulps. Studies have suggested that MTA provides a better seal than formerly used materials such as IRM, amalgam, and Super-EBA. Further, MTA has low cytotoxicity and excellent biocompatibility. In vivo studies demonstrated a beneficial effect of MTA on pulpal and periodontal regeneration. Although controlled randomized clinical trials are still missing, MTA appears to be a suitable material to tightly seal dental hard tissues from the periodontium. Case report: A case of severe crown fracture and luxation in the upper permanent incisors of a 6-year-old boy is reported. The boy presented an extrusive luxation and enamel fracture of 2.1, a lateral luxation of 1.1. The teeth was repositioned and fixed with a termoplastic resin device for two weeks. Eighteen months later a discromy appeared and the vitality tests showed that necrosis of 1.1 and 2.1 occurred. The teeth was treated with calcium hydroxide, but as there was no apical stop after 2 years of treatment, it was decided to use a new root-end filling material: mineral trioxide aggregate (MTA). Endodontic treatment was performed and MTA was used as filling material. The boy has been followed for four years with clinical and radiographic examinations every six months during the first two years and then every years. At follow-up 4 years later the tooth was asymptomatic and radiographically showed the repair of the apex and absence of radiolucent apical lesion. Conclusion: This case report demonstrates the placement of an apical barrier using MTA as an alternative to conventional calcium hydroxide therapy. One negative aspect of the apexification with calcium hydroxide is that the treatment can take a very long time and complications can then appear. Many authors has already demonstrated that MTA has very good root sealing abilities, so it can be correctly used as a root-end filling material. Nevertheless, more long-term follow-up studies in humans are necessary to confirm these conclusions. References 1.Torabinejad M, Chivian N. Clinical applications of mineral trioxide aggregate. J Endod 1999;3: 197–205. 2.Giuliani V, Baccetti T, Pace R, Pagavino G. The use of MTA in teeth with necrotic pulps and open apices.Dent Traumatol. 2002 Aug;18(4):217-21 3.Joffe E. Use of mineral trioxide aggregate (MTA) in root repairs. Clinical cases. N Y State Dent J. 2002 Jun-Jul;68(6):34-6. 4.Hayashi M, Shimizu A, Ebisu S MTA for obturation of mandibular central incisors with open apices: case report. J Endod. 2004 Feb;30(2):120-2.