Two- to four-year follow-up analysis of three different pulpally involved high degree of difficulty cases managed with endodontic treatments using Mineral Trioxide Aggregate / Шинэ санаа Шинэ нээлт

ABSTRACT

@#Mineral Trioxide Aggregate (MTA) is a biocompatible, antibacterial, radiopaque, and dimensionally stable material after setting. Furthermore, it can set in the presence of moisture, and has a high sealing ability. The objectives of this study were to describe managements of three different exceptionally complicated endodontics cases using MTA, and to evaluate its outcomes of using MTA in long-term follow-up based on modern concept of endodontics. Case #1 A 23-year-old patient diagnosed with combined endodontic-periodontal lesion with palatogingival groove of maxillary right lateral incisor was referred to our department. A treatment of interdisciplinary approach involving root canal treatment, periodontal initial therapy, root resection, guided tissue regeneration and bone grafting was performed. The case showed complete clinical normalcy and radiographic healing on periapical radiograph after 3-year follow-up, and outcome was defined as healed. Case #2 A 33-year-old patient had a perforated resorptive lesion to mesial external root surface of tooth 21. The diagnosis was perforating internal root resorption with pulp necrosis and asymptomatic apical periodontitis. A treatment plan of revascularization with MTA coronal plug was made. The case #2 showed clinical normalcy, complete healing of alveolar bone and incomplete healing of resorptive area radiolucency on CBCT after 4-year follow-up, and outcomes were defined as healing. Case #3 An 18-year-old patient with pulp necrosis and chronic apical abscess at immature left maxillary lateral incisor with open apex received treatment of apexification with MTA and followed-up regularly. The case showed complete clinical normalcy and radiographic healing on periapical radiograph, but incomplete healing of the periapical lesion was observed on CBCT after 4-year follow-up. This outcome was defined as healing. 1. MTA may be a suitable material for use as a plug material that prevents infection and blood flow to the main root canal during periodontal surgery, perforation repair and internal root resorption filling and root canal obturation of apexification treatment. 2. Extruded MTA through the apical foramen may not have an adverse effect to periapical tissues, also could be result in osseous healing. Moreover, extruded MTA might have a property to resorb. 3. Tooth discoloration could be a potential drawback of white MTA when it is used as endodontic repair material and the discoloration tends to continuously develop for a while.