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REPARING CEMENT

The treatment for accidents and


endodontic complications

Radicular
Reabsorption
Apexification

Direct Pulp
Protection
Pulpotomy

Furcation
Perforation

Root
Perforation

Apexigenesis
(Vital Root)

RetroObturation

MTA- Angelus
1. DESCRIPTION
MTA-Angelus is an endodontic cement composed of several mineral oxides. It is indicated specially for root
lateral trepanations treatment and furcation, internal re-absorptions, pareodontics surgeries, retro
obturation, direct pulp protection, pulpotomy in incomplete root development teeth.

1.1. Main Advantages:

MTA-Angelus presents great advantages relating to amalgam and cements


based on zinc oxide and eugenol:

1.

Excellent marginal sealer which avoids bacterial migration and tissue fluids penetration to the interior
of the radicular canal;

2.

Radicular perforations biological enclosing and furcation enclosing through induction of peri-radicular
cement formation;

3.

Induction of dental barrier formation used upon the pulp;

4.

Utilization in locals with presence of relative humidity, without lost of its properties. Different of other
materials which demand an operatory field completely dry, normally difficult to get, principally in
cases like pareodontics surgeries and retro-obturation.

2. USAGE TECHNIQUE
To prepare medium size portion: one measure of MTA-Angelus powder + 01 drop of distilled
water.

a- Put one measure of powder and one drop of distilled water upon a sterilized glass plate;
b- Spatulate both for 30 seconds until the perfect homogeneity of the components. The
cement got must have a sandy consistency, similar to amalgam, but more humid;
c- Insert the spatulated cement in the place desired, using a sterilized amalgam-place or
another professional instrument of your preference;
d- Condensate the material inside the dental cavity.

3. INDICATIONS AND TECHNICAL SURGERIES


3.1. RADICULAR CANAL PERFORATIONS OR FURCATION
a. Anesthesia, isolating;
b. Irrigation of the perforation area with sodium hypochlorite;
c. Instrumentation, irrigation and obturation of the canal apex portion until the perforation
area (Fig 01);

d. MTA-Angelus preparing, application into the perforation and


condensation of the material with condensing equipments or with sterile
cotton balls;
(Fig. 02)

e. Obturation of the remnant of the radicular canal; (Fig.

03)

f. Immediate radiographic control and after 3 to 6 months, in two


years (at least).

3.2. RADICULAR PERFORATIONS TREATMENT BY INTERNAL RE-ABSORPTION


(by means of canal)
First section

Second section

a anesthesia, isolating;

a Calcium hydroxide removal with sodium


hypochlorite;
b Obturation of the canal apex portion;

b access to the canal and to the internal reabsorption area; (Fig. 01)
c irrigation with sodium hypochlorite;
d pulp and granulation tissue removal;
e curative application of calcium hydroxide
paste [Ca(OH)2 + distilled water}. (Fig. 02)

c MTA-Angelus preparation and fulfilling


the re-absorption local using condensing
equipments or sterile cotton balls; (fig.03)
d Immediate radiographic control and after
3 to 6 months for 2 years, at least.

3.3. Radicular Perforation Treatment (by


means of surgery)
The surgical procedure is indicated for the cases
which a perforation realized by means were
unsuccessful.
Operational Technique
a- Patch rising for localizing the perforation area;

(Fig.01)

b- Preparing of the perforation with burs in order


to facilitate the material condensing process;

(Fig. 02)

c- Control of the hemorrhage area;


d- MTA-Angelus preparation and
application inside the dental cavity utilizing
condensing equipments; (Fig.03)
e- Material excess removal (do not irrigate
it);
f- Suture process and immediate
radiographic control;
g- Immediate Radiographic control and also
after 3 to 6 months for at least 02 years.

3.4. PAREODONTIC SURGERIES WITH RETRO-OBTURATOR MATERIAL


Indicated for cases in which conventional endodontic treatment has failed or in cases of an
impediment to the radicular canal by coronary means.
Operational Technique
a- Patch separation, ostectomy and
radicular apex exposure.; (Fig. 01)

b- Radicular Resection
from 2 to 3mm around the
apex; (Fig.02)
c- Class I retro-cavity
preparation;
d- Local humidity control;

e- MTA-Angelus preparation and application with an amalgam carrier and special


apex condensing equipments; (Fig.03)
f- Material excess removal (do not irrigate it);
g- Hemorrhage induction
from the periodontal junction
and osseous tissue for the
obturation exposure of the
MTA-Angelus to the blood,
aiming the hardening
induction, which might
happen in the presence of
humidity;
h- Suture process and
immediate radiographic
control;
i- Radiographic Control after
3 to 6 months for at least 02
years.

3.5. DIRECT PULP


PROTECTION
MTA-Angelus application upon the
DPP pulp aims treatment of the pulp
which was exposed by means of burs,
caries or fractures.
a- Anesthesia;
b- Caries removal;
c- Antisepsis of the cavity using
sodium hypochlorite;
d- MTA-Angelus preparation;
e- Recovering of the local exposed
area utilizing MTA-Angelus;
f Material covering and provisional
restoration;
g- Post-surgical control to verify the
pulp vitality.

3.6. PULPOTOMY AND


APEXIGENESIS*
The surgical technique sequence is to
be followed for both of the cases
a- Anesthesia, absolute isolation;
b- Access to the pulp chamber, pulp
coronary removal and physiological
serum irrigation;

(Fig.
01)
*Apexigenesis:
: induction of the end
of the root development portion inside
vital teeth with a swollen coronary
pulp.

c- Bleeding control;
d- MTA-Angelus
preparation and cement
insertion upon the pulp
utilizing a sterilized
amalgam carrier; (Fig. 02)

e- Adaptation of the
material applied utilizing a
moisturized cotton ball;
f- Protection of the material
utilizing a sterilized cotton
ball upon it;
g Provisionary
Restoration (Fig. 03)

h- Clinical control in
accordance with the symptoms
and radiographic control from
3 to 3 months up to the end of
the root development;
i- After radicular formation is
finished, either a conventional
endodontic treatment or a
coronary cavity restoration
can be done. (Fig. 04)

3.7. APEXIFICATION*
First Section:
a- Anesthesia, complete
isolation;
b- Access to the pulp
chamber, radicular canal
odontometry and
biomechanics, utilizing
sodium hypochlorite for the
irrigation process; (Fig. 01)
* Inducing the development of
the apex region hard tissue
barrier on permanent young
teeth utilizing incomplete
developed roots with a necrotic
pulp.

c- Insertion of Calcium
Hydroxide paste
utilizing distilled water
as an intra-radicular
curative for a week.
(Fig. 02)

Second Section:
a- Sodium Hypochlorite irrigation
to eliminate the Calcium
Hydroxide paste;
b- Dry it with absorbent paper
drying;
c- MTA-Angelus preparation;
d- Canal cement filling,
condensating it up to the apex
region, utilizing paper points or
apex condensing, forming an apex
tampon of 3 to 4mm; (Fig. 03)

e- Immediate radiography
control to verify the correct
canal filling procedure;
f- Moisturized cotton ball
placement upon the canal
outlet;
(Fig. 04)

g- Tooth restoration using a


provisionary material for 24
hours.
Third section:
a- Provisionary restoration and
cotton balls removal;
b- Remnant radicular canal
obturation, utilizing gutta-percha
and conventional endodontic
cement; (Fig. 05)

*( TIP ) Important: A
reinforcement on the canal walls
are recommended if they happen
to be too thin, utilizing composite
resins for the canal filling;

c- Permanent
restoration;
d- Radiographic
clinical control after 3
to 6 months until the
development of a hard
tissue barrier on the
apical region. (Fig. 06)

4. COMPOSITION:
SiO2 ,K20, Al2O3, Na2O, Fe2O3, SO3, CaO, Bi2O3,MgO and unsolved residues (crystalline silica,
calcium oxide and potassium sulfate and sodium).

5. IMPORTANT PROPERTIES
5.1. Chemic-Physic Property
In contact with water it becomes a little colloidal gum which solidify itself, forming a rigid structure in an
interval of 10 minutes.

5.2. Hydrogeneization Potential (pH)


Its PH is highly alkaline (12,0) avoids the bacterial growth, keeping its anti bacterial potential for a long
period.

5.3. Radio-opacity
The MTA-Angelus radio-opacity is superior than the dentines and bone tissue, and near to the guta
perchas, facilitating its visualization in operatory radiographic control and preservation.

5.4. HARDENING TIME


The MTA-Angelus hardening time occurs in 10 minutes.
Its not necessary to wait for its hardening to continue the following procedures.
One of the important MTA-Angelus characteristic is getting better results in humid
places.
In case of long procedures, the manipulated cement in the plate can harden,
becoming difficult its utilization. For these situations, it is recommended to
protect the cement with humid gauze.

5.5. COMPRESSION RESISTANCE


The compression resistance after 28 days is of 44,2 MPa.
Its resistance is under very acceptable values, considering that it wont have direct occlusal load
in the applied areas.

5.6. SOLUBILITY
It doesnt present significant signals of solubility in contact with humidity, guaranteeing a
excellent marginal closing.

5.7. SEALING POWER AND BACTERIAL MICRO-INFILTRATION


The MTA-Angelus sealing power was tested through in vitro technique for evaluation of
the coloring infiltration quantity in the dentine interface - MTA-Angelus. The result was
a little grade of coloring infiltration. So, we conclude that the material presents a high
sealing power, getting difficult the bacterial infiltration, once the bacterias have bigger
dimensions than the coloring molecules.

5.8. EXTRAVASATING
The presence of material outside de operatory cavity during the procedures of
radicular perforation obturation, overcoming the periodontal linking, will result into
an inflammation and traumatic lesion, consequently, delaying in the scar process.
5.9. RESISTANCE TO THE MOVEMENT
MTA-Angelus has a good adherence capacity in the dentine walls becoming, by this
reason, resistant to dislocation forces. It may also be indicated to furcation
perforations. In this case it must be covered with a intermedium restoration material,
before the final restoration material.

Dear Dentist Surgeon


The information referring to the product are based on clinical and scientific
works. However, clinical success is subjected to a correct diagnostic, to a careful
operatory technique, to local conditions of the treated tooth, as well as to the
patients systemic situation.