PRESENTED BY;

P. FAZILRAM
CRI
INTRODUCTION
 Mineral trioxide aggregate apical plug method is
alternative for calcium hydroxide to avoid weakened
tooth root, root canal reinfection,and long treatment
time
MINERAL TRIOXIDE AGGREGATE
 MTA is a bioactive material
 Hard tissue conductive
 Hard tissue inductive
 Biocompatible
 COMPOSITION:
Fine hydrophilic particles of tricalcium silicate
Silicate oxide
Tricalcium oxide
SETTING REACTION:
MTA +STERILE WATER =COLLOIDAL GEL
SETTING TIME:
3-4 hours in the presence of moisture
CASE REPORT
 CHIEF COMPLAINT:
Patient complaints of pus drainage and
mild swelling in upper anterior tooth region.
PAST MEDICAL HISTORY:
No relevent history
PAST DENTAL HISTORY:
Patient gave a history of fall 4 years back
with orofacial trauma to permanent maxillary left
incisor(21).
 CLINICAL EXAMINATION:
Labial sinus tract seen in upper left incisor region
accompanied by swelling
No tender on percussion
Vitality test –negative
INVESTIGATION:
IOPA 21 reveals immature tooth with a wide
open apex and a radiolucent area in the apical region
of the maxillary left incisor
 DIAGNOSIS :
Chronic irreversible pulpitis with pulp necrosis.
TREATMENT PLAN:
Advised endodontic treatment (MTA APICAL
PLUG METHOD)
TREATMENT PROCEDURE
 1) Rubber dam application
 2)Access cavity preparation
 3)Approximate working length was established with
both radiographic method and the apex locator
 4)The root canal was gently cleaned using Hedstroem
files under irrigation with 3% sodium hypochloride
 5)Then the canal was dried with sterile paper points
and metapex
 6)After 2 weeks,the metapex was removed by repeated
rinsing with 3%NaOCl followed by rinsing with sterile
water.
 7)Small portion of MTA was deposited in apical region ,
1mm short of the working length using proRoot MTA
delivery gun
 8)Then MTA was gently condensed with an endodontic
plugger.
 9)A wet cotton pellet with sterile water was then placed in
the pulp chamber , and access cavity was closed with
temporary filling material
 10)After a week , the temporary filling material and cotton
 11)The rest of canal was obturated with thermoplastic
gutta-purcha technique.
 12)The tooth was later coronally sealed with composite
resin.
The clinical follow up at 6 months and 1 year revealed an
adequate clinical function,an absence of cliical
symptoms , and the absence of the labial sinus tract.
 FOLLOW- UP:
 6 MONTHS – decrease in size of the periapical
lesion
 12 MONTHS-complete resolution of the periapical
radiolucency with evidence of regeneration of the
periradicular tissue and apical barrier formation at the
end of the root.
DISCUSSION
 Calcium hydroxidde had a high success rate when used
for apexification treatment in several studies.
 It creates an environment conductive to the formation
of an apical barrier formed by osteocementum tissue
at the end of the root canal in teeth with open apices.
 However, there are some disadvantages of this
material.
 One of them is that the treatment requires a very long
time which is from 6 to 18 months.
 During this period of time, root canal may get
reinfected by the leakage of the temporary coronal
restoration.
 The success rate decreases by 10% in the teeth with
poor coronal seal.
 Hence, performing a permanent treatment is better to
avoid reinfection of the root canal.
 Furthermore, there is possibility of fracture of the
weakened teeth.
 After leaving calcium hydroxide in the root for more
than 30 days, the fracture resistance reduces.
 MTA has less leakage, better antibacterial properties,
high marginal adaptation, short setting time, a pH of
12.5 and is more biocompatible.
 From a practical point of view, MTA can be used in the
presence of moisture in the root canal.
 The application of MTA mixture should be preceded
by a temporary calcium hydroxide dressing to limit
bacterial infection in the tooth.
 The present case confirms that MTA acts an apical
barrier can be considered to be a very effective
material to support regeneration of apical tissue and to
promote apical obturation in traumatized, infected
immature teeth wih open apices.
 Both clinical and radiographic follow-ups showed
optimal healing of the apical periodontitis and new
hard tissue formation in the apical area of the
traumatized incisor.
CONCLUSION
 Thus it can concluded that MTA plug offers the
advantage of high predictability of apical closure,
along with shorter treatment time and less
dependence on the patient compliance.
REFERENCE:
Journal of Indian Society of Pedodontics and
Preventive Dentistry. 2017, vol:35, Issue:4