MTA in Apexification of Non-vital Young Permanent Incisors in Children

Friday, 15 February 2008 14:01

It has been shown that approximately 20–30% of 12-year old children have suffered dental injuries . Although trauma may not directly affect the pulp, it may still result in a loss of vitality . If this occurs at a young age, when the root development is incomplete, the clinician faces a difficult case of an immature permanent tooth with thin dentine walls and a wide, open apex in need of endodontic treatment.

For many years the treatment of choice in these cases has been the apexification technique using calcium hydroxide which is known to induce the formation of a hard tissue barrier in the apex , allowing for the obturation of the root canal to be completed. However, the apexification procedure may take many months and require multiple visits, making patient compliance a problem. It may also further weaken the teeth by the repetition of endodontic procedures during the replacement of the intracanal dressing and the prognosis may be compromised by the placement of a temporary coronal seal . To eliminate the disadvantages of the apexification technique, many alternative approaches have been suggested aiming mainly at developing a one-step procedure for the completion of the endodontic treatment. Some of these alternatives showed potential but were abandoned because of limitations in the availability of materials, while others proved to be unacceptable because of the lack of biocompatibility of the materials.

Recently, a new material has been developed for endodontics that appears to be a significant improvement over other materials used against bone.This material is mineral trioxide aggregate (MTA), which is a powder that consists of fine hydrophylic particles and sets in the presence of moisture in less than 4 h. MTA has been found to have impressive physical and chemical properties , and is also shown to have a high degree of biocompatibility.

Reaserchers from Leeds Dental Institute ,England conducted a pilot study to evaluate the clinical efficacy of mineral trioxide aggregate (MTA) as an apexification material when used in non-vital immature permanent incisors in children.Fifteen children with a mean age of 11.7 years and 17 non-vital permanent incisors were ajudged suitable for inclusion. Standard endodontic procedures were followed and an apical plug of 3–4 mm was created by using MTA after a calcium hydroxide intracanal dressing had been applied for at least 1 week. Final obturation was completed by using thermoplastisized Gutta–Percha (Obtura II) at least 1 week following MTA placement. Subjects were reviewed clinically and radiographically at 3-month intervals. Mean follow-up time for MTA was 12.53 months (±2.94 SD). Of the total of 17 teeth treated, MTA placement was considered to be adequate in 13 teeth. The procedure showed clinical success in 94.1% of the cases, radiographic success was found to be 76.5% and in further three cases (17.6%) the outcome was considered to be uncertain. This is one of the very few studies that have reported the out coming of MTA as an apexification material in children with non-vital teeth and incomplete root development. However, larger clinical studies are required to evaluate the long-term success of this procedure.

Source: Dental Traumatology Volume 24 Issue 1 Page 79-85, February 2008