Aim. To compare microleakage of apexification using MTA in one or two sessions. Materials and Methods. 88 single rooted teeth were prepared and divided into two groups then received MTA apical plug. In the first group, the teeth were immersed in normal saline for 24 hours and then backfilled with guttapercha and AH26 sealer. In the second group, the teeth were obturated immediately after receiving apical plug. Four positive and four negative controls were selected. All specimens were placed in 1% methylene blue and decalcified in 5% nitric acid and finally were placed in methyl salicylate until getting transparent. All teeth were visualized for assessment of dye penetration under stereo dissecting microscope. Results. 36 and 35 teeth showed dye leakage in the first and second groups. Dye penetration into the entire canal length was confirmed in the positive control group, and in the negative control group no dye penetration was seen. Mean dye penetration in the first and second group was 5813 and 9152？μm. -test revealed a significant difference between dye penetrations of two groups ( ). Conclusion. MTA requires adequate time for setting in the presence of the moisture, and final obturation should be delayed until final setting of MTA. 1. Introduction The presence of vital pulp is essential for root development. Therefore, when the pulp is reversibly inflamed it is crucial to maintain pulp vitality [1]. Caries and traumas are the main cause of pulp necrosis. If these occur prior to root maturation, the root development would be halted, and it can lead to an open apex tooth [2]. One of the main treatment methods of nonvital open apex teeth is apexification [3]. For many years calcium hydroxide (CaOH) has been the first choice of an intra canal dressing in apexification [4]; however, some drawbacks like coronal micro-leakage, tooth susceptibility to fracture [5], and multisession treatments [2, 6, 7] made clinicians look for an appropriate alternative for CaOH. It has been suggested that MTA plugs are more convenient and efficient compared to traditional CaOH [8]. MTA is used in different clinical cases in dentistry including direct pulp cap, internal resorption treatment, perforation management, and root canal filling [3]. Also MTA is used for pulpotomy in primary dentition [9–11]. One of the most interesting aspects of pulp-capping studies is utilizing this material for pulp treatment. It has been shown that MTA stimulates natural dentin repair at pulpal exposure sites during direct pulp cap [9]. It was declared that MTA can prevent the micro-leakage
References
[1]
M. L. de Leimburg, A. Angeretti, P. Ceruti, M. Lendini, D. Pasqualini, and E. Berutti, “MTA obturation of pulpless teeth with open apices: bacterial leakage as detected by polymerase chain reaction assay,” Journal of Endodontics, vol. 30, no. 12, pp. 883–886, 2004.
[2]
F. J. Harty, B. J. Parkins, and A. M. Wengraf, “Success rate in root canal therapy. A retrospective study of conventional cases,” British Dental Journal, vol. 128, no. 2, pp. 65–70, 1970.
[3]
O. A. S. El-Meligy and D. R. Avery, “Comparison of apexification with mineral trioxide aggregate and calcium hydroxide,” Pediatric Dentistry, vol. 28, no. 3, pp. 248–253, 2006.
[4]
W. T. Felippe, M. C. S. Felippe, and M. J. C. Rocha, “The effect of mineral trioxide aggregate on the apexification and periapical healing of teeth with incomplete root formation,” International Endodontic Journal, vol. 39, no. 1, pp. 2–9, 2006.
[5]
M. Torabinejad, T. R. P. Ford, D. J. McKendry, H. R. Abedi, D. A. Miller, and S. P. Kariyawasam, “Histologic assessment of mineral trioxide Aggregate as a root-end filling in monkeys,” International Endodontic Journal, vol. 42, no. 5, pp. 408–411, 2009.
[6]
H. Schilder, “Filling root canals in three dimensions (Reprinted from Dental Clinics of North America, pg 723–744, 1967),” Journal of Endodontics, vol. 32, no. 4, pp. 281–290, 2006.
[7]
J. Coviello and J. D. Brilliant, “A preliminary clinical study on the use of tricalcium phosphate as an apical barrier,” Journal of Endodontics, vol. 5, no. 1, pp. 6–13, 1979.
[8]
M. Torabinejad and N. Chivian, “Clinical applications of mineral trioxide aggregate,” Journal of Endodontics, vol. 25, no. 3, pp. 197–205, 1999.
[9]
R. E. Mcdonald, D. R. Avery, and J. A. Dean, Dentistry for the Child and Adolescence, Mosby Elsevier, Maryland Heights, Minn, USA, 2011.
[10]
G. Holan, E. Eidelman, and A. B. Fuks, “Long-term evaluation of pulpotomy in primary molars using mineral trioxide aggregate or formocresol,” Pediatric Dentistry, vol. 27, no. 2, pp. 129–136, 2005.
[11]
N. Farsi, N. Alamoudi, K. Balto, and A. Mushayt, “Success of mineral trioxide aggregate in pulpotomized primary molars,” Journal of Clinical Pediatric Dentistry, vol. 29, no. 4, pp. 307–311, 2005.
[12]
A. Aminoshariae, G. R. Hartwell, and P. C. Moon, “Placement of mineral trioxide aggregate using two different techniques,” Journal of Endodontics, vol. 29, no. 10, pp. 679–682, 2003.
[13]
G. R. Lawley, W. G. Schindler, W. A. Walker III, and D. Kolodrubetz, “Evaluation of ultrasonically placed MTA and fracture resistance with intracanal composite resin in a model of apexification,” Journal of Endodontics, vol. 30, no. 3, pp. 167–172, 2004.
[14]
J. Camilleri and T. R. Pitt Ford, “Mineral trioxide aggregate: a review of the constituents and biological properties of the material,” International Endodontic Journal, vol. 39, no. 10, pp. 747–754, 2006.
[15]
C. Estrela, L. L. Bammann, F. C. Pimenta, and J. D. Pécora, “Control of microorganisms in vitro by calcium hydroxide pastes,” International Endodontic Journal, vol. 34, no. 5, pp. 341–345, 2001.
[16]
M. Torabinejad, P. W. Smith, J. D. Kettering, and T. R. Pitt Ford, “Comparative investigation of marginal adaptation of mineral trioxide aggregate and other commonly used root-end filling materials,” Journal of Endodontics, vol. 21, no. 6, pp. 295–299, 1995.
[17]
E. T. Koh, F. McDonald, T. R. P. Ford, and M. Torabinejad, “Cellular response to mineral trioxide aggregate,” Journal of Endodontics, vol. 24, no. 8, pp. 543–547, 1998.
[18]
V. Giuliani, T. Baccetti, R. Pace, and G. Pagavino, “The use of MTA in teeth with necrotic pulps and open apices,” Dental Traumatology, vol. 18, no. 4, pp. 217–221, 2002.
[19]
E. K. Siren, M. P. P. Haapasalo, K. Ranta, P. Salmi, and E. N. J. Kerosuo, “Microbiological findings and clinical treatment procedures in endodontic cases selected for microbiological investigation,” International Endodontic Journal, vol. 30, no. 2, pp. 91–95, 1997.
[20]
M. Tselnik, J. C. Baumgartner, and J. G. Marshall, “Bacterial leakage with mineral trioxide aggregate or a resin-modified glass ionomer used as a coronal barrier,” Journal of Endodontics, vol. 30, no. 11, pp. 782–784, 2004.
[21]
M. R. Pichardo, S. W. George, B. E. Bergeron, B. G. Jeansonne, and R. Rutledge, “Apical leakage of root-end placed SuperEBA, MTA, and Geristore restorations in human teeth previously stored in 10% formalin,” Journal of Endodontics, vol. 32, no. 10, pp. 956–959, 2006.
[22]
E. J. Fischer, D. E. Arens, and C. H. Miller, “Bacterial leakage of mineral trioxide aggregate as compared with zinc-free amalgam, intermediate restorative material, and Super-EBA as a root-end filling material,” Journal of Endodontics, vol. 24, no. 3, pp. 176–179, 1998.
[23]
C. Mangin, C. Yesilsoy, R. Nissan, and R. Stevens, “The comparative sealing ability of hydroxyapatite cement, mineral trioxide aggregate, and super ethoxybenzoic acid as root-end filling materials,” Journal of Endodontics, vol. 29, no. 4, pp. 261–264, 2003.
[24]
M. Wu, E. G. Kontakiotis, and P. R. Wesselink, “Long-term seal provided by some root-end filling materials,” Journal of Endodontics, vol. 24, no. 8, pp. 557–560, 1998.
[25]
M. Torabinejad, T. F. Watson, and T. R. Pitt Ford, “Sealing ability of a mineral trioxide aggregate when used as a root end filling material,” Journal of Endodontics, vol. 19, no. 12, pp. 591–595, 1993.
[26]
M. Torabinejad, S. Lee, and C. Hong, “Apical marginal adaptation of orthograde and retrograde root end fillings: a dye leakage and scanning electron microscopic study,” Journal of Endodontics, vol. 20, no. 8, pp. 402–407, 1994.
[27]
W. E. Andelin, D. F. Browning, G. R. Hsu, D. D. Roland, and M. Torabinejad, “Microleakage of resected MTA,” Journal of Endodontics, vol. 28, no. 8, pp. 573–574, 2002.
[28]
S. N. Bhaskar, J. M. Brady, L. Getter, M. F. Grower, and T. Driskell, “Biodegradable ceramic implants in bone. Electron and light microscopic analysis,” Oral Surgery, Oral Medicine, Oral Pathology, vol. 32, no. 2, pp. 336–346, 1971.
[29]
R. Rossmeisl, A. Reader, R. Melfi, and J. Marquard, “A study of freeze-dried (lyophilized) dentin used as an apical barrier in adult monkey teeth,” Oral Surgery Oral Medicine and Oral Pathology, vol. 53, no. 3, pp. 303–310, 1982.
[30]
D. E. Witherspoon and K. Ham, “One-visit apexification: technique for inducing root-end barrier formation in apical closures,” Practical Procedures & Aesthetic Dentistry, vol. 13, no. 6, pp. 455–460, 2001.
[31]
S. E. Saber and A. A. R. Hashem, “Efficacy of different final irrigation activation techniques on smear layer removal,” Journal of Endodontics, vol. 37, no. 9, pp. 1272–1275, 2011.
[32]
A. Al-Kahtani, S. Shostad, R. Schifferle, and S. Bhambhani, “In-vitro evaluation of microleakage of an orthograde apical plug of mineral trioxide aggregate in permanent teeth with simulated immature apices,” Journal of Endodontics, vol. 31, no. 2, pp. 117–119, 2005.
[33]
P. J. Vizgirda, F. R. Liewehr, W. R. Patton, J. C. McPherson, and T. B. Buxton, “A comparison of laterally condensed gutta-percha, thermoplasticized gutta-percha, and mineral trioxide aggregate as root canal filling materials,” Journal of Endodontics, vol. 30, no. 2, pp. 103–106, 2004.
[34]
D. R. Hachmeister, W. G. Schindler, W. A. Walker, and D. D. Thomas, “The sealing ability and retention characteristics of mineral trioxide aggregate in a model of apexification,” Journal of Endodontics, vol. 28, no. 5, pp. 386–390, 2002.
