Obturation of Avulsed Immature Permanent Incisor with MTA

Resident: Swan

Article Title: Complete Endodontic Obturation of an Avulsed Immature Permanent Incisor with Mineral Trioxide Aggregate: A Case Report

Author: Karp, et al.

Journal: Pediatric Dentistry; case report

Volume (Number): 28:3, 2006

Major Topic: novel therapy for treating avulsed immature permanent incisor

Type of Article: case report

Overview of Case: 9 y.o. boy was struck in mouth at close range by a golf ball. Left central incisor was avulsed, placed in water for 10 mintues, in cold milk for 10 minutes, then replaced in socket by they family. PA revealed immature incisors with open apices. Incisor was repositioned and splinted with fishing line. Splint removed after two weeks, with no symptoms or radiographic change noted. One month later, tooth showed normal mobility, color, and response to percussion/palpation. PA revealed external inflammatory resorption in the middle to cervical 3^rd of the root. Apexification was carried out using CaOH powder/2% lidocaine mixture. Material was placed into root canal space using a 25 mm lentulo spiral in a slow-speed handpiece.

One month later, tooth presents the same clinically with further external root resorption noted radiographically.

Three months later, tooth clinically normal, with cessation of external resorption. A well-defined PDL space was evident along with osseous regeneration in the areas of previous inflammation. CaOH paste was changed out.

After three months, calcific barrier had not formed yet; CaOH paste was changed for last time.

At one year mark post injury, pt reports no symptoms, but radiographically the tooth had undergone pulp canal obliteration.

Three months later, after consultation with an endodontist, the tooth was obturated with MTA to the CEJ. MTA was mixed with sterile water and placed in canal with a large amalgam carrier and condensed with a plugger. After 865 days, the patient was asymptomatic with no signs of replacement resorption or pathology on radiograph.

Findings: MTA (powder made of mainly lime, silica, and bismuth oxides) mixed with water has been advocated as a root-end-filling material for endo on immature permanent teeth. The authors described clinical success using MTA as an obturation material. They used MTA because they feared the external resorption had possibly perforated the middle to cervical third of the root; MTA has superior marginal integrity resulting in reduced bacterial microleakage; it also is believed to be able to induce hard tissue formation in areas of previous external resorption. Thus, MTA was chosen as opposed to Gutta percha or composite resin. The described case showed excellent clinical results after 2+ years.

Key Points/Summary: Another great potential use for MTA—canal obturation of immature permanent teeth.

Assessment of Article: Great case. Technique should definitely be examined in larger numbers.