Multifaceted Use of ProRoot MTA Root Canal Repair Material

Resident’s Name: Dan Boboia Date: 8/22/08
Article title: Multifaceted Use of ProRoot MTA Root Canal Repair Material
Author(s): Don Schmitt, Jacob Lee, George Boen
Journal: Pediatric Dentistry
Volume (number): 23
Month, Year: 2001
Major topic: MTA’s physical / biological properties and the clinical techniques of direct pulp capping, apexification, and repair of failed CaOH therapy.
Minor topics: MTA composition and cost
Type of Article: Literature Review
Main Purpose: Review MTA’s physical and biological properties and the clinical techniques of direct pulp capping, apexification, and repair of failed CaOH therapy.
Overview of method of research: Review of literature pertaining to challenges encountered in direct pulp capping, physical properties / composition of MTA, and benefits of MTA use in procedures such as apexification, direct pulp capping, and repair of failed CaOH therapy.
Findings:
MTA has superior sealing ability to amalgam, ZOE, and IRM as well as superior characteristics as a direct pulp capping agent compared to CaOH in animal models.
The set compressive strength of MTA is equal to IRM and about (1/4) strength of amalgam.
Histological studies demonstrate MTA allows for regrowth of cementum when used in root perforation repair & new bone formation with minimal PA inflammation when used as root end filling material.
Stimulates release of cytokines and interleukin
Antimicrobial properties similar to that of amalgam, ZOE, SuperEBA
Setting uninhibited by blood or water / mixed with sterile water to for set up
Composition of MTA: calcium phosphate, calcium oxide, and bismuth oxide to achieve radiopacity similar to gutta percha.
Cost $300 / 5 grams
Direct Pulp Capping:
Case selection most important --- asyptomatic teeth testing normal to CO2 ice test or recent onset of mild sensitivity to chewing or temperature
Remove caries, irrigate with NaOCl 5-10 min, rinse out
Place 1-1.5mm MTA over exposed pulp, place wet cotton pellet over MTA, temporize with IRM or Photocore (no Cavit - absorbes water and can damage vital pulp)
Clinical success likely if hemostasis achieved 5-10 minutes of pulpal exposure using cotton pellet soaked in 5.25% NaOCl
Return 1 week, remove cotton pellet, test MTA set (same consistency as set concrete), assess vitality of tooth
Place final restoration over MTA
F/U 6 months to check vitality
Apexification:
Place rubber dam, remove pulp, clean root canals with NaOCl
Place CaOH in root canals 1 week to fully disinfect
1 week later rinse out CaOH with NaOCl and dry
Condense MTA to apex creating 3-4mm plug and check with radiograph
Place moist cotton pellet and close with IRM or Cavit
Restore case after 2 weeks (due to MTA’s excellent marginal adaptability and non-resorbable property)
Continual apexogenesis of immature root apices occurs with MTA
Can fill entire canal with MTA
Anterior teeth ---risk of MTA fill leaching toward clinical crown creating dark appearance.
Repair of Failed CaOH Therapy:
Case presentation of tooth #9 replanted & splinted 2hrs s/p avulsion
4 weeks F/U shows external resorption
CaOH placed
3 week F/U show increased resorption
CaOH removed, MTA placed with apexification sequenced described
7 weeks F/U showed healing resorption
10 months s/p original trauma external resorption ceased and PA lesion was healing
Key points/Summary : MTA is a material with numerous possibilities for pulp therapy
Assessment of article: Excellent reference article with clinical instruction for direct pulp capping apexogenesis, and repair of failed CaOH Therapy with MTA