• Restorative Dentistry and Endodontics
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• v.35 no.3
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• pp.149-151
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• 2010

Since its introduction in 1993, Mineral Trioxide Aggregate (MTA) has been shown to be superior to others in sealing, biocompatibility, and many other aspects of clinical endodontics. MTA is primarily Portland cement with bismuth oxide as a radiopacitifier. Although some studies suggested that the reasonable-priced Portland cement could be used instead of MTA, but MTAs are different from Portland cement in its composition, especially in heavy metal contents. Therefore, clinicians should be meticulous adapting the Portland cement as a MTA substitute.

• Restorative Dentistry and Endodontics
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• v.22 no.1
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• pp.305-324
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• 1997

Numerous materials such as amalgam, IRM, SuperEBA, dessicated ZOE, and Ketac-Silver have been used as a root-end filling material or to repair furcation perforations. But so far no material has been found to satisfy all of the requirements of an ideal restorative material. Recently, mineral trioxide aggregate (MTA) has been suggested for use as a root end filling material and for the repair of furcation perforations. The purpose of this study was to compare the effect of MTA on the proliferation of MC3T3/E1 osteoblastic cell, formation of bone nodule, alkaline phosphatase activity, and finally the tissue reaction of bone with those of amalgam, IRM, SuperEBA, dessicated ZOE, and Ketac-Silver. The following conclusions were drawn within the limits of the experimental results : 1. MTA showed a excellent proliferation of osteoblastic cell and Ketac-Silver showed moderate proliferation of osteoblastic cell. The rest of test materials showed no proliferation of osteoblastic cell. 2. Many of definite bone nodules were found in the MTA group. In contrast, Ketac-Silver group showed no definite bone formation but only showed mild sign of bone formation. 3. Alkaline phosphatase activity of Ketac-Silver and MTA showed similar results. But both of them showed higher activity than that of other materials (p<0.005). 4. The tissue reaction to implanted MTA in the calbarium of mouse was milder than that observed with other materials. The tissue reaction of dessicated ZOE showed the worst results among the test materials.

• Restorative Dentistry and Endodontics
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• v.37 no.4
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• pp.188-193
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• 2012

Mineral trioxide aggregate (MTA) was developed in early 1990s and has been successfully used for root perforation repair, root end filling, and one-visit apexification. MTA is composed mainly of tricalcium silicate and dicalcium silicate. When MTA is hydrated, calcium silicate hydrate (CSH) and calcium hydroxide is formed. Formed calcium hydroxide interacts with the phosphate ion in body fluid and form amorphous calcium phosphate (ACP) which finally transforms into calcium deficient hydroxyapatite (CDHA). These mineral precipitate were reported to form the MTA-dentin interfacial layer which enhances the sealing ability of MTA. Clinically, the use of zinc oxide euginol (ZOE) based materials may retard the setting of MTA. Also, the use of acids or contact with excessive blood should be avoided before complete set of MTA, because these conditions could adversely affect the hydration reaction of MTA. Further studies on the chemical nature of MTA hydration reaction are needed.

• Restorative Dentistry and Endodontics
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• v.23 no.1
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• pp.515-524
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• 1998

The purposes of this study were to observe the cavity wall morphology and to evaluate the degree of cavity cleanliness when root-end retrograde cavity preparation was done with ultrasonic diamond instruments. To observe the morphology of retrocavity and to evaluate the degree of cavity cleanliness. root-end resections were done on 20 palatal roots of extracted maxillary first molars after canal filling with gutta-percha. Retrocavities were prepared using either ultrasonic diamond instruments or stainless steel ones of medium power setting of level 6 ($Miniendo^{TM}$, EIE, CA, U.S.A.). Morphology of the cavity. degrees of the remaining canal debris and smear layer were evaluated under the scanning electron microscope. The results were as follows: Cavities prepared with ultrasonic diamond instruments showed scratched appearance of wall, while ultrasonic stainless steel preparation showed hatcheted appearance. Ultrasonic diamond instruments induced more smear layer than stainless steel ones did (p<0.01) in the cavity. However, there was no significant difference in canal debris (p>0.05).

• Restorative Dentistry and Endodontics
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• v.22 no.2
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• pp.536-545
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• 1997

The purposes of this study were to evaluate the degree of cavity cleanliness and to observe cavity wall morphology when root-end retrograde cavity preparation was done with ultrasonics. Root resections were done on 20 extracted human maxillary central incisors after canal filling with gutta-percha, and retrocavities were prepared using a slow-speed round bur as a control, and stainless steel ultrasonic tips of power settings of 2 and 6 ($Miniendo^{TM}$, EIE, SA, USA) as experimentals. The degree of the remaining cavity debris and smear layer, and wall morphology were evaluated under the scanning electron microscope. The results were as follows : Cavity prepared with ultrasonics of either power setting showed significantly less smear layer than did slow-speed preparations (p<0.01). However, there was no significant difference in canal debris (p<0.05). Cavity prepared with ultrasonics showed hatcheted appearance of wall, while slow-speed preparation showed relatively plain one.

• Restorative Dentistry and Endodontics
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• v.24 no.1
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• pp.166-179
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• 1999

Apical sealing is essential for the success of surgical endodontic treatment. Root-end cavity is apt to be contaminated with moisture or blood, and is not always easy to be dried completely. The purpose of this study was to evaluate the influence of dry methods of retrocavity on the apical seal in endodontic surgery. Apical seal was investigated through the evaluation of apical leakage and adaptation of filling material over the cavity wall. To investigate the influence of various dry methods on the apical leakage, 125 palatal roots of extracted human maxillary molar teeth were used. The clinical crown of each tooth was removed at 10 mm from the root apex using a slow-speed diamond saw and water spray. Root canals of the all the specimens were prepared with step-back technique and filled with gutta-percha by lateral condensation method. After removing of the coronal 2 mm of filling material, the access cavities were closed with Cavit$^{(R)}$. Two coats of nail polish were applied to the external surface of each root. Apical three millimeters of each root was resected perpendicular to the long axis of the root with a diamond saw. Class I retrograde cavities were prepared with ultrasonic instruments. Retrocavities were washed with physiologic saline solution and dried with various methods or contaminated with human blood. Retrocavities were filled either with IRM, Super EBA or composite resin. All the specimens were immersed in 2% methylene blue solution for 7 days in an incubator at $37^{\circ}C$. The teeth were dissolved in 14 ml of 35% nitric acid solution and the dye present within the root canal system was returned to solution. The leakage of dye was quantitatively measured via spectrophotometric method. The obtained data were analysed statistically using one-way ANOVA and Duncan's Multiple Range Test. To evaluate the influence of various dry methods on the adaptation of filling material over the cavity wall, 12 palatal roots of extracted human maxillary molar teeth were used. After all the roots were prepared and filled, and retrograde cavities were made and filled as above, roots were sectioned longitudinally. Filling-dentin interface of cut surfaces were examined by scanning electron microscope. The results were as follows: 1. Cavities dried with paper point or compressed air showed less leakage than those dried with cotton pellet in Super EBA filled cavity (p<0.05). However, there was no difference between paper point- and compressed air-dried cavities. 2. When cavities were dried with compressed air, dentin-bonded composite resin-filled cavities showed less apical leakage than IRM- or Super EBA-filled ones (p<0.05). 3. Regardless of the filling material, cavities contaminated with human blood showed significantly more apical leakage than those dried with compressed air after saline irrigation (p<0.05). 4. Outer half of the cavity showed larger dentin-filling interface gap than inner half did when cavities were filled with IRM or Super EBA. 5. In all the filling material groups, cavities contaminated with blood or dried with cotton pellets only showed larger defects at the base of the cavity than ones dried with paper points or compressed air.

• Restorative Dentistry and Endodontics
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• v.41 no.4
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• pp.310-315
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• 2016

Two case reports describing a new technique of creating a repositionable piezoelectric bony window osteotomy during apicoectomy in order to preserve bone and act as an autologous graft for the surgical site are described. Endodontic microsurgery of anterior teeth with an intact cortical plate and large periapical lesion generally involves removal of a significant amount of healthy bone in order to enucleate the diseased tissue and manage root ends. In the reported cases, apicoectomy was performed on the lateral incisors of two patients. A piezoelectric device was used to create and elevate a bony window at the surgical site, instead of drilling and destroying bone while making an osteotomy with conventional burs. Routine microsurgical procedures - lesion enucleation, root-end resection, and filling - were carried out through this window preparation. The bony window was repositioned to the original site and the soft tissue sutured. The cases were re-evaluated clinically and radiographically after a period of 12 - 24 months. At follow-up, radiographic healing was observed. No additional grafting material was needed despite the extent of the lesions. The indication for this procedure is when teeth present with an intact or near-intact buccal cortical plate and a large apical lesion to preserve the bone and use it as an autologous graft.

• Restorative Dentistry and Endodontics
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• v.46 no.3
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• pp.35.1-35.11
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• 2021

Objectives: Endosequence Bioceramic Root Repair Material (BC-RRM) is used in endodontic microsurgery. It is available as a paste and a putty. However, no studies to date have examined the sealing ability of these forms alone or in combination as root-end filling materials. Hence, this study aimed to compare the sealing properties of these 2 forms of BC-RRM. Materials and Methods: Forty-two extracted upper anterior teeth were divided into 3 experimental groups, a positive and negative control. After the root canal treatment, the root ends were resected, retroprepared and retrofilled with either putty, paste + putty or mineral trioxide aggregate (MTA). The teeth were mounted in tubes so the apical 3 mm was submerged in Brain Heart Infusion (BHI) broth. The coronal portions of the canals were inoculated with Enterococcus faecalis and BHI broth and incubated for 30 days. The broth in the tubes was analyzed for colony forming units to check for leakage of bacteria from the canal. The teeth from the groups were sectioned and analyzed using scanning electron microscopy (SEM). The Kruskal-Wallis test and analysis of variance were used to analyze the data with a significance level p < 0.05. Results: The BC-RRM and MTA groups showed similar sealing ability. The positive control showed leakage in all samples. The SEM imaging showed the presence of bacteria in all experimental groups at the material-tooth interface. Conclusions: No significant differences were noted in the experimental groups, providing sufficient evidence that any combination could be effectively used during endodontic microsurgery.

• Restorative Dentistry and Endodontics
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• v.47 no.4
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• pp.35.1-35.9
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• 2022

Although the success rates of microsurgery and micro-resurgery are very high, the influence of a recurrent perforation combined with radicular cyst remains unclear. A 21-year-old white female patient had a history of root perforation in a previously treated right maxillary lateral incisor. Analysis using cone-beam computed tomography (CBCT) revealed an extensive and well-defined periapical radiolucency, involving the buccal and palatal bone plate. The perforation was sealed with bioceramic material (Biodentine) in the pre-surgical phase. In the surgical phase, guided tissue regeneration (GTR) was performed by combining xenograft (lyophilized bovine bone) and autologous platelet-rich fibrin applied to the bone defect. The root-end preparation was done using an ultrasonic tip. The retrograde filling was performed using a bioceramic material (Biodentine). Histopathological analysis confirmed a radicular cyst. The patient returned to her referring practitioner to continue the restorative procedures. CBCT analysis after 1-year recall revealed another perforation in the same place as the first intervention, ultimately treated by micro-resurgery using the same protocol with GTR, and a bioceramic material (MTA Angelus). The 2-year recall showed healing and bone neoformation. In conclusion, endodontic micro-resurgery with GTR showed long-term favorable results when a radicular cyst and a recurrent perforation compromised the success.

• Restorative Dentistry and Endodontics
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• v.23 no.1
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• pp.54-67
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• 1998

The purposes of this study were to evaluate the efficiency of dentin cutting and root-end cavity preparation, and to determine the incidence of tooth crack when root-end retrograde cavity preparation was done with. ultrasonic diamond instruments. To evaluate the efficiency of dentin cutting, ultrasonic diamond and stainless steel instruments were applied to 20 exposed bovine dentin surfaces perpendicularly or parallely at the low, and medium power settings for 1 minute ($Miniendo^{TM}$, EIE, CA, U.S.A.). The resultant cavity depth was measured. To evaluate the efficiency of cavity preparation and to investigate the incidence of tooth crack, 165 mesiobuccal, distobuccal and palatal root-ends of extracted human maxillary first molars were resected by 3 mm perpendicularly to the long axis of tooth using a slow speed diamond saw after root canal preparation and filling. Retrocavities were prepared using a ultrasonic diamond instrument or a stainless steel one of the low- or medium power settings of 2 or 6. Time consumed and the number of strokes used for the cavity preparation were measured and the incidence of tooth cracks was evaluated under a stereomicroscope. The results were as follows: Both at the low and medium power settings, and both with perpendicularly- and parallely applied tips to dentin, diamond instruments showed higher dentin cutting efficiency than stainless steel ones did (p<0.01). When tips were applied to dentin perpendicularly, both diamond instrument and stainless steel one showed higher cutting efficiency with medium power setting than with low power one (p<0.01). Both at the low- and medium power settings, both diamond instrument and stainless steel one showed higher cutting efficiency when tips were applied perpendicularly to dentin surface than applied parallely (p<0.01). At the medium power setting, the number of stroke and time consumed were less with diamond instrument than with stainless steel one (p<0.05) for the retrograde cavity preparation. At the low power setting, diamond instrument induced less tooth cracks than stainless steel one did (p<0.01).