Single-visit endodontic treatment of mature teeth with chronic apical abscesses using mineral trioxide aggregate cement: a randomized clinical trial

Abstract

Background: Mature teeth with chronic apical abscesses characterized by intermittent discharge of pus through an associated sinus tract. This communication between oral mucosa and periapical inflammation is challenging for the sealing ability of root canal obturation material. Therefore, the study aim was to compare the outcomes of endodontic treatment using mineral trioxide aggregate (MTA) cement to the conventional gutta-percha cone and root canal sealer as an obturation material in mature teeth with chronic apical abscesses.

Methods: Mature teeth with chronic apical abscesses referred to our clinic for root canal treatment between 2010 and 2012 were treated in a single visit and distributed among treatment (T) and control (C) groups using a predetermined randomization block (TCTC). After chemo-mechanical preparation, teeth in group T received MTA cement mixed in a 0.26 water to powder ratio, and teeth group C received gutta-percha and root canal sealer using the warm vertical technique. The treatment outcomes were defined as obturation length, periapical healing, resorption of extruded material, and survival rate at least 2.5 years after treatment. Three endodontists blinded to the type of obturation material documented treatment outcomes. Statistical analysis at P < 0.05 was conducted to measure difference between the groups.

Results: Thirty-six teeth were treated between 2010 and 2012, and 32 teeth were evaluated in 2015. Complete periapical healing was observed in 87.5 % of MTA-treated teeth and 75.0 % of gutta-percha-treated teeth. Adequate obturation length was reported in 50.0 % of MTA-treated and 37.5 % of gutta-percha-treated teeth. Complete resorption of extruded material was evident in 83.3 % MTA-treated teeth and 100.0 % gutta-percha-treated teeth. The survival rate of MTA-treated teeth was 100 % at 3, and 5 years, while the survival rate of gutta-percha-treated teeth was 83.3 % at 3, and 5 years. There was no significant difference between the groups in term of periapical healing, survival rate, obturation length, or resorption of extruded material.

Conclusions: The outcomes of single-visit endodontic treatment of mature teeth with chronic apical abscesses using MTA cement were better, but not statistically significant, compared to conventional treatment.

Trial registration: ISRCTN15285974 . Registered retrospectively 23 June 2015.

Keywords: Mineral trioxide aggregate; Periapical lesion; Root canal treatment; Single visit.

Fig. 1

Clinical and radiographical presentation of mature teeth with chronic apical abscesses. a Non-restorable tooth with sinus tract and periapical radiolucency (arrow) excluded from the study. b Restorable tooth with sinus tract and periapical radiolucency (arrow) included in the trial

Fig. 2

CONSORT flowchart of patients enrolled in the study

Fig. 3

MTA cement obturation. a White ProRoot powder is mixed with sterile water, and small increment was attached to an ISO #35 paper point held with a cotton plier. b A larger MTA increment was attached to an ISO #60 paper point while the paper point was bent to facilitate compacting MTA cement apically in posterior teeth. c Periapical radiograph of a two rooted premolar. One root canal was filled with gutta-percha and root canal sealer and the other root was filled with MTA cement as described in the methods section. d, e, f, g Micro-CT analysis to evaluate the obturation density of both techniques. Voids were difficult to detect in MTA obturation even at high scanning parameters

Fig. 4

Periapical radiographs of primary treatment in maxillary lateral incisors and secondary treatment in mandibular first molars followed for 5- and 2.5-years

Fig. 5

Periapical radiographs of MTA- and gutta-percha-treated teeth (*) with incomplete periapical healing at 2.5-years follow-up visits