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Case Reports
. 2017 Summer;12(3):376-380.
doi: 10.22037/iej.v12i3.17689.

Endodontic Surgery of a Symptomatic Overfilled MTA Apical Plug: A Histological and Clinical Case Report

Saeed Asgary  1 , Sara Fayazi  2
Affiliations
Case Reports

Endodontic Surgery of a Symptomatic Overfilled MTA Apical Plug: A Histological and Clinical Case Report

Saeed Asgary et al. Iran Endod J. 2017 Summer.

Abstract

This case report presents the successful surgical treatment of a symptomatic open apex upper central incisor with a failed overfilled mineral trioxide aggregate (MTA) apical plug. Unintentional overextension of the MTA had occurred two years before the initial visit. An apical lesion adjacent to the excess MTA was radiographically detectable. Endodontic surgery was performed using calcium-enriched mixture (CEM) cement as a root-end filling material. Curettage of the apical lesion showed a mass of unset MTA particles; histopathological examination revealed fragments of MTA and granulation tissues. Up to 18-month follow-up, the tooth was clinically asymptomatic and fully functional. Periapical radiograph and CBCT images showed a normal periodontal ligament around the root. In conclusion, favorable outcomes in this case study suggested that root-end filling with CEM cement might be an appropriate approach; in addition, however many factors probably related to the initial failure of the case, the extrusion of MTA into the periapical area should be avoided.

Keywords: Apical barrier; Apicoectomy; CEM Cement; Calcium-Enriched Mixture; Endodontics; MTA; Surgical treatment.

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Conflict of interest statement

‘None declared’.

Figures

Figure 1.
Figure 1.
A) Preoperative periapical radiograph of endodontically treated right central incisor; B) Periapical radiograph after CEM cement root-end filling; C) Periapical radiograph after one year follow-up shows complete bone healing and establishment of periodontal ligament (PDL
Figure 2
Figure 2
A) Preoperative clinical view of treated right central incisor; B and C) Clinical view of the unset MTA overextrusion and granulation tissue after flap reflection; D) Removed mass of MTA overextrusion; E) Resected apex; F) Preparation of the root-end cavity and removing the previous root canal fillings; G) Placement of CEM cement as the root-end filling biomaterial
Figure 3.
Figure 3.
) Mass of unset MTA extruded attached to the soft tissue removed from periapical tissue; B) MTA surrounded by granulation tissue, macrophage and fibroblasts; C) MTA particles encapsulated in the fibrous connective tissue
Figure 4
Figure 4
Cone-beam computed tomography (CBCT) image shows the complete healing of periapical lesion and PDL reformation 18 months after root-end filling with CEM cement
See this image and copyright information in PMC

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