Use of Mineral Trioxide Aggregate in the Treatment of Traumatized Teeth
Condition: Periapical Diseases
MeSH terms: Periapical Diseases
Study type: Interventional
Phase: Phase 2

Summary: 
      Traumatic tooth injuries are common in children and adolescents, and often result in pulpal
      necrosis and the development of periapical lesions. Treatment of traumatized teeth with
      endodontic complications depends on the type of injury, number of injured teeth, root
      development and patient cooperation, which altogether will create a challenge and dictate the
      treatment plan for the dentist. The purpose of this study was to assess the effectiveness of
      non-surgical root canal procedures in traumatized permanent teeth with necrotic pulps and
      chronic periapical lesions using a tri-antibiotic paste and calcium-hydroxide as intracanal
      medications and two different mineral trioxide aggregate (MTA) products for definitive
      obturation.
    

Detailed description: 
      Root canal procedures will be performed on single-rooted traumatized permanent teeth (both
      with mature and immature root development) with necrotic pulps and periaoical lesions.
      Following access opening in each tooth, the root canals will be gently debrided with a
      crown-down manual technique using K-files according to the radiographically determined
      working lengths; irrigation with saline was used in all cases. K-files will be only used to
      remove the necrotic tissue and the softened predentinal layer without excessive removal of
      mineralized dentin, as this may have further weaken already thin walls of the root canals,
      particularly those with immature apical development. Subsequently, a reshaping of the canal
      system, followed by a minor curettage of the periapical area through the canal using barbed
      broaches will be made in order to partially destruct the periapical lesion and provoke
      bleeding. Final irrigation will be performed using 2% NaOCl (Chloraxid, Cerkamed, Stalowa
      Wola-Poland), 0.2% solution of chlorhexidine-digluconate (Curasept 220, Curadent Swiss GmbH,
      Kriens-Switzerland) and 40% citric acid solution (40% Citric acid, Cerkamed, Stalowa Wola,
      Poland). The canals will be then dried with sterile paper points and filled with
      triple-antibiotics paste using a lentula, for a period of seven days. Following this initial
      disinfection, calcium-hydroxide paste will be placed into the root canals for at least four
      weeks, for a maximum of six weeks (UltraCal XS, Ultradent Products Inc., South Jordan, UT
      USA). Apical thirds of the root canals will be obturated either with ProRoot MTA (Dentsply
      Tulsa Dental Specialties, Tulsa, OK USA) or MTA+ Cerkamed (Cerkamed, Stalowa Wola, Poland) by
      forming an apical plug of 3-5 mm of thickness. The correct placement of the apical plug will
      be assessed radiographically, and the moist cotton pellet was left in the root canal. The
      next day, the rest of the canal space will be filled with a sealer (Acroseal, Septodont,
      Saint-Maur des Frosses-France) and gutta-percha points (Guttapercha, VDW GmbH,
      Munich-Germany) using a lateral compaction technique. Coronal parts of root canal systems
      will be sealed using glass-ionomer cement (Fuji IX, GC Int., Tokyo, Japan) with a minimum
      thickness of 1.5-2 mm. The teeth will be restored using composite material (Gradia Direct, GC
      Int., Tokyo, Japan). Two dentists with many years of clinical experience, and using
      identical, predetermined treatment protocols will perform all treatments.

      The positive clinical outcome will comprise of absence of spontaneous or provoked pain, no
      discomfort during chewing, no numbness or tenderness to percussion and/or palpation, no
      altered tooth mobility, tooth crown discoloration or abscess and/or sinus tract. Radiological
      assessment of the outcomes will be performed according to the analysis of post treatment
      radiographs (initial, baseline, 3, 6, 12, and 24-months subsequent to obturation) after being
      photographed using a digital camera Kodak EasyShare Max (Z990) with millimetre measurer in
      order to obtain interpretation of sizes of periapical lesions during conversion of pixels in
      mm2 by digital data processing in Adobe Photoshop CS software.
    

Intervention name(s): ProRoot MTA; MTA+ Cerkamed
Intervention type(s): Device; Device
Intervention description(s): Apical thirds of the root canals obturated with ProRoot MTA (Dentsply Tulsa Dental Specialties, Tulsa, OK USA).; Apical thirds of the root canals obturated with MTA + (Cerkamed, Stalowa Wola, Poland).
Intervention MeSH terms: Pemetrexed
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: periapical diseases; dental injuries; MTA