Treatment of Teeth with Apical Root Resorption Using MTA

Öz

ABSTRACT Objective: Apical stenosis may be impaired due to pulpal pathologies, iatrogenically, etc. Apical inflammatory root resorption usually occurs due to periapical pathology without any clinical symptoms. The aim of this case series is to utilize calcium silicate based materials to provide hermetic occlusion in the treatment of teeth with compromised apical integrity. Case Report: Case 1: A 21-year-old woman with no systemic disease. Tooth number 11 had swelling and fistula tract extending to the buccal mucosa. Clinical examination revealed inadequate and incomplete root canal treatment and extensive lesion in the apical region. The old root canal treatment was removed. Apical narrowing was found to be impaired. After dressing with Ca(OH)2, MTA (mineral trioxide aggregate) was placed in the apical region. Root canal treatment was completed with the warm vertical condensation technique in the middle and coronal region of the root. Six months later, the patient was called for a follow-up visit and it was observed that all objective complaints had resolved and the periapical lesion had disappeared in the radiographs. Case 2: A 43-year-old male patient with no systemic disease. Radiographic images obtained from the patient revealed dentigerous cysts affecting teeth number 38 and 37. External root resorption was detected in the distal canal of tooth number 37. The entire distal canal of tooth number 37 was filled with MTA and the mesial canals were filled with gutta percha. Tooth number 38 was extracted and the dentigerous cyst was enucleated. The patient was called for follow-up three and six months later and it was determined that all objective complaints had resolved and the borders of the periapical lesions had healed in the radiographs. Conclusion: In cases of external root resorption with impaired apical stenosis, conservative endodontic treatment with effective irrigation, Ca(OH)2 medicaid and MTA in combination with an apical plug is one of the successful treatment options. Key words: Periapical pathology, external root resorption, mineral trioxide aggregate

Anahtar Kelimeler

• Periapical pathology
• external root resorption
• mineral trioxide aggregate

Apikal Kök Rezorpsiyonu Olan Dişlerin MTA ile Tedavisi

Öz

ÖZET Amaç: Pulpal patolojilere bağlı olarak, iatrojenik olarak vb. etkenler ile apikal daralım bozulabilmektedir. Apikal enflamatuar kök rezorpsiyonu genellikle herhangi bir klinik belirti göstermeden, periapikal patolojiye bağlı olarak meydana gelmektedir. Bu vaka serisinin amacı apikal bütünlüğü bozulmuş dişlerin tedavilerinde kalsiyum silikat esaslı materyallerden yararlanılarak hermetik tıkama sağlamaktır. Vaka Raporu: Vaka 1: 21 yaşında kadın hasta, sistemik hastalığı bulunmamaktadır. 11 numaralı dişinde bukkal mukozaya yayılmış şişlik ve fistül yolu mevcuttu. Klinik muayenede yetersiz ve eksik kök kanal tedavisi ve apikal bölgede yaygın lezyon tespit edildi. Eski kök kanal tedavisi söküldü. Apikal daralımın bozulmuş olduğu tespit edildi. Ca(OH)2 ile yapılan pansuman sonrası apikal bölgeye MTA (mineral trioksit agregat) yerleştirildi. Kökün orta ve koronal bölgesine sıcak dolum ile kanal tedavisi tamamlandı. Altı ay sonra kontrole çağırılan hastanın tüm objektif şikayetlerinin geçtiği, alınan radyografilerde periapikal lezyonun kaybolduğu izlenmiştir. Vaka 2: 43 yaşında erkek hasta, sistemik hastalığı bulunmamaktadır. Hastadan alınan radyografik görüntülerde 38 ve 37 numaralı dişleri etkileyen dentigeröz kist tespit edildi. 37 numaralı dişin distal kanalında eksternal kök rezorpsiyonu tespit edildi. 37 numaralı dişin distal kanalının tamamı MTA ile dolduruldu, mezial kanallar güta perka ile dolduruldu. 38 numaralı diş çekildi, dentigeröz kist enükle edildi. Üç ve altı ay sonra kontrole çağırılan hastanın tüm objektif şikayetlerinin geçtiği, alınan radyografilerde periapikal lezyon sınırlarının küçüldüğü tespit edilmiştir. Sonuç: Apikal daralımın bozulduğu eksternal kök rezorpsiyonu vakalarında konservatif endodontik tedavinin etkili bir irrigasyon, Ca(OH)2 medikaman ve MTA’nın apikal tıkaç ile birlikte uygulanması başarılı görülen tedavi seçenekleri arasında yer almaktadır. Anahtar kelimeler: Periapikal patoloji, eksternal kök rezorpsiyonu, mineral trioksit agregat

Anahtar Kelimeler

• Periapikal patoloji
• eksternal kök rezorpsiyonu
• mineral trioksit agregat

Kaynakça

1. 1. Heboyan A, Avetisyan A, Karobari MI, et al. Tooth root resorption: A review. Sci Prog. 2022;105(3):00368504221119664. doi:10.1177/00368504221119664.
2. 2. Boukpessi T, Cottreel L, Galler KM. External inflammatory root resorption in traumatized immature incisors: MTA plug or revitalization? A case series. Children (Basel). 2023;10(7):1236. doi:10.3390/children10071236.
3. 3. Karamifar K, Tondari A, Saghiri MA. Endodontic periapical lesion: An overview on the etiology, diagnosis and current treatment modalities. Eur Endod J. 2020;5:54-67.
4. 4. Guerrero F, Mendoza A, Ribas D, et al. Apexification: A systematic review. J Conserv Dent. 2018;21(5):462-465.
5. 5. Boufdil H, Mtalsi M, El Arabi S, et al. Apexification with calcium hydroxide vs revascularization. Case Rep Dent. 2020;2020:9861609. doi:10.1155/2020/9861609.
6. 6. Santos JM, Diogo P, Dias S, et al. Long-term outcome of nonvital immature permanent teeth treated with apexification and corono-radicular adhesive restoration: a case series. J Endod. 2022;48(9):1191-1199. doi:10.1016/j.joen.2022.06.008.
7. 7. Özel B, Erisen R. Management of non-vital anterior teeth with open apex: A report of two cases. Turk Endod J. 2020;5(1):7-10.
8. 8. Adel M, Nima MM, Shivaie Kojoori S, et al. Comparison of endodontic biomaterials as apical barriers in simulated open apices. ISRN Dent. 2012;2012:359873. doi:10.5402/2012/359873.

9. 9. Aktaş N, Sakaryalı Uyar D, Atabek D. Evaluation of marginal adaptation of three biomaterials as apical barrier in experimental apexification model. ADO Klin Bil Derg. 2024;13(3):409-415.
10. 10. Torabinejad M, Parirokh M, Dummer PMH. Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview—part II: other clinical applications and complications. Int Endod J. 2018;51(3):284-317.
11. 11. Wang X, Xiao Y, Song W, et al. Clinical application of calcium silicate-based bioceramics in endodontics. J Transl Med. 2023;21(1):853.
12. 12. Savin C, Balan A, Sirghe A, et al. Mineral trioxide aggregate use in children's primary and permanent teeth. Int J Med Dent. 2019;23(3):211-215.
13. 13. Ashi T, Bourgi R, Cuevas-Suárez CE, et al. Healing ability of endodontic filling materials in retrograde treatment: a systematic review of clinical studies. Appl Sci (Basel). 2025;15(12):6461. doi:10.3390/app15126461.
14. 14. Patel S, Saberi N, Pimental T, et al. Present status and future directions: Root resorption. Int Endod J. 2022;55:892-921.
15. 15. Vizgirda PJ, Liewehr FR, Patton WR, et al. A comparison of laterally condensed gutta-percha, thermoplasticized gutta-percha and mineral trioxide aggregate as root canal filling materials. J Endod. 2004;30:103-106.
16. 16. Utneja S, Garg G, Arora S, et al. Nonsurgical endodontic retreatment of advanced inflammatory external root resorption using mineral trioxide aggregate obturation. Case Rep Dent. 2012;2012:624792.
17. 17. Ağaçkıran E, Toptancı İR, Adıgüzel Ö. Total kron kaybı olan geniş periapikal lezyonlu maksiller santral kesici dişin çok seanslı endodontik tedavisi ve fiber post destekli kompozit rezin ile restorasyonu: 5 yıllık takip. Atatürk Univ Diş Hek Fak Derg. 2013;23:89-97.
18. 18. Farhad A, Mohammadi Z. Calcium hydroxide: a review. Int Dent J. 2005;55:293-301.
19. 19. Tolibah YA, Kouchaji C, Lazkani T, et al. Comparison of MTA versus Biodentine in apexification procedure for nonvital immature first permanent molars: a randomized clinical trial. Children (Basel). 2022;9(3):410. doi:10.3390/children9030410.
20. 20. Paranna S, Gogawale R, Patil A, et al. Clinical and radiographic evaluation of Biodentine for apexogenesis in young permanent mandibular molars: a systematic review and meta-analysis. Cureus. 2025;17(7):e70262. doi:10.7759/cureus.70262.
21. 21. Yadav A, Chak RK, Khanna R. Comparative evaluation of mineral trioxide aggregate, Biodentine, and calcium phosphate cement in single-visit apexification procedure for nonvital immature permanent teeth: a randomized controlled trial. Int J Clin Pediatr Dent. 2020;13(Suppl 1):S1-S7. doi:10.5005/jp-journals-10005-1787.
22. 22. Holden DT, Schwartz SA, Kirkpatrick TC, et al. Clinical outcomes of artificial root-end barriers with mineral trioxide aggregate in teeth with immature apices. J Endod. 2008;34:812-817.
23. 23. Majidinia S, Ahrari F, Hoseinzadeh M, et al. Internal bleaching with calcium oxalate and laser irradiation for managing discolorations induced by mineral trioxide aggregate. BMC Oral Health. 2025;25(1):349. doi:10.1186/s12903-025-05703-1.
24. 24. Choi YL, Jang YE, Kim BS, et al. Pre-application of dentin bonding agent prevents discoloration caused by mineral trioxide aggregate. BMC Oral Health. 2020;20(1):163. doi:10.1186/s12903-020-01162-3.
25. 25. Özüdoğru S, Düzyol E, Kayacı ŞT, et al. Spectrophotometric evaluation of tooth discoloration caused by ProRoot MTA, Biodentine, and NeoPutty in regenerative endodontics: an in vitro study. J Clin Pediatr Dent. 2026;50(1):236-244.