Travmatik Diş Yaralanmalarında Mineral Trioksit Agregat Kullanımının Etkinliği: Açık Apeksli Üst Daimi Dişler Üzerine Bir Vaka Raporu

Öz

Özet: Bu vaka raporu, travma sonucu açık apeksli üst daimi santral dişlerin mineral trioksit agregat (MTA) kullanarak tedavi edilmesini incelemektedir. Bir olgu iki üst santral diş üzerinden gerçekleştirilen bu rapor, travma geçirmiş dişlerde kök kanal tedavisi ve apeksifikasyon işlemleri sonrasında klinik ve radyografik iyileşmelerin gözlemlendiğini ortaya koymaktadır. Vakada, ilk olarak kök kanalları şekillendirilmiş ardından kanalların dezenfekte edilmesi amacıyla kalsiyum hidroksit tedavisi uygulanmış sonrasında MTA(mineral trioksit agregat) apikal açıklıkta tıkaç olarak kullanılmıştır. MTA’nın koronal kısmı güta perka konlarla soğuk lateral kompaksiyon yöntemiyle doldurulmuş ve devital beyazlatma işlemi uygulanmıştır. İki hafta sonra üst daimi veneer kompozit restorasyonları yapılmıştır. Tedavi sonrası hastada, dişlerde ağrı semptomlarının ve periapikaldeki lezyonların iyileşmesi gibi olumlu bulgular elde edilmiştir. Radyografik takiplerde periapikal radyolusent alanların küçüldüğü ve kemik yoğunluğunun arttığı gözlemlenmiştir. Elde edilen sonuçlar, MTA'nın travma sonrası periradiküler lezyonların tedavisinde etkili ve öngörülebilir bir seçenek olduğunu desteklemekte ve açık apeksli dişlerin apeksifikasyonunda kullanılabilirliğini vurgulamaktadır. Bu bulgular, MTA'nın üst düzey biyouyumluluğu ve hızlı iyileşme süreci ile desteklenen bir alternatif olduğunu göstermektedir.

Anahtar Kelimeler

• Apeksifikasyon
• açık apeks
• mineral trioksit agregat (MTA)
• travmatik diş yaralanmaları

Efficacy of Mineral Trioxide Aggregate Use in Traumatic Dental Injuries: A Case Report on Open Apex Upper Permanent Teeth

Öz

This case report presents the treatment of maxillary permanent central incisors with open apices resulting from trauma, utilizing mineral trioxide aggregate (MTA) for apexification. Based on a clinical case involving two traumatized maxillary central incisors, the report highlights the clinical and radiographic healing observed following root canal treatment and apexification procedures.Initially, the root canals were mechanically shaped and subsequently disinfected using calcium hydroxide as an intracanal medicament. MTA was then placed as an apical plug to seal the wide apical foramen. The coronal portion of the canal was obturated with gutta-percha cones using the cold lateral compaction technique. A non-vital bleaching procedure was performed thereafter. Two weeks later, composite veneer restorations were complated.Postoperative follow-ups revealed favorable clinical outcomes, including the resolution of pain symptoms and healing of periapical lesions. Radiographic examinations demonstrated a reduction in the size of periapical radiolucencies and an increase in bone density over time.These findings support the effectiveness and predictability of MTA as a treatment option for periradicular lesions following dental trauma. The results also emphasize the material’s applicability in the apexification of immature teeth with open apices. The observed outcomes are attributed to MTA’s superior biocompatibility and its capacity to promote rapid healing

Anahtar Kelimeler

• Apexification
• mineral trioxide aggregate
• open apex
• traumatic dental injuries

Kaynakça

1. 1. Levin L, O’Connell AC, Tewari N, Mills SC, Stasiuk H, Roettger M, Abbott PV. The International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD) guidelines for prevention of traumatic dental injuries: Part 1: General introduction. Dent Traumatol. 2024;40:1-3.
2. 2. Andreasen J. Textbook and color atlas of traumatic injuries to the teeth. Munksgard, Copenhagen; 1993. p.155-172.
3. 3. Bourguignon C, Cohenca N, Lauridsen E, Flores MT, O’Connell AC, Day PF, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations. Dent Traumatol. 2020;36(4):314-30.
4. 4. Özan Ü, Oruçoğlu H. Diş revaskülarizasyonu ve uygulama yöntemleri. Cumhuriyet Dent J. 2014;17(1):92-100.
5. 5. Karim FA, Mahmud KH, Sultana A, Chawdhari SS, Hossain M, Mohamed S, Costa PD. Management of non-vital anterior tooth with open apex by MTA apical plug — a case report. Update Dent Coll J. 2019;9(1):42-45.
6. 6. Torabinejad M, Chivian N. Clinical applications of mineral trioxide aggregate. J Endod. 1999;25(3):197-205.
7. 7. Shabahang S, Torabinejad M. Treatment of teeth with open apices using mineral trioxide aggregate. Pract Periodontics Aesthet Dent. 2000;12(3):315-20.
8. 8. American Association of Endodontists. Glossary of Endodontic Terms. Chicago: American Association of Endodontists; 2003;8th ed. p.324-387.

9. 9. Maroto M, Barbería E, Planells P, Vera V. Treatment of a non-vital immature incisor with mineral trioxide aggregate (MTA). Dent Traumatol. 2003;19(3):165-69.
10. 10. Duggal M, Tong HJ, Al-Ansary M, Twati W, Day P, Nazzal H. Interventions for the endodontic management of non-vital traumatised immature permanent anterior teeth in children and adolescents: a systematic review of the evidence and guidelines of the European Academy of Paediatric Dentistry. Eur Arch Paediatr Dent. 2017;18:139-51.
11. 11. Nicoloso GF, Pötter IG, Rocha RdO, Montagner F, Casagrande L. A comparative evaluation of endodontic treatments for immature necrotic permanent teeth based on clinical and radiographic outcomes: a systematic review and meta-analysis. Int J Paediatr Dent. 2017;27(3):217-27.
12. 12. Araújo RA, Silveira CF, Cunha RS, De Martin AS, Fontana CE, Bueno CE. Single-session use of mineral trioxide aggregate as an apical barrier in a case of external root resorption. J Oral Sci. 2010;52(2):325-28.
13. 13. Tahan E, Çelik D, Er K, Taşdemir T. Effect of unintentionally extruded mineral trioxide aggregate in treatment of tooth with periradicular lesion: a case report. J Endod. 2010;36(4):760-63.
14. 14. Silva EJ, Pinto KP, Riche FN, Carestiato MG, Martins JN, Duncan HF, et al. A meta-analysis of calcium silicate–based cements and calcium hydroxide as promoters of hard tissue bridge formation. Int Endod J. 2025;58(5):685-714.
15. 15. Wikström A, Romani Vestman N, Rakhimova O, Lazaro Giymen D, Tsilingaridis G, Burundi M. Microbiological assessment of success and failure in pulp revitalization: a randomized clinical trial using calcium hydroxide and chlorhexidine gluconate in traumatized immature necrotic teeth. J Oral Microbiol. 2024;16(1):2343518.
16. 16. Arıcıoğlu B, Gunacar DN, Koşar T, Sanal Cikman A, Pertek Hatipoğlu F, Maraş E. Assessment of bone quality of apical periodontitis treated with MTA plug and regenerative endodontic techniques. Aust Endod J. 2022;48(3):444-50.
17. 17. Steiner DR, West JD. A method to determine the location and shape of an intracoronal bleach barrier. J Endod. 1994;20(6):304-06.
18. 18. Roy D, Kataki R, Gogoi S, Seal M. Evaluation of peroxide release during nonvital bleaching using three different coronal barriers: an in vitro study. J Conserv Dent Endod. 2024;27(9):920-24.
19. 19. Plotino G, Buono L, Grande NM, Pameijer CH, Somma F. Nonvital tooth bleaching: a review of the literature and clinical procedures. J Endod. 2008;34(4):394-407.
20. 20. Demarco F, Freitas J, Silva M, Justino L. Microleakage in endodontically treated teeth: influence of calcium hydroxide dressing following bleaching. Int Endod J. 2001;34(7):495-500.