Prophylactic treatment of dens evaginatus using mineral trioxide aggregate.

Two case reports with dens evaginatus are presented. Each patient had one tooth affected. There was a prominent tubercle on the occlusal surface of the mandibular second premolar. Under local anesthesia and rubber dam isolation a partial pulpotomy was conducted and mineral trioxide aggregate was placed. After 6 months the teeth were removed as part of planned orthodontic treatment. Histological examination of these teeth showed an apparent continuous dentin bridge formation in both teeth, and the pulps were free of inflammation. These cases show that mineral trioxide aggregate can be used as an alternative to existing materials in the proplylactic treatment of dens evaginatus.

Tissue reaction to implanted root-end filling materials in the tibia and mandible of guinea pigs.

The purpose of this study was to examine the tissue reaction to implanted mineral trioxide aggregate (MTA), amalgam, Intermediate Restorative Material, and Super-EBA in the tibias and mandibles of guinea pigs. After anesthetizing 20 guinea pigs, raising tissue flaps, and preparing bony cavities, the test materials were placed in Teflon cups and implanted in the tibias and 10 days later in the mandibles. The animals were euthanized 80 days later and the tissues prepared for histological examination. The presence of inflammation, predominant cell type, and thickness of fibrous connective tissue adjacent to each implant were recorded. The tissue reaction to MTA implantation was the most favorable observed at both sites; as in every specimen, it was free of inflammation (p < 0.01). In the tibia, MTA was the material most often observed with direct bone apposition. Based on these results, MTA seems to be a biocompatible material.

Short-term tissue response to potential root-end filling materials in infected root canals.

The short-term tissue responses to two potential root-end filling materials, a light-cured glass ionomer cement (Vitrebond) and a reinforced zinc oxide-eugenol cement (Kalzinol), were compared with that to amalgam using a previously devised experimental model. In 24 premolar teeth of beagle dogs (47 roots), a collection of endodontic pathogenic bacteria was first inoculated into the root canals to induce periradicular lesions. On each root, an apicoectomy was performed and root-end cavities prepared to receive fillings of each material. The teeth and surrounding jaw were removed after 2 weeks (23 roots) and 1 week (24 roots); they were then prepared for histological examination. The tissue response to amalgam fillings after 2 weeks and 1 week was marked by moderate or severe inflammation on all roots, and extended to < or = 0.5 mm or > 0.5 mm in 15 out of 16 roots. In contrast, after 2 weeks, the majority of roots filled with Kalzinol showed little or moderate inflammation, while the tissue response to Vitrebond was the best of the three materials, and was also the least extensive. After 1 week, the overall best tissue response was with Vitrebond, followed by Kalzinol. The differences between materials for both time periods with either none or few inflammatory cells when compared with that with either moderate or severe inflammation were not statistically significant (P < 0.02). However, the differences between materials for both time periods with no inflammation or inflammation extending < 0.2 mm when compared with that with inflammation extending > 0.2 mm (< or = 0.5 mm or > 0.5 mm) were statistically significant (P < 0.01). Apart from amalgam, in which healing was marked by the persistence of a localized focus of inflammation adjacent to the root-end filling, even though there were intersample variations, there was little overall difference in the temporal and qualitative healing response to Vitrebond and Kalzinol. Both Vitrebond and Kalzinol have potential as root-end filling materials, as the tissue response was considerably more favourable than that to amalgam even in the short-term.

Histologic assessment of mineral trioxide aggregate as a root-end filling in monkeys.

Mineral Trioxide Aggregate (MTA) has been shown in a number of experiments to be a potential root-end filling material. The purpose of this study was to examine the periradicular tissue response of monkeys to MTA and amalgam as root-end fillings. The pulps were removed from all the maxillary incisors of three monkeys. The root canals were prepared and filled with laterally condensed guttapercha and sealer, and the access cavities were restored with amalgam. Buccal mucoperiosteal flaps were raised, and root-end resections were performed before root-end cavity preparation with burs. The root-end cavities in half of the teeth were filled with MTA, while amalgam was placed in the other cavities. After 5 months the periradicular tissue response was evaluated histologically. The results showed no periradicular inflammation adjacent to five of six root ends filled with MTA; also five of six root ends filled with MTA had a complete layer of cementum over the filling. In contrast, all root ends filled with amalgam showed periradicular inflammation, and cementum had not formed over the root-end filling material, although it was present over the cut root end. Based on these results and previous investigations, MTA is recommended as a root-end filling material in man.

Tissue response to potential root-end filling materials in infected root canals.

The tissue responses to two potential root-end filling materials, a light-cured glass ionomer cement (Vitrebond) and a reinforced zinc oxide-eugenol cement (Kalzinol) were compared with that to amalgam. In 27 premolar teeth of beagle dogs (54 roots), a collection of endodontic pathogenic bacteria was first inoculated into the root canals to induce periapical lesions. On each root, an apicectomy was performed and root-end cavities prepared to receive fillings of each material. The teeth and surrounding jaw were removed after 8 weeks (24 roots) and 4 weeks (30 roots); and they were prepared for histological examination. The tissue response to amalgam fillings after 4 and 8 weeks was marked by moderate or severe inflammation on all roots, and extended > 0.5 mm in 10 out of 18 roots. In contrast, after 8 weeks, the majority of roots filled with Kalzinol showed little or moderate inflammation while the tissue response to Vitrebond was the best of the three materials, and was also less extensive. After 4 weeks, the overall best tissue response was with Kalzinol, followed closely by Vitrebond. The differences between materials for both time periods with either none or few inflammatory cells when compared with that with either moderate or severe inflammation were statistically significant (P < 0.01). Similarly, the differences between materials for both time periods with no inflammation or inflammation extending < 0.2 mm when compared with that with inflammation extending > 0.2 mm (< or = 0.5 mm or > 0.5 mm) were statistically significant (P < 0.01). Both Vitrebond and Kalzinol have potential as root-end filling materials as the tissue response was considerably more favourable than that to amalgam.

Using mineral trioxide aggregate as a pulp-capping material.

This study examined the dental pulp responses in monkeys to mineral trioxide aggregate, or MTA, and a calcium hydroxide preparation when used as pulp-capping materials. After the pulps of 12 mandibular incisors were exposed with a No. 1 round bur, they were capped with either MTA or the calcium hydroxide preparation. After five months, the authors noted no pulpal inflammation in five of six samples capped with MTA, and all six pulps in this group had a complete dentin bridge. In contrast, all of the pulps capped with the calcium hydroxide preparation showed pulpal inflammation, and bridge formation occurred in only two samples. Based on these results, it appears that MTA has the potential to be used as a pulp-capping material during vital pulp therapy.

Effect of various sealers with gutta-percha as root-end fillings on healing after replantation.

This study examined histologically the effect of three sealers used with gutta-percha as root-end fillings placed in a replantation model. A total of 14 molar teeth were used in seven monkeys. After extraction, root ends were resected, the canals contaminated with oral bacteria, root-end cavities prepared, and fillings of gutta-percha and sealer placed prior to replantation. After 8 weeks the teeth and surrounding jaw were removed and prepared for histological examination. Six roots filled with gutta-percha plus a fortified zinc oxide-eugenol cement (IRM), 13 with gutta-percha plus zinc oxide-eugenol (EP), and eight with gutta-percha plus Kloropercha, were available for examination. The tissue response to gutta-percha with either zinc oxide material was characterized by little or no inflammation of limited extent. In contrast, more severe inflammation was observed against root ends filled with gutta-percha and Kloropercha. Gutta-percha plus IRM or zinc oxide-eugenol had a much more favourable response than that to amalgam reported previously in a similar experiment.

Effect of various zinc oxide materials as root-end fillings on healing after replantation.

This study examined the effect of various zinc oxide materials as root-end fillings of teeth in a replantation model. A total of 35 molar teeth were used from 19 monkeys. After extraction, root ends were resected, the canals contaminated with oral bacteria, root-end cavities prepared and fillings placed prior to replantation. After 8 weeks the teeth and surrounding jaw were removed and prepared for histological examination. Twelve roots were filled with IRM plus dentine chips, and six with Cavit; the tissue response around root ends filled with these materials as assessed by inflammation was similar to that previous reported to IRM and Super EBA cement and was characterized by little or no inflammation of limited extent. In contrast, more severe inflammation was observed around root ends filled with plain zinc oxide-eugenol or Kalzinol; however, the reaction was neither as severe nor as extensive as that to amalgam root-end fillings. Giant cells were observed most often on the surface of fillings with Cavit and zinc oxide-eugenol. It is concluded that the tissue response to IRM with or without added dentine, Super EBA and Cavit was similar and mild; it was less severe than that to zinc oxide-eugenol and Kalzinol. All these materials had a much more favourable response than amalgam

Use of mineral trioxide aggregate for repair of furcal perforations.

The histologic response to intentional perforation in the furcations of 28 mandibular premolars in seven dogs was investigated. In half the teeth, the perforations were repaired immediately with either amalgam or mineral trioxide aggregate; in the rest the perforations were left open to salivary contamination before repair. All repaired perforations were left for 4 months before histologic examination of vertical sections through the site. In the immediately repaired group, all the amalgam specimens were associated with inflammation, whereas only one of six with mineral trioxide aggregate was; further, the five noninflamed mineral trioxide aggregate specimens had some cementum over the repair material. In the delayed group, all the amalgam specimens were associated with inflammation; in contrast only four of seven filled with the aggregate were inflamed. On the basis of these results, it appears that mineral trioxide aggregate is a far more suitable material than amalgam for perforation repair, particularly when used immediately after perforation.

Effect of super-EBA as a root end filling on healing after replantation.

The effect of Super-EBA cement as a root-end filling placed in teeth before replantation was examined in eight molar roots in monkeys. After extraction, root ends were resected, the canals contaminated with oral bacteria, root-end cavities prepared, and fillings of Super-EBA placed before replantation. After 8 wk, the jaws were removed and prepared for histological examination. The tissue response to Super-EBA was very mild, with only a few inflammatory cells being observed at the root end of 3 of the 8 roots filled. Previous work showed a similarly mild response to Intermediate Restorative Material and a very much more severe response to amalgam. It is concluded that the tissue response to Super-EBA as a root-end filling is acceptable and considerably more favorable than that to amalgam.

Effect of IRM root end fillings on healing after replantation.

The effect of IRM as a root end filling placed in teeth prior to replantation was examined in 21 molar teeth in monkeys. After extraction, root ends were resected, the canals contaminated with oral bacteria, root end cavities prepared, and fillings of IRM or amalgam placed prior to replantation. After 8 wk the jaws were removed and prepared for histological examination. Bacteria were demonstrated in only 9 of 15 teeth filled with IRM; 18 of the roots (60%) were associated with inflammation, which was only moderate or severe around 5 (17%), and extended > 0.1 mm around only 2 roots. In contrast, of the 6 teeth filled with amalgam, all contained bacteria in the root canals and 11 roots were associated with moderate or severe inflammation, which around 8 roots extended > 0.5 mm. The difference in severity of inflammation for the two materials was statistically significant (p < 0.001). The tissue response to root end fillings of IRM in replanted teeth was less severe and less extensive than that to amalgam.