Root-end resection with or without retrograde obturation after orthograde filling with two techniques: A micro-CT study.

To evaluate the filling ability of two orthograde obturation techniques followed by the apical resection with or without retrograde obturation through micro-computed tomography (CT). Thirty-two single-rooted permanent teeth were prepared and randomised into four groups (n = 8) according to the orthograde obturation technique (single cone technique [SCT] and mineral trioxide aggregate placement) combined or not with retrograde obturation. The volume of voids (VoV) within the entire endodontic space, the apical 3 mm, and 1 mm after root resection was calculated by micro-CT. Statistical analysis showed no significant difference among the groups regarding the total VoV in all root canals, as well as within the apical 1 mm after root resection. The SCT and apical resection without retrograde filling showed significantly better results in terms of VoV at the apical 3 mm after root resection. Within the study limitations, SCT associated with apical resection without retrograde preparation exhibited a similar or less amount of voids than the other groups.

Manejo ortógrado de perforaciones radiculares: a propósito de dos casos / Orthograde management of root canal perforations: two case reports

Las perforaciones radiculares son complicaciones no deseadas que pueden ocurrir durante el tratamiento de conductos. Los principales factores que afectan el pronóstico de un diente que presenta una perforación son la localización y el tamaño de esta, el tiempo transcurrido hasta su reparación, el grado de contaminación previa, y la presencia de una radiolucidez adyacente. La aparición de materiales biocompatibles como el agregado de trióxido mineral (MTA) incrementó de forma sustancial el pronóstico de estos dientes alcanzando tasas de éxito de alrededor del 90%. El objetivo de este artículo es describir el manejo ortógrado de dos casos con perforaciones radiculares laterales en los que se utilizaron materiales y técnicas distintas para su sellado. En ambos casos, previamente al sellado ortógrado de las perforaciones, se realizó una desinfección abundante con hipoclorito de sodio (NaOCl) al 2,5%. En el primer caso, se realizó la obturación del tercio apical del conducto usando una técnica de condensación vertical con gutapercha caliente, y posteriormente se obturó el resto del conducto, incluida la perforación, mediante MTA blanco (Angelus, Londrina, PR, Brasil). En el segundo caso, que además presentaba la dificultad añadida de un instrumento fracturado, se utilizó Biodentine (Septodont, Saint-Maur-des-Fosses, Francia) en toda la longitud del conducto radicular donde se encontraba la perforación. La ausencia de signos y síntomas clínicos y la curación radiográfica en progreso revelan unos resultados satisfactorios en las revaluaciones postoperatorias a los 6 y 18 meses

Root perforations are undesired complications that can occur during root canal treatments. The prognosis of teeth with root perforations could be affected by several factors described in the literature, such as location, size, immediacy in the repair, previous microbial contamination and the presence of a radiolucency adjacent to perforation. However, the introduction of mineral trioxide aggregate (MTA) resulted in an improved prognosis and higher success rates. The purpose of this case report was to describe two nonsurgical endodontic retreatments with lateral root perforations using two different materials and techniques for filling. A disinfection with 2,5% sodium hypochlorite was carried out in both root canals with root perforation. In the first case, the apical third of the canal was filled with vertically compacted warm gutta-percha, while the rest of the canal was sealed with white MTA (Angelus, Londrina, PR, Brazil) for proper sealing of the perforation. In the second case, in addition to presenting the added difficulty of a separated instrument, the complete root canal filling with perforation was performed using Biodentine (Septodont, Saint-Maur-des-Fosses, France). The absence of clinical signs and symptoms and the radiographic healing in progress revealed satisfactory results after 6 and 18 months of follow-up

Non-surgical management of an extraoral cutaneous sinus tract of odontogenic origin.

Chronic apical periodontitis associated with dental pulp necrosis is the main cause of odontogenic extraoral cutaneous sinus openings. These tracts are often initially misdiagnosed unless the treating clinician considers a dental aetiology. This case report of a 19-year-old woman describes the diagnosis and treatment of an extraoral cutaneous sinus tract of odontogenic origin. Non-surgical conservative endodontic therapy was opted as the involved teeth were restorable. One month after the completion of obturation, there was closure of the sinus tract. One year follow-up showed complete resolution of the sinus tract with minimal scar formation.

A 10-year Follow-up Study of 119 Teeth Treated with Apical Surgery and Root-end Filling with Mineral Trioxide Aggregate.

INTRODUCTION: The objective of this clinical study was to assess the long-term outcome (clinical signs/symptoms and radiographic healing) of teeth treated with apical surgery and mineral trioxide aggregate (MTA) for root-end filling. METHODS: One hundred ninety-five patients were recalled 1, 5, and 10 years after apical surgery for clinical and radiographic examinations. Three calibrated observers evaluated the periapical radiographs independently. The evolution of the cases over time was analyzed. Healing classification of teeth was divided into "healed" versus "not healed" teeth using well-established clinical and radiographic healing criteria. The potential influence of sex, age, type of treated tooth, type of MTA, and first-time versus repeat surgery on healing outcome was statistically analyzed. RESULTS: The inception cohort included 195 teeth. The dropout rate after 10 years amounted to 39% (n = 76). Of the 119 teeth available for the 10-year analysis, 97 teeth were classified as healed (81.5%). No significant differences were found with regard to the rate of healed cases for the subcategories of the parameters of age, sex, type of MTA, and first-time or repeat surgery. Concerning the type of treated tooth, the rate of healed maxillary molars (95.2%) differed significantly (P = .035) from the rate of healed maxillary premolars (66.7%). The predictive value of the cases classified as healed at 1 year and remaining so over the 10-year observation period was 86.8%. CONCLUSIONS: This 10-year follow-up study of teeth treated with apical surgery and MTA as root-end filling material showed an acceptable rate of healed cases. Many of the lost teeth had been extracted because of longitudinal root fractures during the observation period.

Retrograde root canal treatment: a prospective case series.

AIM: Root canal treatment of teeth with necrotic pulps and apical periodontitis may be complicated by limited access to the root canals due to restorations and dystrophic calcifications. The objective of this study was to evaluate retrograde root canal as a primary treatment using a surgical approach as an alternative to conventional orthograde treatment. METHODOLOGY: Patients with apical periodontitis in the anterior region of the maxilla were consecutively recruited to the study over a period of 4 years. Fifty-seven patients met the inclusion criteria and received retrograde root canal treatment. A clinical and radiographic evaluation was made after 1 and 2 years postoperatively. RESULTS: Clinical and radiographically evaluation after 2 years revealed a successful outcome (as defined in this study) in 90% of the cases. CONCLUSION: Retrograde root canal as a primary treatment was a reliable alternative to treat apical periodontitis on single- and two-rooted teeth with limited orthograde access to the root canals in the maxilla.

Agregado de trióxido mineral (MTA) em obturações retrógradas / The mineral trioxide aggregate (MTA) in retrograde obturation

A apicectomia seguida pela obturação retrógrada constituem no corte da porção apical da raiz do elementodentário, seguido do preparo de uma cavidade na porção final do remanescente radicular e a obturação desteespaço com um material apropriado. Vários materiais retrobturadores têm sido propostos com o objetivo depromover adequado selamento apical. O material ideal para ser utilizado em obturações retrógadas devepreencher alguns requisitos como radiopacidade, insolubilidade, promover um adequado selamento apical, serbiocompatível, inibir o crescimento microbiano, facilidade no preparo e inserção. O presente trabalho seconstitui de uma revisão de literatura sobre o uso do Agregado Trióxido Mineral (MTA) em obturaçõesretrógradas

The apicectomy followed by the dental root-end-filling represents the cut of the apical portion of the root ofthe tooth, followed by the preparation of a cavity in the final portion of the root and the filling of this spacewith a suitable material. Several root-end filling materials have been proposed in order to promote adequateapical seal. The ideal material for retrograde fillings must meet certain requirements like radiopacity,insolubility, promote adequate apical seal, biocompatibility, inhibit microbial growth, ease of preparation andinsertion. This work constitutes a literature review on the use of mineral trioxide aggregate (MTA) inendodontic surgery as root-end filling material

Management of a Previously Treated, Calcified, and Dilacerated Maxillary Lateral Incisor: A Combined Nonsurgical/Surgical Approach Assisted by Cone-beam Computed Tomography.

Teeth with calcified canals, dilacerated roots, and associated large periradicular lesions involving both cortical plates pose a challenge to dentists. In addition to the nonsurgical endodontic treatment, such teeth may require surgical intervention with concomitant use of bone grafting materials and barrier techniques. These techniques, when combined with the use of a host modulating agent such as platelet-rich fibrin (PRF), may improve the chances of success. A 26-year-old woman was referred for dental treatment with a recurrence of an intraoral sinus tract 2 months after periradicular surgery in the upper anterior region. Clinical and radiographic examinations revealed a calcified and perforated maxillary left lateral incisor with a severely dilacerated root as well as an associated large radiolucent lesion surrounding the roots of the maxillary left central and lateral incisors. A cone-beam computed tomographic scan of the anterior maxilla showed erosion of the labial and palatal cortical plates in the same region. A calcified canal in the lateral incisor was negotiated up to the straight line portion of the canal. Periradicular surgery with root-end resection was performed, and root-end filling was performed with mineral trioxide aggregate. The perforation present on the middle third of the labial surface of the root was repaired with mineral trioxide aggregate, and the canal was cleaned, shaped, and obturated. A PRF scaffold was prepared and used with a collagen membrane and a freeze-dried bone allograft. Follow-up visits after 3 months, 6 months, and 1 year revealed satisfactory clinical and radiographic healing. The combined use of nonsurgical and surgical modes of treatment cannot be overemphasized in this case. The use of PRF along with a bone graft and a barrier membrane may have enhanced the speed of healing and the resolution of periradicular radiolucency by enhancing bone regeneration.

The Influence of an Isthmus on the Outcomes of Surgically Treated Molars: A Retrospective Study.

INTRODUCTION: The purpose of this study was to investigate the effects of an isthmus on the success rate of surgically treated molars. METHODS: The study included 106 maxillary and mandibular first molars with endodontic lesions limited to the periapical area. Endodontic microsurgical procedures were performed according to the Yonsei protocol reported in a previous study. When an isthmus was observed after a high-magnification inspection, it was included in the retrograde preparation design. When an isthmus was not observed, only the main root canal space was prepared. The patients were followed up periodically every year after treatment. Success was defined as the absence of clinical signs and symptoms and radiographic evidence of complete or incomplete healing. RESULTS: Of the 106 teeth included in the study, 72 teeth had an isthmus, and 34 did not. Kaplan-Meier analysis revealed that the cumulative survival rate after surgery was 61.5% and 87.4% for 4 years when an isthmus was present and absent, respectively. A multivariate Cox proportional hazards regression analysis showed that the adjusted hazard ratio for failure was 6.01 times higher for the isthmus-present teeth than for the isthmus-absent teeth (P < .05). CONCLUSIONS: In this study, the success rate for endodontic microsurgery on isthmus-absent teeth was higher than that for isthmus-present teeth. Considering the success rate and potential risk of weakening the root after preparation, the techniques of isthmus preparation need to be improved.

Solubility and bacterial sealing ability of MTA and root-end filling materials.

Objective To evaluate solubility and sealing ability of Mineral Trioxide Aggregate (MTA) and root-end filling materials. Material and Methods The materials evaluated were: MTA, Calcium Silicate Cement with zirconium oxide (CSC/ZrO2), and zinc oxide/eugenol (ZOE). Solubility test was performed according to ANSI/ADA. The difference between initial and final mass of the materials was analyzed after immersion in distilled water for 7 and 30 days. Retrograde cavities in human teeth with single straight root canal were performed by using ultrasonic tip CVD 9.5107-8. The cavities were filled with the evaluated materials to evaluate sealing ability using the bacterial leakage test with Enterococcus faecalis. Bacterial leakage was evaluated every 24 hours for six weeks observing the turbidity of Brain Heart infusion (BHI) medium in contact with root apex. Data were submitted to ANOVA followed by Tukey tests (solubility), and Kruskal-Wallis and Dunn tests (sealing ability) at a 5% significance level. Results For the 7-day period, ZOE presented highest solubility when compared with the other groups (p<0.05). For the 30-day period, no difference was observed among the materials. Lower bacterial leakage was observed for MTA and CSC/ZrO2, and both presented better results than ZOE (p<0.05). Conclusion MTA and CSC/ZrO2 presented better bacterial sealing capacity, which may be related to lower initial solubility observed for these materials in relation to ZOE.

Sealing ability of MTA, CPM, and MBPc as root-end filling materials: a bacterial leakage study.

Objectives To evaluate the sealing ability of three root-end filling materials (white MTA, CPM, and MBPc) using an Enterococcus faecalis leakage model. Material and Methods Seventy single-root extracted human teeth were instrumented and root-ends were resected to prepare 3 mm depth cavities. Root-end preparations were filled with white MTA, CPM, and MBPc cements. Enterococcus faecalis was coronally introduced and the apical portion was immersed in BHI culture medium with phenol red indicator. The bacterial leakage was monitored every 24 h for 4 weeks. The statistical analysis was performed using the Wilcoxon-Gehan test (p<0.05). Results All cements showed bacterial leakage after 24 hours, except for the negative control group. The MBPc showed significantly less bacterial leakage compared with the MTA group (p<0.05). No significant differences were found between the CPM and the other groups. Conclusions The epoxy resin-based cement MBPc had lower bacterial leakage compared with the calcium silicate-based cements MTA and CPM.

Sealing ability of MTA, CPM, and MBPc as root-end filling materials: a bacterial leakage study

ABSTRACT Objectives To evaluate the sealing ability of three root-end filling materials (white MTA, CPM, and MBPc) using an Enterococcus faecalis leakage model. Material and Methods Seventy single-root extracted human teeth were instrumented and root-ends were resected to prepare 3 mm depth cavities. Root-end preparations were filled with white MTA, CPM, and MBPc cements. Enterococcus faecalis was coronally introduced and the apical portion was immersed in BHI culture medium with phenol red indicator. The bacterial leakage was monitored every 24 h for 4 weeks. The statistical analysis was performed using the Wilcoxon-Gehan test (p<0.05). Results All cements showed bacterial leakage after 24 hours, except for the negative control group. The MBPc showed significantly less bacterial leakage compared with the MTA group (p<0.05). No significant differences were found between the CPM and the other groups. Conclusions The epoxy resin-based cement MBPc had lower bacterial leakage compared with the calcium silicate-based cements MTA and CPM.

Solubility and bacterial sealing ability of MTA and root-end filling materials

ABSTRACT Objective To evaluate solubility and sealing ability of Mineral Trioxide Aggregate (MTA) and root-end filling materials. Material and Methods The materials evaluated were: MTA, Calcium Silicate Cement with zirconium oxide (CSC/ZrO2), and zinc oxide/eugenol (ZOE). Solubility test was performed according to ANSI/ADA. The difference between initial and final mass of the materials was analyzed after immersion in distilled water for 7 and 30 days. Retrograde cavities in human teeth with single straight root canal were performed by using ultrasonic tip CVD 9.5107-8. The cavities were filled with the evaluated materials to evaluate sealing ability using the bacterial leakage test with Enterococcus faecalis. Bacterial leakage was evaluated every 24 hours for six weeks observing the turbidity of Brain Heart infusion (BHI) medium in contact with root apex. Data were submitted to ANOVA followed by Tukey tests (solubility), and Kruskal-Wallis and Dunn tests (sealing ability) at a 5% significance level. Results For the 7-day period, ZOE presented highest solubility when compared with the other groups (p<0.05). For the 30-day period, no difference was observed among the materials. Lower bacterial leakage was observed for MTA and CSC/ZrO2, and both presented better results than ZOE (p<0.05). Conclusion MTA and CSC/ZrO2 presented better bacterial sealing capacity, which may be related to lower initial solubility observed for these materials in relation to ZOE.

Comparison of Mechanical and Indirect Ultrasonic Placement Technique on Mineral Trioxide Aggregate Retrofill Density in Simulated Root-end Surgery.

INTRODUCTION: The objective of this study was to evaluate the density of mineral trioxide aggregate (MTA) root-end filling placed by either manual condensation or manual condensation with indirect ultrasonic activation under simulated root-end surgery conditions in vitro. METHODS: Extracted human molar teeth were obtained and sectioned to provide single-rooted samples (n = 50). Roots were instrumented to a size of 40 with a .04 taper and obturated with a warm vertical technique. The coronal end of each root was embedded in resin. A root-end resection and root-end preparation were completed on each root. Samples were randomly assigned to receive root-end fillings with ProRoot MTA (Dentsply, Tulsa, OK) by 1 of 2 techniques: manual condensation alone (group M, n = 25) or manual condensation with indirect ultrasonic activation (group U, n = 25). MTA was placed incrementally to the level of the root end using the enumerated technique. Samples were weighed immediately before and after filling placement. MTA was removed from all samples so as not to change the root-end preparation, rinsed, and dried. Each sample then underwent MTA placement by the opposite technique, and weight was again measured immediately before and after MTA placement. MTA filling weights for each technique were analyzed statistically using a technique for repeated measures analysis. Statistical analysis was conducted to account for any carryover or order effects. RESULTS: After adjustment for carryover effects, it was found that regardless of the order of placement, the mean fill weight of MTA produced by the indirect ultrasonic method was on average 4.42 mg heavier than that produced by manual condensation alone. This result was statistically significant (P < .0003). CONCLUSIONS: Under simulated root-end surgery conditions, indirect ultrasonic condensation of MTA root-end fillings was shown to produce a filling that was significantly denser than MTA placed by manual condensation alone.

Sealing ability of root-end filling materials.

BACKGROUND: The aim of this research was to compare the apical sealing ability of different root-end filling materials (SuperEBA(®), ProRoot MTA(®), thermoplasticized gutta-percha + AH-Plus(®), thermoplasticized RealSeal(®)), by means of microbial indicators. MATERIALS AND METHODS: Thus, 50 human single-rooted teeth were employed, which were shaped until size 5 0, retro - prepared with ultrasonic tips and assigned to 4 groups, retro-filled with each material or controls. A platform was employed, which was split in two halves: upper chamber-where the microbial suspension containing the biological indicators was introduced (E. faecalis + S. aureus + P. aeruginosa + B. subtilis + C. albicans); and a lower chamber containing the culture medium brain, heart influsion, where 3 mm of the apical region of teeth were kept immersed. Lectures were made daily for 60 days, using the turbidity of the culture medium as indicative of microbial contamination. Statistical analyses were carried out at 5% level of significance. RESULTS: The results showed microbial leakage at least in some specimens in all of the groups. RealSeal(®) has more microbial leakage, statistically significant, compared to ProRoot(®) MTA and SuperEBA(®). No significant differences were observed when compared ProRoot(®) MTA and SuperEBA(®). The gutta-percha + AH Plus results showed no statistically significant differences when compared with the other groups. CONCLUSIONS: All the tested materials showed microbial leakage. Root-end fillings with Super-EBA or MTA had the lowest bacterial filtration and RealSeal shows highest bacterial filtration.

Dye leakage and modification of fast-setting mineral trioxide aggregate.

The objective of this investigation was to determine and decrease dye leakage of fast-setting mineral trioxide aggregate (FSMTA). Specimens using differing setting times or concentrations of calcium sulfate modified FSMTA were assessed for dye penetration. Based on the results, no statistical difference was found in the dye leakage of FSMTA compared with regular mineral trioxide aggregate (MTA). The addition of 10 percent calcium sulfate resulted in a statistical reduction in dye leakage compared to both unmodified FSMTA and regular MTA.

Outcome of orthograde retreatment after failed apicoectomy: use of a mineral trioxide aggregate apical plug.

INTRODUCTION: This controlled, single-center historic cohort study project evaluates treatment outcomes of a nonsurgical treatment approach after failed apicoectomy. METHODS: The treatment outcomes of nonsurgical retreatment after a failed apicoectomy were evaluated clinically and radiographically. The study cohort consisted of teeth that had received primary root canal treatment and subsequent apicoectomy elsewhere before the patients presented with post-treatment disease. Orthograde retreatment and obturation using an apical mineral trioxide aggregate plug was performed by postgraduate students and endodontic specialists in 25 cases between 2004 and 2012. Pre-, intra-, and postoperative information and the potential effect on the retreatment outcome were evaluated and statistically analyzed using the chi-square test. RESULTS: Twenty-two patients with 23 teeth attended the follow-up examinations (recall rate = 92%). The follow-up periods ranged from 12 to 102 months (median = 35 months). Twenty teeth (87%) were classified as "success," and 3 teeth were considered (17%) "failure." The chi-square test confirmed that the preoperative factor "number of roots" had a statistically significant effect on treatment outcome (odds ratio = 0.08; 95% confidence interval, 0-1.76; P = .03). The factor "tooth location" was of borderline significance (odds ratio = 0.1; 95% confidence interval, 0-2.14; P = .05). CONCLUSIONS: The results of the present study suggest that orthograde retreatment combined with orthograde placement of an apical mineral trioxide aggregate plug is a promising long-term treatment option for teeth with postsurgical pathosis. The success rates were higher for single-rooted teeth. The use of cone-beam computed tomographic imaging in cases of inconclusive periapical radiographs is recommended to minimize the risk of misinterpretation when assessing treatment outcome.

Periapical microsurgery: the effect of root dentinal defects on short- and long-term outcome.

INTRODUCTION: The purpose of this prospective clinical study was to evaluate the clinical outcome of endodontic microsurgery on roots exhibiting the presence or absence of dentinal defects at 1-year and 3-year follow-up period. METHODS: One hundred fifty-five teeth were treated with periapical microsurgery using a modern microsurgical protocol in a private practice setting. The root apices were resected and inspected for dentinal defects with a surgical operating microscope and a 0.8-mm head diameter light-emitting diode microscope diagnostic probe light. After inspection, root-end preparations were performed using ultrasonic tips, and root-end fillings were placed. Follow-up visits occurred at 1 year and 3 years postoperatively. The primary outcome measure used was the change in the radiographic apical bone density, and the secondary outcome measure used was the absence of clinical symptoms. RESULTS: Of the 155 treated teeth, a total of 134 teeth were assessed at the 1-year follow-up and 127 teeth at the 3-year evaluation. In the "intact" group, 94.8% healed at 1 year, and 97.3% healed at 3 years. In the "dentinal defect" group, 29.8% healed at 1 year, and 31.5% healed at 3 years. The baseline root condition of either "dentinal defect" or "intact" showed a statistical difference in the healing outcome at both 1 and 3 years. CONCLUSIONS: This prospective periapical microsurgery study showed a significant superior clinical outcome for intact roots when compared with roots with dentinal defects at both 1 year and at 3 years postoperatively.

Do gingival soft tissues benefit from the application of a papilla preservation flap technique in endodontic surgery?

PURPOSE: A healthy gingival condition after endodontic surgery may depend on adequate soft tissue management. The aim of this study was to compare 2 incision techniques, papilla base incision (PBI) and intrasulcular flap (IS), which are currently used in endodontic surgery. MATERIALS AND METHODS: In the present nonrandomized controlled clinical trial, patients requiring endodontic surgery on a single tooth were enrolled. PBI was used in 1 group and IS was used in the other group. The primary outcomes were changes in periodontal probing depth, gingival recession, and height of the interproximal mesial and distal papillae. Outcome variables were assessed preoperatively and 6 months after surgery. Between-group differences were evaluated through appropriate statistical analysis, with significance set at a P value equal to .05. RESULTS: Each group was composed of 12 patients and the 2 groups were comparable at baseline. Two weeks after surgery, papilla height decreased significantly in the IS group (2.05 and 1.80 mm at the mesial and distal aspects, respectively), whereas no significant decrease in papilla height was observed in the PBI group (0.10 and 0.20 mm). No statistically significant difference between groups was observed after 6 months. No significant difference between groups was found for gingival recession or probing depth at any follow-up time. CONCLUSIONS: Better soft tissue preservation in the early postoperative period was achieved using the PBI approach compared with the IS approach. The PBI can be recommended for endodontic surgical procedures involving esthetic regions.

18-year follow-up of dens invaginatus: retrograde endodontic treatment.

INTRODUCTION: Dens invaginatus is a rare developmental anomaly that occurs during odontogenesis, with a higher prevalence in the Caucasian race and no significant sex predilection; it can be bilateral. This anomaly occurs in approximately 1.26% of the teeth, and the maxillary lateral incisor is most often affected. METHODS: This case report describes a female patient with dens invaginatus in the maxillary right conoid lateral incisor. The patient presented to Araçatuba School of Dentistry, Universidade Estadual Paulista, São Paulo, Brazil, in 1995 with an acute periapical abscess in the palatal region of the tooth in question. After access preparation, the pulp in the main root canal was found to be vital and not associated with the abscess; therefore, surgical drainage of the abscess and root canal treatment of the main canal were performed. Surgical complementation was also performed to eliminate the infectious focus, which involved retrograde endodontic treatment of the dens invaginatus being obturated with Sealapex (Sybron Dental Specialties, Glendora, CA) and Ultrafil (Coltène/Whaledent AG, Altstätten, Switzerland). Radiographic assessments were completed periodically to verify healing. After 18 years, the patient returned to Araçatuba School of Dentistry, presenting crown fracture of the tooth in question. RESULTS: Radiographic examination showed repair and favorable conditions for tooth maintenance, so a post and porcelain core were made. CONCLUSIONS: The treatment was successful, achieving adequate repair with 18 years of follow-up.