Technique Tips: Practical alternatives to Mineral Trioxide Aggregate (MTA) Formulations for Root-end Plug Procedures

MTA may often be considered the material of choice for the management of wide apices not conducive to conventional root canal treatment. Alternatives, such as hydraulic calcium silicate-based materials, may be better suited in cases where the disadvantages associated with MTA may be undesirable. In this case report, the patient presented with a shortened (horizontally fractured) root due to mechanical trauma, for which Biodentine (Septodont, Saint-Maur-des-Fossés, France) was used as a plug, as an alternative material, such as MTA, would be likely to cause discolouration of the tooth. This Technique Tip suggests an alternative for the practitioner to consider when choosing material choices for apical plugs, particularly for teeth in the aesthetic zone.

MTA is suggested for use in a number of endodontic procedures, including the management of immature teeth with open apices.¹ The management of immature teeth involves chemo-mechanical preparation using sodium hypochlorite, followed by an apical plug of MTA. MTA is placed in contact with blood, dentine and remnants of sodium hypochlorite. Substrates in contact with bismuth oxide in MTA result in material discolouration,^2,3,4 and also tooth discolouration.⁵ This is considered a significant clinical shortcoming associated with MTA.⁶ A number of hydraulic calcium silicate-based materials are available as an alternative to MTA for use as an apical barrier, and may prove a reasonable alternative choice for practitioners to consider more frequently, as recent research findings suggest similar clinical performance and material properties to MTA without the issue of discolouration.⁷

Case report

In the case reported, the UL1 had sustained a trauma resulting in a transverse root fracture. The treatment plan involved provision of a root-end plug and root canal treatment to attempt to retain the UL1. Thorough disinfection with sodium hypochlorite over two visits was undertaken. Drying of the root canal space was completed prior to obturation, which was completed using Biodentine. An apical plug, 3 mm in length owing to the reduced overall working length, was used for apexification, followed by thermoplastic gutta-percha, resin-modified glass ionomer cement, and finally, composite resin to seal the access cavity, as illustrated by the final periapical radiograph. Manipulation and placement of the Biodentine was completed using appropriately sized pluggers. Figure 1 illustrates the final result.