Managing teeth with open apices can be a challenging scenario for clinicians. This case report describes the 24-year follow-up of a maxillary central incisor that failed to develop after a traumatic injury resulting in a wide-open apex. A 10-year-old girl presented complaining of discomfort in her upper teeth. Tooth #9 had received a traumatic blow several years before and was discoloured with a resin composite restoration on the mesio-incisal edge. The tooth was painful to percussion and palpation. An inadequate root canal filling and incomplete root formation were observed on the initial periapical radiograph. Root canal retreatment was initiated, and the canal filled entirely with mineral trioxide aggregate (MTA) because of the extremely wide canal and open apex. The patient was asymptomatic at the 24-year follow-up with the cone beam computed tomography and periapical radiographs demonstrating the stability of the MTA.

UNASSIGNED: Optimal dimensional stability is required for successful root canal treatment. A sealant called EndoSeal mineral trioxide aggregate (MTA) was recently introduced to the market due to its favorable physical and chemical properties. On the other hand, AH Plus (AHP) is considered the gold-standard seal.
UNASSIGNED: In this ex vivo quasi-experimental study, 24 single-canal premolars extracted from humans were cleaned and shaped with a motorized and rotary file, then that is divided into two groups. The teeth of each group were filled with gutta F3 and each type of sealant. The teeth were scanned by a micro-computed tomography device after 24 h. After 7 days of storage in phosphate-buffered saline solution, the samples were re-scanned. Data were analyzed using SPSS software (version 21). Descriptive data were presented as frequency, percentage, mean, and standard deviation. The Shapiro-Wilk and Kolmogorov-Smirnov tests were used to investigate the normality of the data. The Mann-Whitney test was used to compare the two groups, and the differences were ultimately not significant. The level of significance was set at 0.05 (P < 0.05).
UNASSIGNED: The mean differences between sealer volumes before and after the intervention were not significantly different between the two groups indicating that the EndoSeal MTA sealer is not inferior to the gold-standard root canal sealer, AHP.
UNASSIGNED: EndoSeal MTA can be considered a reliable sealer in endodontic treatments and be subjected to further investigation.

UNASSIGNED: To provide a continuous seal of the root canal, root-filling material should bond to the root canal dentin, ensuring the integrity of both the root-filling material and dentin remains in a static and functional state. The present study assessed the push-out bond strength of mineral trioxide aggregate (MTA) and cold ceramic (CC).
UNASSIGNED: In this laboratory trial study, 20 single-rooted, extracted human teeth without caries and cracks were selected. Each tooth was mounted in cold-curing resin. Then, 3 mm slices of mid-root dentin were obtained from each tooth. The specimens were randomly divided into two groups (n = 10) and filled with MTA ProRoot and CC. All specimens were stored for 30 days in an incubator at 37°C and 100% humidity. The push-out bond strength of the test materials was measured using a cylindrical punch with a 1-mm diameter. The punch was pushed against the test specimen at a speed of 1.0 mm/min using a universal material testing machine, extruding the filling test material. The push-out force during the test was recorded, and then, the internal surface of the teeth was examined to evaluate the mode of failure. Independent t-test and Chi-square were used to analyze the data. P < 0.05 was considered a significance threshold.
UNASSIGNED: The mean push-out bond strength in the CC group was 24.58 (MPa), and in MTA ProRoot, it was 23.77. No significant difference was observed between the two groups. The most frequent mode of failure in both groups was adhesive failure.
UNASSIGNED: The two materials have adequate push-out bond strength to root dentin, and there is no difference between the bond strength and mode of failure of the two materials.

UNASSIGNED: Calcium silicate cement like mineral trioxide aggregate (MTA) and Biodentine are known for their biocompatibility and are effectively used as retrograde filling materials. During their placement, the materials interact with oral tissue fluids like saliva and blood, so the aim of the present study was to assess the effect of distilled water, saline, and blood on the surface microstructure and compressive strength of MTA and Biodentine.
UNASSIGNED: In this experimental study, a total of 84 custom-made cylindrical molds were randomly allocated into two main cement groups (n = 42) MTA and Biodentine. Each group was further subdivided into three subgroups (n = 14) as per the testing conditions, that is, samples exposed to distilled water, saline, and fresh blood. Around 10 samples from each subgroup were tested for compressive strength using a universal testing machine (UTM), and the remaining four samples were used to examine the surface characteristics of MTA and Biodentine using a scanning electron microscope (SEM). One-way analysis of variance (ANOVA) and Tukey\'s post hoc tests were employed to calculate the mean compressive strength and standard deviation values.
UNASSIGNED: There was a significant difference in the compressive strength between MTA and Biodentine, especially in the presence of blood. During the SEM analysis, it was found that samples contaminated with blood or saline were devoid of acicular crystals in both groups. MTA group showed a more porous matrix with few hexagonal crystals than Biodentine.
UNASSIGNED: Biodentine may be advantageous as a root-end filling or root repair material in the presence of blood.
UNASSIGNED: Bhullar KK, Gupta V, Sapra M, et al. Evaluation of Surface Microstructure and Compressive Strength of Mineral Trioxide Aggregate and Biodentine in the Existence and Absence of Oral Tissue Fluids. Int J Clin Pediatr Dent 2024;17(S-1):S1-S5.

UNASSIGNED: This study aimed to evaluate and compare the clinical and radiographic success of platelet-rich fibrin (PRF) and mineral trioxide aggregate (MTA) as direct pulp capping (DPC) agents in primary molars.
UNASSIGNED: In this study, 50 primary first and second molars from healthy children aged 5-9 years requiring pulp therapy were randomly allocated into two groups. In the PRF group, after coronal pulp removal and hemostasis, the remaining pulp tissue was covered with PRF preparation. In the MTA group, after coronal pulp removal and hemostasis, MTA was placed, followed by a zinc oxide eugenol (ZOE) base and glass ionomer cement (GIC) in both groups. Clinical and radiographic evaluations were undertaken at 1-, 3-, 6-, 9-, and 12-month intervals.
UNASSIGNED: By the end of the 12th month, the overall success rate was 82.6% in the PRF group, whereas it was 61.9% in the MTA group.
UNASSIGNED: Platelet-rich fibrin can be used successfully as an appropriate alternative material in DPC of primary teeth when compared with MTA.
UNASSIGNED: Tiwari T, Tyagi P, Tiwari S, et al. To Evaluate and Compare Platelet-rich Fibrin and Mineral Trioxide Aggregate as Direct Pulp Capping Agents in Primary Molars: A Randomized Prospective Clinical Study. Int J Clin Pediatr Dent 2024;17(S-1):S25-S29.

BACKGROUND: This study aimed to compare the in vitro shear bond strength (SBS) of mineral trioxide aggregate (MTA) and dual-cured, resin-modified calcium silicate material (Theracal PT) to composite resin, compomer, and bulk-fill composite, and to evaluate the bond failure mode under a stereomicroscope.
METHODS: Ninety acrylic specimens, each with a 4 mm diameter and 2 mm height central hole, were prepared. These specimens were randomly divided into two groups based on the capping materials: MTA and Theracal PT. Each group was further subdivided into three subgroups (n = 15) according to the restorative materials: composite resin, compomer, and bulk-fill composite. The specimens were then subjected to shear testing using a universal testing machine at a crosshead speed of 1 mm/min. Post-test, the fracture locations were examined using a stereomicroscope. Data were analyzed using a two-way analysis of variance (ANOVA) and the Tukey test.
RESULTS: The SBS values for the Theracal PT group were significantly higher than those for the MTA group (p < 0.001). Within the MTA groups, no significant differences were observed in SBS values across the different restorative materials. However, a significant difference was found between the mean SBS values of the Theracal PT + composite resin group and the Theracal PT + compomer group (p < 0.001).
CONCLUSIONS: Theracal PT shows promise in dentistry due to its superior bond strength. Given its bond values, Theracal PT appears capable of forming durable and long-lasting restorations by establishing reliable bonds with various restorative materials commonly used in dentistry.

OBJECTIVE: Jf the study was to assess the efficacy of mineral trioxide aggregate for treatment of children with complicated permanent teeth trauma.
METHODS: The study comprised 29 children aged 6-13 years (mean age 8.6±1.7 years) with 36 injured constant teeth, from which 30 had immature roots, 27 (75%) teeth had necrotic pulp at baseline examination, 12 (33.3%) teeth showed radiological signs of external imflammatory root resorbtion, 2 teeth were diagnosed with of the root fracture (5.6%). MTA was used for pulp regeneration procedure in 25 (69.5%) teeth, external closure of resorbtion site in 3 (8.3%) teeth, root canal filling in 4 (11.1%) teeth, apical plug creation in 4 teeth (11.1%). The patients were folowed up for 1 to 9 years.
RESULTS: From 36 teeth only one was extracted 9 years after regenerative endodontic procedure because of cervical root fracture. In 2 teeth with external imflammatory resorbtion progession of replacement resorption took place, in 1 tooth necrosis of regenerated pulp tissue occurred 2 years after the procedure because of restoration marginal seal failure. In 25 teeth favorable outcome was registered with stabilisation of external root resorbtion, continous root growth in 24 teeth and radioluscent lesions healing in 6 teeht showing them at baseline examination. Change of external imflammator root resorbtion to replacement resorption was detected in 1 teeth from 3 with external closure of resorbtion site. Root calan filling with MTA was performed in 3 avulsed teeth with replantation delayed for more than 1 day and in 1 tooth with root fracture. All teeth were clinically asymptomatic during more than 5 years follow-up. Favorable outcome was received in all cases of apicl plug formation.
CONCLUSIONS: MTA is highly effective for preservation of constant teeth in children with clinically complicated situations. In many cases with hopeless long-term prognosis for a teeth MTA allows stabilization of dental tissue level with the teeth being an object for guided tissue regeneration.
UNASSIGNED: Оценить эффективность применения минерал триоксид агрегата (МТА) для лечения детей с осложнениями травмы постоянных зубов.
UNASSIGNED: В исследовании приняли участие 29 детей в возрасте 6—13 лет (средний возраст 8,6±1,7 года), имеющих в анамнезе травму 36 постоянных зубов. Из 36 зубов в 30 были несформированные корни, у 27 (75%) зубов был некроз пульпы на момент обращения, у 12 (33,3%) — признаки наружной воспалительной резорбции корня, у 2 (5,6%) — переломы корней. Были проведены: регенерация пульпоподобной ткани в 25 (69,5%) зубах, закрытие зоны резорбции или перелома в 3 (8,3%) зубах, пломбирование канала МТА в 4 (11,1%) зубах, создание апикального барьера МТА в 4 (11,1%) зубах. Период наблюдения составил от 1 года до 9 лет.
UNASSIGNED: Из 36 зубов только 1 был удален через 9 лет после выполнения в нем регенерации пульпоподобной ткани в связи с патологическим переломом корня. В 2 зубах отмечен переход наружной воспалительной резорбции в наружную заместительную резорбцию, еще в 1 зубе через 2 года обнаружен некроз вновь образованной пульпоподобной ткани в связи с нарушением герметизма реставрации. В остальных 25 зубах отмечено благополучное течение со стабилизацией наружной воспалительной резорбции, продолженным ростом корня в 24 зубах и заживлением обширных очагов просветления в периодонте, имевшихся в 6 зубах до начала лечения. При наружном закрытии зоны резорбции или перелома корня переход в наружную заместительную резорбцию отмечен в 1 зубе из 3. Пломбирование МТА канала было выполнено в 3 зубах с полным вывихом при обращении более чем через 1 сут после травмы и в 1 зубе с переломом корня. Все зубы клинически бессимптомны при более чем 5-летнем наблюдении. При формировании апикального барьера из МТА во всех случаях отмечен благополучный исход.
UNASSIGNED: МТА высокоэффективен для сохранения постоянных зубов после травмы у детей в клинически сложных ситуациях. Во многих случаях, когда долгосрочное сохранение зуба невозможно, лечение с применением МТА позволяет стабилизировать состояние костной ткани, используя зуб как объект для направленной регенерации кости.

BACKGROUND: The existence of voids within the mineral trioxide aggregate (MTA) composition is one of the factors that can influence the treatment outcome. The primary objective of this study was to quantitatively assess and compare the MTA orthograde obturation quality in severe curved root canals using two different MTA compaction techniques: manual compaction with K-file, or Auger technique using micro-computed tomography (micro-CT) imaging.
METHODS: For this study, 26 mandibular first molar teeth with severely curved mesiobuccal root canals were selected. These samples were randomly divided into two groups. All root canals were instrumented using ProTaper Gold rotary files up to the F3 file at the working length. In one group, OrthoMTA was compacted using a stainless steel K-file, while in the other group, the Auger technique was employed for compaction into the root canals. Once the MTA had completely set, the filled root canals were subjected to scanning using a high-resolution micro-CT scanner. The porosity volume was determined as a percentage in relation to the overal volume of the canal, and the collected data were subjected to analysis using SPSS software, with the significance level set at P < 0.05.
RESULTS: The two techniques had no significant difference in open, closed, and total mean porosity. In both groups, the mean of open porosity was significantly more than closed porosity.
CONCLUSIONS: According to the results of the present study, neither of these two techniques is preferred to the other, and factors such as working time, etc., can be considered to choose the more appropriate clinical technique.

The objectives of this article are to report 2 cases of nonsurgical endodontic treatment for the management of periapical lesions associated with large cortical bone perforations and review the literature on the clinical efficacy of nonsurgical endodontic treatment to draw insights from published case reports. Large, cyst-like periapical lesions in 2 patients were successfully treated with combined modalities of root canal treatment, antimicrobial therapy (calcium hydroxide and triple antibiotic paste [TAP]), and mineral trioxide aggregate (MTA) obturation of the canal space. In both cases, instrumentation was extended 1 mm beyond the apical foramen to facilitate drainage through the root canal, because it was assumed that the periapical lesion could be cystic. After instrumentation, TAP was placed within the canal space to aid in disinfection and healing of the dental, pulpal, and periapical conditions. In both patients, the teeth were asymptomatic and functional at follow-up examinations (case 1, 3 years; case 2, 30 months). Supporting the positive outcomes in the 2 clinical cases, the published literature suggests that the use of biocompatible materials such as MTA, which can promote the deposition of hydroxyapatite, has the potential to contribute to tissue regeneration and the healing of large periapical lesions.

Mineral Trioxide Aggregate (MTA) is the gold standard for vital pulp treatment (VPT), but its superiority over novel calcium silicate-based cements in permanent teeth lacks systematic evidence. This study aimed to compare the efficacy of these materials in VPT through a network meta-analysis. A systematic search was conducted in MEDLINE, EMBASE, Cochrane Library, and Web of Science until January 20, 2024. The inclusion criteria were randomized controlled trials involving VPT with biomaterials and reversible or irreversible pulpitis diagnoses in mature permanent teeth. The primary outcome was the odds ratio (OR) of failure rates with 95% confidence intervals. In the 21 eligible trials, failure rates were significantly higher with calcium-hydroxide than MTA at six (OR 2.26 [1.52-3.36]), 12 (OR 2.53 [1.76-3.62]), and 24 months (OR 2.46 [1.60-3.79]). Failure rates for Totalfill at six (OR 1.19 [0.55-2.58]) and 12 months (OR 1.43 [0.71-2.92]), and Biodentine at six (OR 1.09 [0.66-1.78]), 12 (OR 1.21 [0.74-1.96]), and 24 months (OR 1.47 [0.81-2.68]) were not significantly different from MTA. The results were similar in the direct pulp capping subgroup, whereas, in the partial and full pulpotomy subgroup, there was not enough evidence to achieve significant differences. MTA, Biodentine, and Totalfill are the most efficient materials for VPT. However, calcium-hydroxide-based materials are not recommended in VPT.