Asgary Saeed, Fayazi Sara
Iranian Center For Endodontic Research, Research Institute of Dental Sciences, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
The University of Texas Health Science Center at San Antonio, Texas, USA.
Iran Endod J. 2017 Summer;12(3):376-380. doi: 10.22037/iej.v12i3.17689.
This case report presents the successful surgical treatment of a symptomatic open apex upper central incisor with a failed overfilled mineral trioxide aggregate (MTA) apical plug. Unintentional overextension of the MTA had occurred two years before the initial visit. An apical lesion adjacent to the excess MTA was radiographically detectable. Endodontic surgery was performed using calcium-enriched mixture (CEM) cement as a root-end filling material. Curettage of the apical lesion showed a mass of unset MTA particles; histopathological examination revealed fragments of MTA and granulation tissues. Up to 18-month follow-up, the tooth was clinically asymptomatic and fully functional. Periapical radiograph and CBCT images showed a normal periodontal ligament around the root. In conclusion, favorable outcomes in this case study suggested that root-end filling with CEM cement might be an appropriate approach; in addition, however many factors probably related to the initial failure of the case, the extrusion of MTA into the periapical area should be avoided.
本病例报告展示了对一例症状性开放根尖的上颌中切牙成功进行的外科治疗，该牙之前用超充的三氧化矿物凝聚体（MTA）进行根尖充填失败。在初次就诊前两年，MTA出现了意外超填。在X线片上可检测到与多余MTA相邻的根尖病变。采用富钙混合物（CEM）水泥作为根尖充填材料进行了牙髓外科手术。对根尖病变进行刮治时发现了一团未凝固的MTA颗粒；组织病理学检查显示有MTA碎片和肉芽组织。随访长达18个月，该牙临床无症状且功能完全正常。根尖X线片和CBCT图像显示牙根周围牙周膜正常。总之，本病例研究的良好结果表明，用CEM水泥进行根尖充填可能是一种合适的方法；此外，尽管该病例最初失败可能涉及许多因素，但应避免MTA挤入根尖区。
