MTAApplications

in Pediatric
Dentistry
Guided by : Dr Navneet Presented by : Paridhi Tiwari
Agrawal Paediatric and Preventive
Professor & Head Dentistry
Author:
Maturo P, Costacurta M, Bartolino M, Docimo R. MTA
applications in pediatric dentistry. Oral & Implantology.
2009 Jul;2(3):37.
Introduction
• The Objective of deciduous teeth endodontic therapy is that of
keeping if possible, teeth active till their normal exfollation
time.
• Ensuring root development continuity.

MTA is most helpful in these circumstances, allowing the operator

to perform difficult therapies In a highly secure and predictive
way compared to other materials.
Carious pathology 8.4–8.5.
Periapical endoral radiography 8.4–8.5.
MTA placement after cameral pulpotomy.
Control radiography (6 mths post-op).
Clinical Applications
Deciduous Element
Pulpotomy
A seven years old child that reported Pain during Mastication at the lower
right hemi-arch. The Intraoral clinical examination revealed that the
patient presented carious pathology on dental elements.
At the time of exposure of various tissue

Coronal Pulp exposure was noticed

Bleeding Grade Evaluated

Evaluation of integrity of root structure &

periapical lesions
 Pulpotomy was done

Pulp content was removed and accurately sectioned

from canal entrance with sterile excavator

Radicular pulp bleeding was controlled with sterile

cotton pellets moistened with physiological solution

MTA used to cover sectioned Pulp

 Moistened Cotton is placed in direct contact
with MTA

Tooth filled with temporary material

After 3 days MTA solidified was checked

Permanent teeth
capping
▶ Materials to perform direct capping MTA is the material of choice
▶ Direct capping is to be considered as an appropriate procedure in
immature apex teeth and pulp exposure, without any sign of
irreversible pulpitis.
▶ MTA Stimulates the formation of dentinal bridge in contact with
dental pulp tissue.
▶ The dentinogenic effect of MTA may be a consequence of it’s sealing
properties, it’s biocompatibility and it’s alkalinity.
▶ The patient We have observed, an 11 years old child, presented a
various pathology on the lower left first molar.
▶ The decay was symptomless, non- aching to percussion or touch,
with absence of any periradicular pathology visible on radiographic
examination and had a positive response to sensibility test.
▶ Once the various tissue was removed we noticed the exposure of
the pulp horn at the mesiolingual cusp.
▶ We proceeded cleansing the dental surface with a cotton pellet
moistened in sodium hypochlorite 5.25%
▶ In order to reach haemostasis of the pulp exposure, we used sterile
cotton pellet moistened in physiological solution.
▶ Afterwards, we applied the MTA cement in the exposed pulp area, and
then, we placed a cotton pellet moistened in sterile water and a
temporary filling.
▶ We performed a radiological control by means of periapical endoral
radiography.
▶ Three days after, we performed the pulp vitality test, obtaining a
positive sult.
▶ We proceed to remove the temporary fill, so as to be able to check
the MTA solidification .
▶ Proceed with permanent reconstruction of the element with
composite material .
▶ We repeated vitality tests and control radiographies at 1,3,6 and 12
months.
Periapical endoral radiography 3.6.
Element 3.6, mesio-lingual pulp corn exposure.
MTA placement radiography.
Restored element radiography.
Control radiography (12 mths
post-op).
Apexogenesis

▶ Apexogenesis is the elective therapy in case of pulp exposures due to

iatrogenic or carious trauma in dental elements that do not have complete
root maturation yet.

▶ This procedure is performed with the goal of preserving pulp vitality and,
thus, allowing the physiologic growth, the thickening of canal walls and the
closure of root apex to follow their natural trend.
▶ MTA seems to have all requested characteristics that are normally
asked to an ideal cement in order to be able to seal any existing
communication between root canals.

▶ The oral Cavity and, at the same time, it guarantees a high

biocompatibility on the pulp stump.

▶ A 10 years old girl that presented a contusive trauma an upper central

incisors occured more or less four days prior to the visit.
▶ At oral examination we observed an enamel- dentin crown fracture of
elements 1.1 and 2.1 with pulp exposure with a direct pulp capping.
▶ In the endoral radiography we observed that apices from elements 1.1 and
2.1 we’re not yet completely formed.
▶ We, then decided to preserve the root pulp in order for apexogenesis to
take place.
▶ After having administered local infilteation anesthesia and after having
isolated the concerned elements with dental rubber dam we proceeded to
clean the exposed pulp with sodium hypochlorite at 5.25℅.
▶ We opened the pulp chamber of 1.1 and 2.1 elements and amputated
the pulp with a sterile ex- cavator.

▶ In order to have bleeding under control we compressed a physiologic

solution moistend cotton pellet into the canal for five minutes.

▶ Once we checked whether haemostasis was taking place we used non

– diluted, sterile, calcium hydroxide on element 1.1 and white MTA on
element 2.1.
▶ The cavity element of 1.1 was filled with glass ionomer cement,
while, on element 2.1,in order to stimulate setting reaction of MTA we
Placed a direct contact sterile water moistened cotton pellet.

▶ The cavity was filled with temporary material and we made a control
radiography.

▶ 72 hours after the intervention on element 2.1 we removed both , the

temporary filling material and the cotton pellet.
▶ Once we had checked the setting reaction of MTA, the cavity was
filled with glass ionomer cement.

▶ Then, we restored both elements with composite materials .

▶ We check again the patient on months 3,6,9,12 and 24.

▶ In all visits both elements resulted positive to vitality tests and no

periradicular lesion radiographically visible was observed.
Complicated crown fracture of
1.1 e 2.1, front view.
Complicated crown fracture of
1.1 e 2.1, occlusal view.
Periapical endoral radiography
1.1–2.1.
MTA placement.
Control radiography (24
mths post-op).
Apexification

The apexification technique with calcium hydroxide has always had a

great success ; nevertheless, it also has some disadvantages :
▶ Time needed for the apex to mature is sometimes too long and
cannot be programmed beforehand.
▶ We need to regularly replace the canal medication enen if with this
procedure we risk to loose the crown barrier and contaminate the
root canal.
Complicated crown fracture
of 2.1, front view.
Exploratory radiography
and length of intervention.
MTA placement
radiography.
Control radiography (12
mths post-op).
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Thank You