Clinical Evaluation of MTA and Amalgam Retrofillings

Objectives: Unsuccessful endodontic cases or teeth with large periapical cysts can be treated with apical surgery. The use of root-end fillings during apical surgery may seal impermeably the resected root canal and prevent the leakage of bacterial toxins to the periapical area. Methods: Mineral trioxide aggregate (MTA, Dentsply, Tulsa, US) is a new dental material and can be used as a root-end filling material. MTA has reported to possess a high biocompatibility and superior sealing ability when compared with other root-end filling materials such as amalgam and zinc oxide eugenol derivatives. Thirty single-rooted cases including unsuccessful retreatments, overfillings and large periapical cysts were selected for the study. The root canals were dressed with calcium hydroxide mixed with saline for three weeks and then obturated using laterally condensed gutta-percha and a sealer. During the periapical surgery, the inflammatory tissues were removed and the root-ends were resected with minimum buccal angle. Root-end cavities were prepared with ultrasonic tips or with a bur in a low-speed handpiece. MTA was used as a root-end filling material in half of the cases and an amalgam (Oralloy, Coltene AG, Altstalten, Switzerland) was placed in the remaining fifteen cases. Results: The periapical healing was followed radiographically for 2 years. Thirteen of MTA cases showed periapical bone healing and the remaining two cases exhibited periapical healing both with scar tissue and bone. Twelve of amalgam cases showed healing with bone and the rest of teeth exhibited both scar tissue and bone. There was no significant difference in the healing of periapical tissues around MTA and amalgam root-end fillings after two years (p>0.0.5). Conclusion: The results of this study indicated that both MTA and amalgam root-end fillings may provide successful results when both root-end filling materials are used in endodontically treated single-rooted teeth.