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Apical barrier technique with MTA - Courtesy ROOTS
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From: Marga Ree
Sent: Friday, April 10, 2009 05:08 PM
Subject: [roots] Easy MTA barrier

Nothing fancy, just a regular case. Apical barrier technique with MTA,
fiber post and composite BU. Completed in 3 sessions, as usual - Marga

Hi marga, nice case, are you using a fast set MTA??? - Edward Abadia No, I use ProRoot - Marga Hello Marga, Any Us tip. - Georgette Yes, but I would prefer to pick one that can be used at a high power setting.....otherwise it might be an expensive procedure...:-)) - Marga Marga, Can you take us through the MTA placement in exact detail? I struggle with apical control of the plug, despite trying all the tricks in the book - Bill Hi Bill, As you know, I use an extraradicular barrier the control MTA placement if there is a wide open apex. 1. First session: access, irrigation with NaOCl 5% US activated, EDTA and CHX 2%. WL determination with LS, light interumentation with LS, application of CaOH for at least 4 weeks 2. Second session: Check whether a dry canal has been obtained. If not, reapply CaOH for another month. If the canal is dry: application of CaSO4 outside the root canal (condense with pluggers and fat paper point) to create a matrix against which MTA can be applied. Check with rad., CaSO4 a radiopacity similar to dentin. Mix MTA in a consistency of wet sand, pick it up in a MTA Dovgan gun, extrude a pellet to check if it keeps it's form. Prefit the thickest plugger that will reach WL, preset the stop of the plugger 1 mm short of WL, apply MTA as apical as possible, tease the MTA plug genltly in an apical direction with a fat paper point. Then insert the plugger, have your assistant touch the plugger with an US tip for a couple of seconds, dry again with fat paper points. Repeat this procedute till you have a 5 mm plug of MTA. Check with radiographs. In case you have voids, go in with an US tip that penetrates the plug, and repeat the procedure with paper points and pluggers. Hope this helps! - Marga Marga, Thanks very much, I know you will have answered this before, do you have a source for the CaSO4? - Bill - Marga Hi Marga .....nice case as usual . I have a few questions .....I know that you prefer using a calcium sulphate barrier before placing the MTA but what would happen if some of the MTA extrudes out of the canal if we are not using a barrier? I presume that some don't use a barrier with MTA...... if not then how do they condense the MTA...I mean against what ? - Sachin Hi Sachin, The reason for me to use a barrier of CaSO4 is the fact that it gives me a better control on the placement of MTA. I don't care extrusion that much, it will probably do no harm, but I do care the fact that the apical plug is not as dense as it could be. Some people use CollaCote as a barrier, but since this is a bovine product, it may not be suitable for every patient, although I know that many people report nice results with it - Marga Nice case Marga. Fiber posts and their removal are the new headache that is headed our way. I hope someone is working on a solution aside from sweat and tears - Carol Hi Carol, Yes, fiber posts have become very popular over the last years. I use Munce burs, in conjunction with US tips for removal. Ususally it's not a real problem to remove them, use lots of water to distinguish them from tooth structure, they will get a gray appearance when getting wet. - Marga I noticed this thread and wanted to interject that Unicore drills by Ultradent and the ReAccess kit by RTD are both well suited to remove any brand of Fiber posts - Brian

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