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Marga: Would you be kind enough to detail the technique you use to place the CaSO4 barrier............my understanding is that Dr. T. prefers that nothing interface with MTA but tissue and yet, frankly, the excess if it occur doesn't set (well) if at all. This would be most informative.......thank you.- Kendo
Kendo, I use calcium sulphate hemi hydrate 98% medical grade as an extra-radicular matrix, prior to the application of MTA, in cases where there is a wide open apex and I might expect extrusion of MTA. I cannot support its use for this purpose with the available lit, and I only have my own clinical experience (and that of other colleagues) to rely on. I have the impression that I can obtain a closer adaptation of MTA to the canal walls, when an extraradicular barrier is used. An open apex doesn't provide any resistance when you try to condense the MTA in place, meaning that you are inclined to condense it maybe too cautiously. Moreover, it has been shown that the use of ultrasonics provides a radiographically denser MTA fill with fewer voids (Lawley et al. 2004), and again, my experience with a barrier and the use of ultrasonics is a better adapted MTA plug than without the use of a barrier, it simply gives you more control, and that is what I like about it.
Calcium sulphate has had a documented history of safe orthopaedic use for more 100 years (Dreesman 1892), and it has been used as a bone substitute in orthopaedics and oral surgery. According to Sottosanti (1992) and Pecora et al. (1997) it has potential applications in dentistry in guided tissue regeneration and it is a bioresorbable and biocompatible barrier. It is resorbed from 4-8 weeks (Pecora et al. 1997, Yoshikawa et al. 2002). Pecora et al.(2002) used it in through and through osseous defects and reported that it improved the clinical outcome. Murashima et al. (2002) found it to be effective in bone regeneration on both large osseous defects and through and through lesions. It has been reported to be osteoconductive, is applied easily and not expensive.
I apply the calcium sulphate with a messing gun ( I use the MAP system and Dovgan guns) and take all the efforts to prevent the calcium sulphate contaminating the walls of the canal, because it can interfere with the close adaptation of MTA. Therefore the tip of the messing gun must preferably reach beyond the AF. Ca sulphate is placed in small increments, and confirm the placement with a radiograph. It's radiopacity is similar to that of dentin. It sets in 1-2 minutes, so after the confirming the proper location on a rad, MTA can be applied immediately.
Take care: If you are using a messing gun for ca sulphate you have to work very fast, in order to prevent the setting of the material in the application tip. It sets within no time, and once the tip has become clogged, it usually means that you have to discard the tip. - Marga