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MTA : Intracanal placing : Apex case

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I think this is what you are looking for :

They are called Dovgan Carriers. They are disposable carriers, but if you are diligent in cleaning them you can
re-use them after sterilization. The trick is to clean them right after you place the MTA. And I mean right away!
They are rather inexpensive ( ~$22/each).

As you know MTA is NOT condensed, but vibrated in to site. This is the most common misconception with this
material. As dentists we are used to "condensing" everything. What you need with MTA is  gentle
vibration to allow the material fill the space desired. Using a paper point or a condenser to tease the material
in place is OK, but after placing to length, you need to gently touch it with ultrasonic for flowing it densely.
If you have ever watched workers pouring concrete, you notice they never pack it, but instead they vibrate or
"swirl" it as they call it. You can use a wet cotton pellet over the MTA for hydration or better yet, use calcium
hydroxide instead. It is a buffering medium, anti-bacterial and wet. On re-entry just wash the Ca(OH)2 out of the
canal and check harness of MTA. MTA overfill is inconsequential as long as the apical mass is dense - Ahmad

Ahmad, as always man, beautiful description on how to flow MTA in. CaOH......great idea and thanks alot .........
Clap clap clap - Glenn

From: "Renaldas Kanarskas"
To: "ROOTS"
Sent: Sunday, July 30, 2006 2:27 PM
Subject: Re:[roots] Intracanal placing of MTA.

Very nice explanation, Ahmad! Thank you!

Looked for physical parameters of MTA carriers and saw, that minimal diameter of the tip is 0.8 mm. So, we insert
this device into canal far away from apex (considering, canal is not always as wide, as #80 file). What should we
do after this, condense to apex or use an ultrasonic right away? Where should be the tip of US-file against the
apex? - Renaldas

Normally when you place MTA it is either in an open apex case, strip perf or pulpal floor. An internal perforation
where it doesn't communicate with oral fluid. You don't have to be right at the apex with MTA carrier needle.
Normally with MTA carriers you need several masses of MTA delivered to the apex. I never try to place one giant
bolos of MTA. First, the lumen of carrier is very small and packing a bunch of MTA can clog it before you can
express it out. Secondly as you mentioned it is usually short of the apex. Here is a case where you can see the
aliquots of MTA placed shy of the apex. You can see the depth of condenser (top UR) penetration to drive the MTA
apically. I placed the condenser in the canal between the mass of MTA and my asst. touched the condenser with ult.
sonic tip. I was able to gently "swirl" it down to apex. I never try to place the US tip at the apex. Always use
an indirect method . It is easier to visualize under scope, with better control and less likelihood of an
iatrogenic accident. -  Ahmad

From: Nuria Campo To: ROOTS Sent: Sunday, July 30, 2006 5:18 AM Subject: Re: [roots] Intracanal placing of MTA. Hi Ahmad, Vibration VS Condensation of MTA, masterly explained concept...I use retrograde Ag carrier SS 52 from Bontempy, 1mm internal diameter according to calibrator. The suggestion of place Ca(OH)2 for wetting MTA is very interesting, do you use pure Ca(OH)2 power mixed with saline or some comercial registrated product? and why? My prefered is Ultracal XS from Ultradent (xeringe presentation and navitip needle, easy application,not set in time, radiopacity). In my last case I use White MTA in one 11 (or 8 in USA) and the tooth become a bit grey, perhaps I didnīt clean very well the rests of MTA in the pulp chamber, but I think that the grey discoloration didnīt appear with withe presentation. Has someone the same experience? or Are there some lit about that? (I promise send pics and rads of the case in 3m when te patient return to follow-up control) - Nuria, Barcelona From: Ahmad Tehrani To: ROOTS Sent: Monday, July 31, 2006 7:18 AM Subject: Re: [roots] Intracanal placing of MTA. Hi Nuria: The metal carrier is very interesting and probably does a fine job. I use CH over MTA, in cast post spaces while the case is in lab, retreatment cases. or anytime I have to re-enter the tooth at a later time. If you look closely under the scope after you remove the cotton pellet, you can see lint fibers attached to MTA hard surface. These are certainly pathway for bacteria while we are trying to minimize leakage and re-infection. BTW, I have the same concern about paper points ( after Terry brought it up) and anxiously waiting for Dr. Pannkuk's Lint free, fiber-less points. Many years ago while MTA was a hot topic, Dr. Ben Schein posted an article from a very obscure journal (since he reads everything) about MTA releasing Ca(OH)2 as one of its chemical byproducts. So I thought presence of CH over MTA is not going to produce a weird chemical reaction. Certainly Ultracal is easier to use, but I use USP CH powder & mix it with anesthetic solution. CH maintains its paste form and hydrates the MTA to achieve its ultimate hardness in 4-6 hours.... place a tiny layer of cavit over the CH and bond a composite as final layer. I don't use white MTA, but I have heard from others about discoloration. But you should explore the list of usual suspects: Was it is caused by incomplete removal of coronal pulp horn (due to under extension of access preparation)? placement of MTA above the osseous crest or leaving remnants of MTA in the pulp chamber? if Chlorohexidine was used after NaOCl? What volume of NaOCl after EDTA? The length of time treatment that allowed the irrigants to stay inside the tooth? Was access too aggressive or too far facial (instead of lingual) that made the tooth transparent? What was the initial shade of the tooth prior to treatment? was the access sealed correctly? and more importantly did white MTA actually set hard upon inspection with a sharp explorer? - Ahamed Could someone explain to me, a novice compared to y'all, what situations you would use mta to obturate? thanks - Mohammed Apexification and all cases of open apex Retrograde obturation material Lateral root perfs ( as far they are beneath bone crest ) Pulp chamber perfs (Partial) Pulpotomy Direct pulp capping Obturation of certain bizarre RCS anatomy ( dens in dente , ... ) - Jan Berghmans

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