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PubMed1997

Microleakage of Diaket and amalgam in root-end cavities prepared using MicroMega sonic retro-prep tips.

The in vitro sealing ability of the root-canal sealer Diaket when used as a root-end filling material was compared with that of amalgam using linear micro-leakage of Indian ink. Eight groups of 20 extracted teeth each were formed, plus 12 control teeth as follows: 1) root-end resection of 45 degrees bevel, root-end cavity preparation with an 008 round bur, amalgam root-end filling; 2) 45 degrees bevel, bur, Diaket; 3) 45 degrees bevel, using a sonic retro-prep tip, amalgam; 4) 45 degrees bevel, sonic, Diaket; 5) no bevel, bur, amalgam; 6) no bevel, bur, Diaket; 7) no bevel, sonic, amalgam; 8) no bevel, sonic, Diaket. Root-end cavity depths of 3 mm were prepared. Specimens were immersed in Indian ink for 2 weeks. The teeth were demineralized, rendered transparent and linear dye penetration recorded. Results showed that Diaket provided a superior seal to amalgam irrespective of the root-end preparation. The degree of bevel of the resected root-end did not influence leakage. Sonic instrumentation resulted in a larger root-end cavity than with burs.

Apicoectomy↗
PubMed1998

Preliminary results and analysis of a new set of sonic instruments for root-end cavity preparation.

The introduction of microinstruments for root-end cavity preparation has clearly improved the surgical technique in periradicular surgery with apicectomy. The new generation of sonic and ultrasonic root-end preparation devices, usually termed 'retrotips', has simplified the preparation of a sufficiently deep cavity that follows the original path of the root canal. The present paper describes the use of a new set of diamond-surfaced retrotips driven by a sonic handpiece. For clinical evaluation a prospective study was carried out, with assessment of pre-, intra- and postoperative data in 50 teeth (43 patients). This paper analyses: (i) the applicability of the new retrotips; (ii) the quality of the root-end filling assessed radiographically; (iii) the immediate postoperative course. Access with the retrotips to the resected root-end was found to be excellent in 80% of the treated teeth. The postoperative radiographs showed a root-end filling of at least 3 mm in 70% of the resected teeth. Healing was uneventful in all cases and most patients presented without any symptoms after 5 days and 10 days. The long-term treatment outcome will be reported in a future paper.

Adolescent↗
PubMed1999

Apical transportation revisited or 'where did the K-file go'?

CASE REPORT: This case report describes the outcome of a number of retreatments on a failed root filling in a maxillary first molar. The patient wanted all amalgams replaced by tooth-coloured Cerec restorations, including one in a symptomless maxillary molar. This tooth had a pulpotomy or a poorly done root-canal treatment 10 years earlier. The molar was root-canal retreated before placing the Cerec restoration and the palatal canal was filled 5 mm short of the radiographic apex. About 1 year later the patient presented with pain. Suspecting that a second mesiobuccal canal (MB-2) had not been located, a second non-surgical retreatment was instituted. MB-2 was not found and the palatal canal was retreated a third time, setting the working length 2 mm short of the radiographic apex. Because pain persisted palatally an apicectomy was performed and the tooth became symptomless. The resected palatal root apex was subsequently serially cross-sectioned, photographed and the canals analysed. Obvious apical transportation occurred during the cleaning and shaping procedures. Analyses of the canals showed that despite the retreatments, 11% of the canal cross-sectional area remained uncleaned although 7% of the root area was 'shaped'. Radiographically, the obturated palatal canal appeared reasonably well centred. However, this was disproved by the cross-sections, indicating that in this case, the clinician did not know where the K-Files had 'gone'. Apically, the obturated canal was certainly not within the natural canal. The pain located palatally was probably due to inadequate cleaning and shaping of the apical part of the root canal and its accessory canals.

Apicoectomy↗
PubMed1999

Response of periradicular tissues to growth factors introduced into the surgical site in the root-end filling material.

AIM: The objective of this study was to evaluate the healing of the periradicular tissues when exogenous growth factors were delivered to the respected root-end. The healing response was compared with that when Diaket was used as a control. METHODOLOGY: Non-surgical root canal treatment was performed on mandibular teeth in mongrel dogs. Surgical treatment followed and included root-end resection and root-end cavity preparation. Insulin-like growth factor in combination with platelet-derived growth factor, or fibroblast growth factor alone, were then placed in the root-end preparations on a polylactic acid carrier (Atrisorb) with or without the incorporation of the carrier tetracalcium phosphate. The healing was evaluated at 60 days with regard to presence of inflammatory response, bone regeneration, periodontal ligament formation and cementum formation. RESULTS: Osseous regeneration in the excisional would and periodontal formation were significantly greater when Diaket was used as the root-end filling material. Likewise, cementum deposition occurred significantly more frequently in the Diaket group (P < 0.05). The polylactic carrier Atrisorb remained in the surgical sites for the duration of the study. CONCLUSIONS: The use of specific growth factors, FGF and a combination of IGF/PDGF, delivered to the prepared root end in a collagen carrier did not initiate the desired periradicular tissue response of regeneration. Diaket, as used in this study, did stimulate a periradicular tissue response compatible with regeneration.

Analysis of Variance↗
PubMed2000

Prognosis in periradicular surgery: a clinical prospective study.

AIM: The purpose of this prospective study was to evaluate the prognosis of periradicular surgery using well-defined case selection and a rigorous surgical protocol. METHODOLOGY: Teeth to be treated surgically demonstrated a periradicular lesion of strictly endodontic origin with or without clinical signs and symptoms of inflammation. A total of 114 teeth were treated. Following the reflection of a full mucoperiosteal tissue flap, residual soft tissues were curetted, root ends were resected with a fine high-speed diamond bur, root-end cavities were prepared ultrasonically with diamond tips, and IRM root-end fillings were placed. Cases were followed clinically and radiographically for a period ranging from 1 to 4 years. RESULTS: The results of this study showed 91.2% success out of a total of 102 teeth available for follow-up, based on accepted parameters of evaluation. Cases were considered successful if there were no clinical signs or symptoms present and there was radiographic evidence of complete or incomplete healing (scar tissue). Factors related to case selection, parameters of healing and surgical technique are discussed in relation to the success rate identified in this prospective study. CONCLUSIONS: Adherence to a strict endodontic surgical protocol and the use of contemporary techniques and materials will result in a predictably successful outcome in a wide range of teeth.

Adolescent↗
PubMed2000

Analysis of the healing response to gutta-percha and Diaket when used as root-end filling materials in periradicular surgery.

AIM: To analyse the healing response to gutta-percha and Diaket when used as root-end filling materials in periradicular surgery. METHODOLOGY: Periradicular surgery was completed using the mandibular second, third and fourth premolar teeth from nine male mongrel dogs. The six roots on one side of the mouth were randomly allocated to one of the following groups: group A: a resected root end and a burnished gutta-percha root filling; group B: cavities were prepared to a depth of 4.0 mm, using ultrasonic root-end preparation and filled with Diaket. The response was evaluated histologically at 55 (nine specimens) and 150 (three specimens) days post operatively. RESULTS: The data for the 55-day period was analysed statistically using Wilcoxon's Signed Ranks test. No statistical analysis was carried out on the 150-day group due to the small number of specimens. The level of significance was set at P < 0.05. No statistical significance was observed in the healing response between Diaket and gutta-percha in the following categories at 55 days: inflammatory response, angiogenesis, root-end resorption, and cementum deposition. Statistically significant differences were observed in the healing categories: bone apposition (P < 0.05) and periodontal ligament formation (P < 0.05). CONCLUSIONS: At both time intervals, Diaket had a better healing response that was characterized by hard tissue formation adjacent to the root-end filling material bordered by occasional multinucleated giant cells. The nature of both the hard tissue formation and the adjacent cells, however, remains undetermined. Diaket displayed the best healing of either material used in this study.

Animals↗
PubMed2000

In vitro evidence that lipopolysaccharide of an oral pathogen leaks from root-end filled teeth.

AIM: The ability to achieve a complete apical seal of the root canal system is thought to be important in the success of non-surgical and surgical endodontics. The aim of this study was to establish whether or not root-end filled teeth allow leakage of lipopolysaccharide (LPS) from a known oral pathogen in vitro. METHODOLOGY: Lipopolysaccharide (LPS) from a virulent strain of Prophyromonas gingivalis (P. gingivalis) (A7436 from patient with refractory periodontitis), was isolated by the Westphall and Jann technique, dialysed extensively, lyophilyzed, resuspended in distilled water and analysed by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Root canals from 10 teeth were instrumented endodontically and the apical 3 mm of resected roots were filled with gutta-percha. The teeth were mounted in 12 mL polypropylene vials by using sticky wax and root surfaces were covered with two layers of nail varnish. Teeth were filled with 3.3 mg mL-1 LPS and the vials filled with 11 mL of Tris Buffered Saline (TBS) containing 0.05% sodium azide. Both positive and negative controls were run in parallel with the experimental specimens. Aliquots were removed each day and subjected to slot blot analysis to quantitate the amount of LPS that had leaked into the bottom of the vials. The density of slots was analyzed using a laser densitometer and regression analysis was used to generate a standard curve, confidence intervals and experimental values. RESULTS: The data indicated that teeth obturated apically with gutta-percha leaked, whilst no LPS leakage was detected in teeth covered completely with nail varnish (P < 0.05). CONCLUSIONS: In vitro teeth with gutta-percha root-end fills can permit leakage of LPS from an identified oral pathogen.

Apicoectomy↗
PubMed2001

An in vitro study comparing root-end cavities prepared by diamond-coated and stainless steel ultrasonic retrotips.

AIM: This study compared the appearance of root-end cavity preparations and the time required to prepare them using prototype ultrasonic diamond-coated (DC) and stainless-steel (SS) retrotips. METHODOLOGY: In 12 maxillary and 12 mandibular molar teeth 48 root-end cavities were prepared ultrasonically in the palatal, mesio-buccal, distal and mesial root-ends using DC and SS retrotips, alternately. Replicas of the resected root tips and the root-end cavities were examined under a scanning electron microscope (SEM), recording (i) incidence and extent of dentine cracks (ii) minimum remaining thickness of the dentine walls and (iii) surface quality of the resected root-ends. The time taken to complete the preparation was also recorded. Means of these parameters were compared for both types of retrotips using nonparametric tests. RESULTS: No resected root-ends had cracks before preparation. However, after preparation one root-end cavity shaped by an SS retrotip had a microcrack visible at 23x magnification. Four and seven other root-ends had crazed surfaces in the DC and SS groups, respectively (P > 0.05). Remaining minimum dentine thickness was 0.56 +/- 0.28 mm and 0.71 +/- 0.24 for the DC and SS groups, respectively, and this difference was significant (P < 0.05). A root-end cavity in one specimen in the DC group was perforated. Preparation times ranged from 25 s to 361 s and were significantly lower for DC tips (P < 0.01) than the SS tips. The time required to prepare root-end cavities also differed between roots; root-end preparation in mandibular molars was more time consuming. CONCLUSIONS: A better quality surface was produced by the prototype diamond-coated retrotips, in less time than the SS retrotips, which in turn caused fewer cracks than previously reported. DC retrotips removed more dentine than SS retrotips and should therefore be used with care to avoid overpreparation or perforation.

Apicoectomy↗
PubMed2001

The use of calcium sulphate in the surgical treatment of a 'through and through' periradicular lesion.

AIM: This randomized, controlled, clinical study was designed to evaluate the adjunctive effect of calcium sulphate grafts on the surgical treatment of through and through periradicular lesions. METHODOLOGY: Twenty patients each with one tooth showing evidence radiologically of a periradicular lesion wider than 10 mm, with lack of both buccal and lingual cortical bony plates and an indication for surgery were selected for the study. Ten teeth were treated with apicectomy, root-end filling and grafting of the bone defect with calcium sulphate prior to suturing (test group). The other 10 teeth received the same surgical therapy but no grafting with calcium sulphate (control group). The outcome of the healing process was evaluated at 6 and 12 months radiographically following the criteria reported by Rud and Andreasen. RESULTS: At the six- and 12-month evaluation the test group had seven teeth with complete healing and two with incomplete healing, whilst the control group showed three teeth with complete healing, five with incomplete healing and one with unsatisfactory healing. One tooth in each group had to be extracted because of a vertical fracture that occurred during the follow-up period. CONCLUSIONS: The results of the study demonstrate that the addition of calcium sulphate as a bone graft during the conventional surgical treatment of through and through lesions improves the clinical outcome. Histological analysis is desirable to investigate the quality of tissues formed using the two surgical procedures.

Adult↗
PubMed2001

Periapical healing of mandibular molars after root-end sealing with dentine-bonded composite.

AIM: The purpose was to present the frequency of periapical healing in first and second/third mandibular molars, after root-end resections sealed with a dentine-bonded resin composite. METHODOLOGY: Root-end sealing of resected mandibular molar roots was made with dentine-bonded composite (Gluma-Retroplast) as a cover on the entire slightly hollowed root-end, in an attempt to prevent leakage. RESULTS: Out of the 834 roots recalled between 6 months and 12.5 years postoperatively, 92% showed complete apical healing, 1% uncertain healing and 7% exhibited failure. The healing result of 681 first molar roots was not significantly different (P = 0.21) from that of 153 second/third molar roots, and there was no significant difference in healing between mesial and distal roots (P = 0.32 for first molars, P = 0.86 for second/third molars) or amongst six age groups (P = 0.94). In the patient group: 71-89 years, 36 roots showed an average of 97% with complete healing. Out of 25 failures who were retreated surgically, 80% showed complete healing when examined subsequently. CONCLUSION: Root-end sealing of mandibular molars with dentine-bonded resin composite is a promising technique giving 92% complete healing in cases examined between 6 months and 12 years postoperatively.

Adolescent↗
PubMed2001

Periradicular surgery of molars: a prospective clinical study with a one-year follow-up.

AIM: The purpose of this prospective clinical study was to evaluate the outcome of periradicular surgery of molars after one year. METHODOLOGY: The material consisted of 25 molars with 39 roots demonstrating periradicular lesions of endodontic origin. Surgical treatment included root-end resection, root-end preparation with sonic microtips, and root-end filling with Super-EBA cement. At the one-year follow-up examination, healing was evaluated clinically and radiographically. Healing was assigned to three categories: (i) success (ii) improvement, and (iii) failure using well defined criteria. RESULTS: Eighty-eight per cent of the surgically treated molars showed successful healing. In 8%, the healing was rated as improved and only 4% were failures. CONCLUSIONS: The outcome of the present study and data of recently published studies show that periradicular surgery may result in a predictable treatment outcome in molars with persistent periradicular lesions.

Adult↗
PubMed2002

Guided bone regeneration (GBR) using membranes and calcium sulphate after apicectomy: a comparative histomorphometrical study.

AIM: The purpose of the present study was to evaluate the effects of resorbable and non-resorbable membranes, and calcium sulphate on bone regeneration in osseous defects in conjunction with apicectomy. METHODOLOGY: The mandibular third and fourth premolars of 12 beagle dogs were root treated, and apicectomies were performed. The osseous defects were divided randomly into five groups. In groups A, B and C the osseous defects were covered with e-PTFE membranes, PLGA membranes, and collagen membranes, respectively. In group D, defects were filled with calcium sulphate. Nothing was used in group E, which served as controls. The dogs were sacrificed 4, 8, and 16 weeks after the surgery. Undemineralized sections were obtained and evaluated histomorphometrically. RESULTS: Newly formed cortical bone had closed the defect in the cortical plate in all groups at 16 weeks. The degree of concavity of the new cortical bone at 16 weeks in groups A and D was significantly less than in group B (P < 0.01). The percentage of regenerated bone in group A was significantly greater than in groups B (P < 0.01), C (P < 0.05) and E (P < 0.05). In group D, it was significantly greater than in groups B (P < 0.01) and E (P < 0.05). CONCLUSIONS: The data suggests that e-PTFE membrane is more effective compared to resorbable membranes and controls for bone regeneration after apicectomy, and that calcium sulphate could be substituted for e-PTFE membrane.

Absorbable Implants↗
PubMed2002

Papilla base incision: a new approach to recession-free healing of the interdental papilla after endodontic surgery.

AIM: The purpose of the present study was to describe and evaluate a new incision technique: the papilla base incision. METHODOLOGY: Twenty healthy patients referred for surgical treatment of persisting apical periodontitis, who were free of periodontal disease and had intact interdental papillae were included in the study. The preoperative papilla height was recorded by measuring the distance between the contact point and the most coronal point of the papilla. The papilla base flap, consisting of the papilla base incision and two releasing incisions, was used to expose the bone. The papilla base incision consisted of a shallow first incision at the base of the papilla and a second incision directed to the crestal bone, creating a split thickness flap in the area of the papilla base. Further apically a full thickness flap was raised. Following standard root-end resection and filling, flap closure was achieved with microsurgical sutures. The papilla base incision was sutured with 2-3 interrupted sutures, which were removed 3-5 days after the surgery. The experimental sites were evaluated at the conclusion of the surgery, at suture removal and after 1 month, and compared to the preoperative findings. The healing pattern, complications and postoperative recession were recorded. The experimental sites were observed with a x 3 magnification and graded as to whether a visible scar resulting from the incision could be detected. Twenty experimental sites were analysed. RESULTS: Complete closure of the wound was achieved in all cases after surgery. Except for four patients with delayed healing at suture removal, all other patients displayed rapid healing. No noticeable space was created beneath the contact point area. The change in distance between the reference point and the most coronal point of the papilla comparing the preoperative and the one-month postoperative situation was 0.05 +/- 0.39 mm. The probing depth remained within normal limits. One month postoperatively, observation of the incision demonstrated: four sites with a visible incision line (grade 1), in seven sites the incision defect could be partially detected (grade 2) and nine incisions could not be detected (grade 3). CONCLUSIONS: In patients with healthy marginal periodontal conditions the papilla base incision allows rapid and predictable recession-free healing following marginal surgical exposure of the soft tissues. One month postoperatively the majority of the incisions were completely or partially invisible. Long-term healing will be studied.

Adult↗
PubMed2002

Calcium sulphate as a bone substitute for various osseous defects in conjunction with apicectomy.

AIM: The purpose of this study was to investigate the effect of calcium sulphate on various osseous defects when used in conjunction with apicectomy. METHODOLOGY: Mandibular third and fourth premolars of 11 beagle dogs were used. After root-canal treatment and apicectomy, three types of osseous defects were prepared on both sides of the mandible as follows: type 1, osseous defect communicating with the gingival sulcus: type 2, large osseous defect including two roots; type 3, 'through and through' osseous defect. The experimental side was allocated randomly, and the osseous defects were filled with medical grade calcium sulphate. The defects on the opposite side were left unfilled as controls. The dogs were sacrificed at 8 and 16 weeks postoperatively. Undemineralized sections were obtained and examined histomorphometrically. RESULTS: In type 1 defects, bone was not observed on the buccal side of the root on either experimental or control side at 8 and 16 weeks. In both type 2 and 3 defects, bone volume/tissue volume (BV/TV) values on the experimental side were significantly higher than those on the control side (P < 0.01), and mineral apposition rate (MAR) values on the experimental side were significantly higher than those on the control side (P < 0.01). CONCLUSIONS: The use of calcium sulphate was effective in bone regeneration on both large osseous defects and 'through and through' osseous defects. It was less effective in osseous defects communicating with the gingival sulcus.

Alveolar Bone Loss↗
PubMed2002

Comparison of Diaket and MTA when used as root-end filling materials to support regeneration of the periradicular tissues.

AIM: The objective of this study was to evaluate on a comparative basis the potential for mineral trioxide aggregate (MTA) and Diaket to promote periradicular tissue regeneration when used as surgical root-end filling materials. METHODOLOGY: Seven dogs weighing between 15 and 25 kg were anesthetized prior to having the root canals of their mandibular premolars accessed, cleaned, shaped and obturated. Coronal access cavities were restored with IRM. Surgical access to the root ends was established and the root ends were resected and prepared with ultrasonic tips. Root-end fillings of either MTA or thickly mixed Diaket were randomly assigned to the preparations. Reflected tissues were repositioned and sutured with 4-0 vicryl sutures. Sixty days postsurgery, the animals were killed, perfused with 10% neutral buffered formalin and the third and fourth premolars removed in block sections. The specimens were demineralized and sectioned at 6-microm intervals for histological assessment. Sections were stained with either haematoxylin and eosin or Gomori's one step trichrome stain and examined under the light microscope. All evaluations were made by two calibrated examiners and gradings were scored based on established criteria. The raw data was evaluated statistically using anova after adjusting for the animal block effect. RESULTS: Statistical evaluation indicated that there were no statistical differences between the observed regenerative responses of the tissues to the two root-end filling materials. CONCLUSIONS: Both Diaket and MTA can support almost complete regeneration of the periradicular periodontium when used as root-end filling materials in periradicular surgery on noninfected teeth.

Aluminum Compounds↗
PubMed2003

Periapical endodontic surgery: a 3-year follow-up study.

AIM: To monitor the outcome of periradicular surgery in a group of teeth treated with microsurgical technology and ultrasonic root-end preparation. METHODOLOGY: One hundred and twenty-eight teeth with failed conventional root canal treatment were included. The surgical procedure was completed using ultrasonic retrotips and a zinc oxide-EBA (Super Seal, Ogna Pharmaceuticals. Milan, Italy)-reinforced material was used to seal the root end cavities. Lesions were examined radiologically at 1. 3. 6. 12, 24 and 36-month intervals. Radiographs were independently analysed according to a previously published classification. RESULTS: Eight teeth were extracted due to fracture or perforations undetected radiologically: these cases were excluded from the study. Of the 120 teeth examined. the overall success rate was 92.5%; 94 healed with complete bone filling of the surgical cavity, 17 were considered to have healed by apical scar formation, four demonstrated uncertain healing and five were considered failures. Eighty of 120 teeth examined had successfully healed from a radiological point of view within 12 months. No differences in outcome occurred between anterior, premolar and molar teeth. Although all failures occurred in teeth with posts, no statistically significant difference was noted (Mann-Whitney U-test, P = 0.37). CONCLUSION: Modern surgical endodontic procedures associated and ERA (Super Seal, Ogna Pharmaceuticals, Milan, Italy) root end fillings were successful over 3 years in 92.5% of cases.

Adolescent↗
PubMed2003

Evaluation of root-end cavity preparation using ultrasonic retrotips.

AIM: To evaluate and compare the efficiency of root-end preparations using ultrasonic retrotips coated with diamond and zirconium nitride. METHODOLOGY: Eighty-five extracted single-rooted teeth were root filled, and then resected 3 mm from their apices. Root-end cavities were prepared with KiS (zirconium nitride-coated retrotip), CT-5 (stainless steel tip) or diamond-coated (DC) ultrasonic retrotips, and 10 teeth served as controls. Thirty teeth were used for evaluation of the time required to prepare the root-end cavity, the number of microcracks produced on the resected surface and the number of dentinal tubule openings on the root-canal wall using scanning electron microscope (SEM) images. A further 55 teeth were used for evaluation of dye penetration following filling of the root-end cavities with Super EBA. The degree of dye penetration in millimetres was measured under the microscope after 7 days of immersion in India ink. Statistical analyses were performed using the one-way ANOVA and Scheffe's F-test as the post hoc test. RESULTS: There was no significant difference in the number of microcracks and dentinal tubule openings present in the root apices prepared by the three retrotips. The time required for root-end cavity preparation using the DC retrotip was significantly less than that using the other groups (P<0.01). Positive controls showed dye penetration throughout the length of the root-end cavity, and negative controls showed no dye penetration. There was no significant difference between the three experimental groups in dye penetration. CONCLUSIONS: In this laboratory study, the time required to prepare root-end cavities using KiS retrotips was the same as that using CT-5 retrotips, and longer than that using DC retrotips. There was no significant difference in the number of microcracks or dye penetration between the three kinds of retrotips.

Analysis of Variance↗
PubMed2003

A prospective clinical study of Mineral Trioxide Aggregate and IRM when used as root-end filling materials in endodontic surgery.

AIM: To assess the success rate of the root-end filling material, Mineral Trioxide Aggregate (MTA). METHODOLOGY: Referred adult patients were recruited using strict entry criteria and randomly allocated to receive MTA or IRM. A standardized surgical technique was employed: the root end was resected perpendicularly and a root-end cavity was prepared ultrasonically and filled. A radiograph taken immediately after surgery was compared with those taken at 12 and 24 months. Customised film holders and the paralleling technique were used; radiographs were assessed by two trained observers using agreed criteria. The results from 122 patients (58 in IRM group, 64 in MTA group) after 12 months and 108 patients (47 in IRM group, 61 in MTA group) for the 24-month review period were analysed using the chi2 test. RESULTS: The highest number of teeth with complete healing at both times was observed when MTA was used. When the numbers of teeth with complete and incomplete (scar) healing, and those with uncertain and unsatisfactory healing were combined, the success rate for MTA was higher (84% after 12 months, 92% after 24 months) compared with IRM (76% after 12 months, 87% after 24 months). However, statistical analysis showed no significant difference in success between materials (P > 0.05) at both 12 and 24 months. CONCLUSIONS: In this study, the use of MTA as a root-end filling material resulted in a high success rate that was not significantly better than that obtained using IRM.

Adult↗