Apicoectomy and Direct pulp cap
What techniques and products are best for endodontic microsurgery? – MTA Super EBA
Microsurgery has better outcomes than retreatment, which makes sense for many reasons and I agree with UNLESS can see reason for failure like a missed canal. Curtis JOE 2018
BP-RPM is comparable to MTA for endodontic microsurgery according to Zhoe JOE 2017
There is no difference in success with MTA or Super EBA at 4 years 182 teeth RCT based on Kim JOE 2016 Success was determined by following healing using peri-apical x-rays from three angles.
Super EBA = MTA 260 RC study
ProRoot MTA beats SuperEBA May 12 170 RCT
Hemostatic agents epi and AlCl were comparable in terms of impact they have on healing. Peñarrocha-Diago JOE 2018
Endodontic microsurgery : When to give up on a tooth and do the dental implant
Dental implant is a superior option to endodontic microsurgery with respect to survival. Literature does not allow comparison of other relevant outcomes such as psycho-social, economic, and need for additional interventions. Systemic Review Torabinejad Jan 2015 JOE
Endodontic microsurgery survival rates are reported around 96% at 2-4 years and 88% at 4-6 years.
Studies on endodontic surgical treatment
Jang JOE Aug 2015
ProRoot MTA = Endocem
Class V DPC less successful
ProRoot MTA = calcium silicate-based cement
Endocem = fast-setting pozzolan-based MTA
Biodentine = calcium silicate based
RetroMTA = 60-80wt% calcium carbonate, calcium zirconia 20-30%, silicon dioxide 5-15%, aluminum oxide 5-10%
TheraCal = resin-modified calcium silicate liner type III portland cement 45 wt%, resin 40%, radiopacifier 10%, silica 5%
Biodentine = MTA > CaOH2 > Bonding agent at forming dentin Human trial good study Nowicka JOE Aug 2015
ProRoot MTA=RetroMTA>TheraCal dog study in calific barrier formation and lack of inflammation http://www.jendodon.com/article/S0099-2399%2815%2900342-8/abstractLee JOE Aug 2015
MTA pulp cap and Biodentine direct pulp cap
MTA pulp cap procedural steps
Post-Exposure
- 5% NaOCl for 3 minutes. If not stopped then complete pulpotomy or RCT
- Mix MTA and place thin layer
- TheraCal LC over that and cure
- Selective etch technique with gluma after etch
Research on MTA pulp cap procedure
MTA vs Biodentine both similar but MTA stained. Linu 2017 JOE
Can bond immediately over MTA Tsujimoto 2013
Meta-analysis – Appears to me that MTA is the best but “not statistically significant”. and 2014 EBD
Meta-analysis – MTA better than CH Zhaofei Sept 15 Didileschu JADA 2018
MTA beats CH Mente JOE 2014
MTA = Endocem but only 3 month study Song JOE 2015 Jan
Review MTA better than CH EBD 2016
MTA=Biodentine Katge 2017 JOE Awawdeh 2018 JOE
MTA=CH but Biodentine better Brizuela JOE 2017
Biodentine better than MTA Wattanapakkavong JOE 2019
Pulpotomy
Biodentine and MTA beat Theracal likely due to resin. Bakhtiar JOE 2017
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