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.

endodontic microsurgery

Studies on endodontic surgical treatment


 Direct pulp Cap DPC

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


  1. 5% NaOCl for 3 minutes. If not stopped then complete pulpotomy or RCT
  2. Mix MTA and place thin layer
  3. TheraCal LC over that and cure
  4. 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”. Ahmed Elkhadem and Inas Sami 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 Rasaratnam

MTA=Biodentine Katge 2017 JOE Awawdeh 2018 JOE

MTA=CH but Biodentine better Brizuela JOE 2017

Biodentine better than MTA Wattanapakkavong JOE 2019



Biodentine and MTA beat Theracal likely due to resin. Bakhtiar JOE 2017

MTA beats Biodentine, formocresol and ferric sulfate in terms of radiographic success but clinically there are equal. Meta-analysis JADA Shafee 2019

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