title: Orthograde retreatment failure with extruded MTA apical plug in a large periradicular lesion followed by surgical intervention: case report.
abstract: Absence of periapical healing after orthograde retreatment using an apical plug with mineral trioxide aggregate (MTA) can require surgical intervention. A patient with a root-filled maxillary central incisor with chronic apical periodontitis and sinus tract was referred for endodontic retreatment. Excessive apical enlargement was verified, indicating an MTA apical plug placement; however, an unintentional extrusion of MTA occurred during this step. The root canal was filled with gutta-percha and sealer, and periodic recalls were scheduled. The sinus tract was observed after six months and the lesion remained unaltered, although the extruded MTA had resorbed; therefore, an apicoectomy and retrograde root-end filling with MTA were performed. Absence of sinus tract, normal clinical aspect, and complete repair of the lesion were observed at the two-year follow-up.
authors.affiliation: Department of Dentistry, State University of Montes Claros, Minas Gerais, Brazil.
authors.forename: Manoel
authors.initials: M
authors.lastname: Brito-Junior
authors.forename: Andre Luis
authors.initials: AL
authors.lastname: Faria-e-Silva
authors.forename: Alex Carvalho
authors.initials: AC
authors.lastname: Quintino
authors.forename: Gil
authors.initials: G
authors.lastname: Moreira-Junior
authors.forename: Mauro
authors.initials: M
authors.lastname: Geber
authors.forename: Carla Cristina
authors.initials: CC
authors.lastname: Camilo
authors.forename: Janir Alves
authors.initials: JA
authors.lastname: Soares
mesh_terms: D000328:Adult; D017607:Aluminum Compounds / Q000009:adverse effects* / Q000627:therapeutic use; D001047:Apicoectomy / Q000379:methods; D001729:Bismuth / Q000627:therapeutic use; D017610:Calcium Compounds / Q000009:adverse effects* / Q000627:therapeutic use; D002126:Calcium Hydroxide / Q000627:therapeutic use; D003751:Dental Fistula / Q000601:surgery / Q000628:therapy; D004338:Drug Combinations; D005260:Female; D005500:Follow-Up Studies; D005547:Foreign Bodies / Q000209:etiology* / Q000601:surgery; D006171:Gutta-Percha / Q000627:therapeutic use; D006801:Humans; D007180:Incisor / Q000473:pathology; D010087:Oxides / Q000009:adverse effects* / Q000627:therapeutic use; D010485:Periapical Periodontitis / Q000601:surgery* / Q000628:therapy; D059745:Piezosurgery / Q000379:methods; D019233:Retreatment; D012184:Retrograde Obturation / Q000379:methods; D012387:Root Canal Filling Materials / Q000009:adverse effects* / Q000627:therapeutic use; D018915:Root Canal Preparation / Q000379:methods; D012390:Root Canal Therapy / Q000009:adverse effects*; D017640:Silicates / Q000009:adverse effects* / Q000627:therapeutic use; D019227:Tooth Apex / Q000473:pathology*; D019553:Tooth, Nonvital / Q000601:surgery / Q000628:therapy; D017211:Treatment Failure
chemical_list: D017607:Aluminum Compounds; D017610:Calcium Compounds; D004338:Drug Combinations; D010087:Oxides; D012387:Root Canal Filling Materials; C080620:Sealer 26; D017640:Silicates; C086631:mineral trioxide aggregate; D006171:Gutta-Percha; D002126:Calcium Hydroxide; D001729:Bismuth