title: A technique for placement of apical MTA plugs using modified Thermafil carriers for the filling of canals with wide apices.
abstract: OBJECTIVE
  To describe a technique for the placement of apical Mineral trioxide aggregate (MTA) plugs in canals with wide apices.
  
  
  CONCLUSIONS
  A novel technique to fill root canals with an apical diameter larger than 0.4 mm is presented. The technique includes three main stages; three Thermafil carriers of increasing size, previously de-sheathed by removing the Gutta-percha coating, are selected to engage 1, 2 and 3 mm short of the apex. Their use allows the negotiation of acute curvatures and ledged canals. Subsequently, an MTA plug matching the apical gauge is pre-formed with a pellet block, placed and condensed using the modified carriers in sequence. The presented protocol for the management of teeth with apices of a diameter greater than 0.4 mm allows a favourable apical control of the MTA. Clinical cases completed using this methodology are presented.
  
  
  CONCLUSIONS
  MTA placement in teeth with wide apices was facilitated by using de-sheathed Thermafil carriers, to create an appropriate seal and stable platform for Gutta-percha backfilling or subsequent fibre post placement. The use of de-sheathed Thermafil carriers of different sizes allows predictable placement of pre-formed MTA plugs. Gauging of Thermafil carriers enhances control of the condensation phase to limit the extrusion of MTA.
authors.affiliation: Department of Conservative Dentistry, Dental Institute, King's College, London, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Giovarruscio
authors.forename: U
authors.initials: U
authors.lastname: Uccioli
authors.forename: A
authors.initials: A
authors.lastname: Malentacca
authors.forename: G
authors.initials: G
authors.lastname: Koller
authors.forename: F
authors.initials: F
authors.lastname: Foschi
authors.forename: F
authors.initials: F
authors.lastname: Mannocci
mesh_terms: D000328:Adult; D017607:Aluminum Compounds / Q000627:therapeutic use*; D017610:Calcium Compounds / Q000627:therapeutic use*; D003786:Dental Pulp Cavity / Q000473:pathology*; D004338:Drug Combinations; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D009811:Odontometry / Q000295:instrumentation; D010087:Oxides / Q000627:therapeutic use*; D010483:Periapical Diseases / Q000628:therapy; D010485:Periapical Periodontitis / Q000628:therapy; D011176:Post and Core Technique; D019233:Retreatment; D012387:Root Canal Filling Materials / Q000627:therapeutic use*; D012388:Root Canal Irrigants / Q000627:therapeutic use; D012389:Root Canal Obturation / Q000295:instrumentation / Q000379:methods*; D017640:Silicates / Q000627:therapeutic use*; D012973:Sodium Hypochlorite / Q000627:therapeutic use; D019227:Tooth Apex / Q000473:pathology*; D055815:Young Adult
chemical_list: D017607:Aluminum Compounds; D017610:Calcium Compounds; D004338:Drug Combinations; D010087:Oxides; D012387:Root Canal Filling Materials; D012388:Root Canal Irrigants; D017640:Silicates; C086631:mineral trioxide aggregate; D012973:Sodium Hypochlorite