Young Bui

TA is an excellent retrograde material and root perforation sealer because it can enhance the formation of cementoblasts at its interface. I’ve had many successful healings of perforations created from post space to transportation during instrumentation. MTA is also an amazing pulp-capping material. A study by Tziafas et al showed that “a homogeneous zone of crystalline structures was initially found along the pulp-MTA interface, while pulpal cells showing changes in their cytological and functional state were arranged in close proximity to the crystals.  Deposition of hard tissue of osteotypic form was found in all teeth in direct contact with the capping material and the associated crystalline structures.  Formation of reparative dentine was consistently related to a firm osteodentinal zone.”  Aeinehchi et al found that pulp capped with MTA “demonstrated less inflammation, hyperemia and necrosis plus thicker dentinal bridge and more frequent odontoblastic layer formation than calcium hydroxide.”  Moghaddame-Jafari et al found that MTA induces proliferation and not apoptosis of pulp cells in vitro.  All these studies suggest that MTA is a good material to use for direct pulp-capping.
    Pulp-capping using MTA in primary teeth with live pulp tissue has excellent results. It will keep the rest of the pulp healthy until the permanent tooth erupts. If a young child has fractured part of the front tooth, causing an exposure, use MTA to pulp-cap it until the apex matures and closes. Remove the pulp tissue in the chamber with a large round bur and irrigate with saline or anesthetic solution. Place a nice layer of MTA over the pulp stump and pack it tight using a wet cotton pellet. You can seal the rest of the chamber with a core build-up or composite filling and bond the fractured coronal piece back on. If you have a deep carious lesion that shows the pink color dentin after excavation, take a medium round bur, pop through the dentin, and remove a small layer of pulp tissue. Irrigate the debris, pack a little MTA over the pulp, and seal the tooth with IRM until the MTA has set before placing a final restoration. Figure 1 shows tooth #15 with a large carious lesion near the pulp. Figure 2 shows the tooth with MTA into the pulp after all the decay had been excavated. Figure 3 shows a thick dentin bridge formation under the MTA.

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