THE SPECIALIST

In treating an open apex do you prefer Calcium Hydroxide or MTA?

By Dr. Barry H. Korzen

Question:

I read a study about using the MTA for treating open apices after using Calcium Hydroxide (CH) on the first visit. It used to be to just use CH.  So doing an apical plug does sound good but I thought apical closure happened without it? Maybe the treatment time is much shorter and the results might be better, but what is your opinion?

Answer:

Both calcium hydroxide and MTA work well for apical closure, but the advantage of using MTA as a plug is that once it sets you can obturate the canal with gutta percha immediately because you can pack the gutta percha up against it. With the calcium hydroxide, you use it as an intracanal medicament which must be removed once the apex closes and then you can obturate. Besides adding one (or more) additional appointments, the risk in not obturating the canal as soon as possible is that if the coronol restoration leaks the canal then becomes a conduit for bacterial contamination which not only will prevent the apexification from working but may lead to a periapical infection. When we didn’t have MTA, calcium hydroxide was great, even with its limitations. But now I would recommend using the MTA.

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