Saudi Endodontic Journal

: 2013  |  Volume : 3  |  Issue : 3  |  Page : 149--150

Author's Reply

Savitha Adiga 
 Department of Conservative Dentistry and Endodontics, The Oxford Dental College and Hospital, Bommanahalli, Hosur Road, Bangalore, Karnataka, India

Correspondence Address:
Savitha Adiga
Department of Conservative Dentistry and Endodontics, The Oxford Dental College and Hospital, Bommanahalli, Hosur Road, Bangalore - 560 068, Karnataka

How to cite this article:
Adiga S. Author's Reply.Saudi Endod J 2013;3:149-150

How to cite this URL:
Adiga S. Author's Reply. Saudi Endod J [serial online] 2013 [cited 2021 Mar 6 ];3:149-150
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Full Text

Dear Editor,

I would like to thank Dr. Jothi M. Varghese, Associate Professor, department of periodontics, Manipal College of Dental Sciences, for having appreciated our published manuscript [Retreatment and surgical repair of the apical third perforation and osseous defect using mineral trioxide aggregate, Savitha A. et al., 2013;3:34-8], and for providing valuable suggestions. Following are my reply to her queries:

Even though the use of barrier membrane and bone grafts materials were accepted protocol for periodontally involved tooth, this case report presents a rare treatment modality employed for treating a perforation with osseous defect. Several in vitro and in vivo experiments have shown that mineral trioxide aggregate (MTA) prevents leakage, is biocompatible, and promotes regeneration of the original tissues when placed in contact with dental pulp or peri-radicular periodontium. [1],[2],[3] Besides its non-cytotoxicity, [4] it has good biological action [5] and stimulates repair [6],[7] because it allows cellular adhesion, growth, and proliferation on its surface. [8] MTA consistently allows for the overgrowth of cementum, and it may facilitate the regeneration of the periodontal ligament and formation of bone. [9],[10] Studies have demonstrated that in the presence of MTA, cells grow faster and produce more mineralized gene expression in osteoblasts. [9],[11] The histological responses, observed in the study conducted by Falcao-Filho, [12] indicate that the MTA is a reliable material and should be considered effective in bone periapical defects. Qin et al.[13] have hypothesized that MTA has anti-recurrence properties and inhibit recurrence of such large peri-radicular defects. The most characteristic tissue reaction that MTA exhibits is the presence of connective tissue after the first post-operative week. [7] Hence, in the present case, only MTA was chosen to repair the perforation with osseous defect. On the basis of the review of literature and the clinical-radiographic outcomes of the case presented, it can be concluded that large bone defects caused by peri-radicular lesions could be filled with a recognizably effective osteo-inductive and osteo-conductive biomaterials such as MTA.

Even though it was not mentioned in the article, patient had undergone complete non-surgical periodontal root planning treatment before endodontic procedure.

To conclude, the case report suggests the successful outcome of repair of perforation and osseous defect after use of MTA as an effective bone replacing material during regenerative tissue procedures.


1Holland R, Filho JA, de Souza V, Nery MJ, Bernabé PF, Junior ED. Mineral trioxide aggregate repair of lateral root perforations. J Endod 2001;27:281-4.
2Ford TR, Torabinejad M, Abedi HR, Bakland LK, Kariyawasam SP. Using mineral trioxide aggregate as a pulp-capping material. J Am Dent Assoc 1996;127:1491-4.
3Torabinejad M, Chivian N. Clinical applications of mineral trioxide aggregate. J Endod 1999;25:197-205.
4Osorio RM, Hefti A, Vertucci FJ, Shawley AL. Cytotoxicity of endodontic materials. J Endod 1998;24:91-6.
5Torabinejad M, Ford TR, Abedi HR, Kariyawasam SP, Tang HM. Tissue reaction to implanted root-end filling materials in the tibia and mandible of guinea pigs. J Endod 1998;24:468-71.
6Regan JD, Gutmann JL, Witherspoon DE. Comparison of Diaket and MTA when used as root-end filling materials to support regeneration of the periradicular tissues. Int Endod J 2002;35:840-7.
7Economides N, Pantelidou O, Kokkas A, Tziafas D. Short-term periradicular tissue response to mineral trioxide aggregate (MTA) as root-end filling material. Int Endod J 2003;36:44-8.
8Zhu Q, Haglund R, Safavi KE, Spangberg LS. Adhesion of human osteoblasts on root-end filling materials. J Endod 2000;26:404-6.
9Al-Rabeah E, Perinpanayagam H, MacFarland D. Human alveolar bone cells interact with Pro Root and tooth-colored MTA. J Endod 2006;32:872-5.
10Oviir T, Pagoria D, Ibarra G, Geurtsen W. Effects of gray and white mineral trioxide aggregate on the proliferation of oral keratinocytes and cementoblasts. J Endod 2006;32:210-3.
11Hakki SS, Bozkurt SB, Hakki EE, Belli S. Effects of mineral trioxide aggregate on cell survival, gene expression associated with mineralized tissues, and biomineralization of cementoblasts. J Endod 2009;35:513-9.
12Falcao-Filho HB, Issa JP, Nascimento C, Abomasa MM, Regalo SC, Siessere S, et al. Histological evaluation of the bone repair using mineral trioxide aggregate combined to a material carrier. Int J Morphol 2007;25:789-96.
13Qin H, Cai J, Fang J, Xu H, Gong Y. Could MTA be a novel medicine on the recurrence therapy for GCTB? Med Hypotheses 2010;74:368-9.