Apicoectomy / Grey MTA Plus® Retrofill

Dentist:  Richard Rubinstein
Practice location:  Farmington, Hills, MI
Type of practice:  Endodontic

This patient was referred for apical microsurgery on a premolar (Figure 1):

Figure 1: Pre-operative radiograph showing a radiolucency on the premolar and the sinus tract.

After anesthesia was established, I brought the surgical operating microscope into the field and made a full-thickness freegingival margin flap to create the surgical access. After I reflected the flap and retracted it from the visual field, I performed a small osteotomy using a no. 4 round bur in an Impact Air 45 surgical handpiece to expose the root tip. I performed a 3-millimeter apicoectomy with a limited angular bevel using with a Lindemann H161 bone cutter to expose the root filling material. I made a 3-mm circumferential preparation in the long axis of the root, which included all the anatomic outlines of the pulp space, using a no. 1 Pro Ultra ultrasonic microsurgical tip. I rinsed and dried the preparation with a Stropko Irrigator and then examined with apical micromirrors to establish the thoroughness of the preparation. I mixed the Grey MTA Plus retrofilling material to a putty consistency and delivered it with a Micro Apical Placement delivery system and condensed it with apical micropluggers. I wiped the surface of the retrofilling with a moist cotton pellet and inspected the surgical field under magnification (Figure 2).

Figure 2: Surgical photo showing apical retrofilling with Grey MTA Plus in place.

I placed 5 interrupted Tevdek sutures to secure the surgical flap. Finally, I obtained a postoperative radiograph (Figure 3) showing the Grey MTA Plus material in place. Figure 4 shows healing at 12 months.

Figure 3: Post-operative radiograph showing retrofilling with Grey MTA Plus.

Figure 4: One-year follow-up radiograph showing healing.

Why Dr. Rubinstein chose Avalon NeoMTA Plus: I’ve used mineral trioxide aggregate (MTA) materials for microsurgical procedures since the 1990s and MTA Plus since 2014. MTA materials are essential for endodontic surgery because they are bioactive and can seal the root tip after an apicoectomy. The tricalcium silicate (MTA) cements are transformed into calcium hydroxide as they set and induce the formation of hydroxyapatite on surfaces that are in contact with periapical or pulpal tissues; this is important for surgical and nonsurgical uses, such as pulp capping. MTA Plus products have several advantages. The material can be placed in a prepared root-end cavity and the material will stay in place, not be washed out by blood, and set completely. MTA Plus products are available in bulk form and are cost-effective. The kit contains a powder bottle, a gel bottle, and a 0.1 gram scoop to dispense the powder. The powder and gel can be combined on a glass slab using a metal spatula and little gel is needed. For apical retrofillings, a putty consistency is required.

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NeoMTA Plus is a stainproof, tricalcium silicate-based bioactive cement that can be used universally for vital pulp and other endodontic indications in primary and permanent teeth. NeoMTA Plus is a bioceramic cement that triggers the healing process. With NeoMTA Plus, general dentists, pediatric dentists, and endodontists now have a superior and reasonably priced bioceramic. Dentists praise the multi-use NeoMTA Plus because it mixes more smoothly, is easier to dispense and the unique gel enables more stable placement, washout resistance and faster clinical setting.

New, stain-free light color:

Ideal for pediatric dentistry—won’t discolor teeth
Liquids such as sodium hypochlorite won’t cause discoloration

Multiple indications:

Pulp-capping to base/liner
Pulpotomies to apexification
Sealer to perforation repair
Root-end filling to resorption


Inhibits bacterial growth* *Tested in vitro. Not a disinfectant

Grey MTA Plus is a bioceramic tricalcium silicate-based Dental Cement, which is slightly more radiopaque than (white) MTA. The light silvery color of MTA Plus is visible during placement. Grey MTA Plus is indicated for both Vital Pulp Therapy and Endodontic procedures. General dentists and endodontists praise the multi-use Grey MTA Plus because it mixes more smoothly and is easier to dispense. The unique gel enables more stable placement, washout resistance and faster clinical setting.

Multiple indications:

Pulp-capping to Base/Liner
Pulpotomies to Apexification
Sealer to Perforation Repair
Root-end Filling to Resorption

New, light grey color:

More radiopaque than the leading white MTAs
Visible for precise placement
Inhibits bacterial growth in vitro of Staphylococcus aureus, Escherichia coli, Enterococcus faecalis, Pseudomonas aeruginosa.

Better mixing, handling and placement:

Finer powder mixes more easily and smoothly
Dispense as little as 0.1 gm
Unique gel for stable placement
Washout resistant
No special equipment required

Smart, convenient packaging:

Protects fine powder in desiccant-lined bottle
Easy to dispense powder as needed
Dropper-tip gel bottle minimizes waste