Apicoectomy with Grey MTA Plus®

Dentist: Franklin Tay
Practice location: Augusta, GA
Type of practice: Endodontic

This patient was referred to me after a tooth that was previously treated endodontically was failing to resolve the periapical lesion. (Figure 1):

Figure 1: Pre-op periapical radiograph of tooth for retreatment.

After anesthesia was administered, a full thickness free-gingival margin flap was created to provide the surgical access. A small osteotomy was then made with a #4 round bur to expose the distal root tip. A 3-mm apicoectomy with a limited angular bevel was created to expose the root filling material. A 3-mm circumferential preparation was made in the long axis of the root, using a #1 Pro Ultra ultrasonic microsurgical tip. The preparation was rinsed and dried. The Grey MTA Plus retrofilling material was mixed to a putty consistency, delivered with a plastic instrument into the root-end, condensed, and the crypt was wiped with a moist cotton pellet. Grey MTA Plus Plus’s silky clay-like consistency handles well and was not displaced by blood. Sutures were placed to secure the surgical flap and a radiograph was taken (Figure 2).

Figure 2: Post-operative radiograph showing apical resection and root-end filling with Grey MTA Plus. The slightly greater radiopacity of the filling versus the obturation fill is seen.

The tooth restoration with its post and core and crown remained intact at the 6 and 25-month recalls (Figures 3 and 4). Six months post-op, the bone had mostly in-filled the osteotomy; even better resolution was seen at 25 months. The tooth remains in function with healing around the apex and bone replacing the lesion.

Figure 3: Six-month recall of apicoectomy showing diminishment of the periapical lesion.

Figure 4: Two-year recall periapical radiograph showing furcal bone infill and crown retention.

Why Dr. Tay chose Avalon Grey MTA Plus: Grey MTA Plus® is a bioactive tricalcium silicate cement (bioceramic) that is suited to endodontic surgery as well as other indications. I chose Grey MTA Plus for this case because of its bioactivity and versatility. I have used Grey MTA Plus since its introduction in 2012 for several procedures ranging from perforation repair to root-end filling after an apicoectomy. Grey MTA Plus product is sold as a powder-gel system, with separate bottles for the powder and gel and a 0.1 gm scoop. Because the powder and gel are separate, the powder is not wasted; I mix what I need, which is very little for a root-end filling. A small glass mixing slab and medium stiffness spatula are available from Avalon Biomed, and form an easy-to-use set up that can be sterilized. The very fine, smooth powder is dispensed onto the glass slab with the tiny scoop. A 1 cm streak of Grey MTA Plus gel is placed near the powder. The gel is gradually mixed into the powder using the stroking motion used for sealers. The stroking motion ensures that the powder is wetted with the water-based gel. Thorough mixing ensures a faster setting process and a mixture that will be resistant to washout. One can mix a smooth, clay-like putty with a perfect consistency for packing in a root-end filling within seconds. The easy-to-mix, bioactive (hydroxyapatite-forming) Grey MTA Plus helps me treat teeth surgically with confidence. Its radiopacity is higher than the white MTA bioceramic products. Its affordability (under $4 per treatment) allows our school to instruct our undergraduate and graduate students with effective bioactive products, and to give our patients the highest standard of care.

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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