الفهرس 
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Abstract
The present study was designed to compare between the use of Mineral Trioxide Aggregate and Totalfill regarding their healing potentials when used as root-end filling material with or without the addition of bone graft.
56 patients were divided into 2 main groups (28 each) according to the root end filling material and 2 subgroups according to the presence or absence of the composite bone graft material.
group I: MTA root end filling (28 cases)
Sub-group A: without bone graft (14 cases)
Sub-group B: with composite (Xenogenic & autogenous) bone graft (14 cases)
group II: TotalFil root end filling (28 cases)
Sub-group A: without bone graft (14 cases)
Sub-group B: with composite (xenogenic & autogenous) bone graft (14 cases)
The tooth to be treated was anesthetized using a single cartridge of 4% articaine with 1:100,000 epinephrine followed by rubber dam isolation then access cavity preparation. After which root canal treatment or retreatment was performed.
Cleaning and shaping was performed using ProTaper Universal rotary instruments. During instrumentation, after each instrument used, irrigation was done with 2.5% sodium hypochlorite solution, and a K-file size # 15 was used to remove debris between each file & maintain patency of the canal. After instrumentation a final irrigation protocol was used where sodium hypochlorite solution was irrigated for 3 minutes and 17% ethylene-diaminetetraacetic acid solution was used for an additional minute to remove the smear layer, followed by a final flush with saline solution.
Obturation procedures were done after a master cone confirmation radiograph together with ADSEAL sealer in a continuous wave of vertical compaction technique using EQ-V and manual hand pluggers. Postoperative radiograph was taken to confirm the density and length of the fill.
A three-incision line mucoperiosteal surgical flap was done and reflected. This procedure includes elevation of interdental papillae, free gingival margin, attached gingiva and alveolar mucosa. Then retraction was done using Minnesota retractor that rested on sound cortical bone.
A very conservative osteotomy was performed under copious sterile saline solution irrigation cooling with a plastic syringe. In cases where the cortical plate is perforated the osteotomy site is identified with a micro explorer under the microscope. In that case, the osteotomy site is obvious, however if the cortical bone was sound, the measurement of the tooth length by using CBCT software was done to give a precise estimation of the root apex position and hence the osteotomy site.
All granulomatous lesion surrounding the apex was removed to gain access to the apex and to minimize the hemorrhage. Enucleation was done using the concave side of the bony curette.
Root-end resection was performed by a size three long shank tapered with round end abrasive mounted on in an Impact Air 45 handpiece under copious irrigation with saline to cut 3 mm from the root apex with a 0-to-10-degree bevel. Then, class I box shape root-end cavity was done to a depth of 3 mm using the Satalec ultrasonic tip AS3D driven by a piezoelectric ultrasonic unit at a low power setting.
The root end filling material according to group was placed into the retro-cavities in one to three increments and condensed by a suitable sized endodontic plugger.
If the patient was allocated to a group that required bone graft to be placed, bone scrapper was used to obtain autogenous bone particles from healthy bone surrounding the osteotomy which is mixed with a xenogenic bone particles at a ratio 0.5:1; the composite graft was loaded in the osteotomy before closure.
The reflected mucoperiosteal flaps were re-approximated, compressed, stabilized and then sutured. Gentle digital pressure with a sterile gauze pack was inserted over the site of surgical flap postoperatively for several minutes to minimize hematoma formation and to enhance the re-attachment of the flap to the underlying bone and secure homeostasis.
Every patient was subjected to clinical examination as mentioned. Clinical criteria of healing were lack of signs and symptoms of periapical diseases.
Periapical bone healing was evaluated by pre-operative and 12 months postoperative Cone Beam Computerized Tomography digital imaging tool (CBCT) by measuring the volumetric changes in the bone lesion.
Results showed high success rates being achieved using MTA and Totalfill in healing of periapical lesions in endodontic surgery. Addition of bone graft in small and medium sized lesions didn’t affect the success rate of endodontic surgeries.