A technique for placement of apical <scp>MTA</scp> plugs using modified Thermafil carriers for the filling of canals with wide apices

<jats:title>Abstract</jats:title><jats:sec><jats:title>Aim</jats:title><jats:p>To describe a technique for the placement of apical Mineral trioxide aggregate (<jats:styled-content style="fixed-case">MTA</jats:styled-content>) plugs in canals with wide apices.</jats:p></jats:sec><jats:sec><jats:title>Summary</jats:title><jats:p>A novel technique to fill root canals with an apical diameter larger than 0.4 mm is presented. The technique includes three main stages; three Thermafil carriers of increasing size, previously de‐sheathed by removing the Gutta‐percha coating, are selected to engage 1, 2 and 3 mm short of the apex. Their use allows the negotiation of acute curvatures and ledged canals. Subsequently, an <jats:styled-content style="fixed-case">MTA</jats:styled-content> plug matching the apical gauge is pre‐formed with a pellet block, placed and condensed using the modified carriers in sequence. The presented protocol for the management of teeth with apices of a diameter greater than 0.4 mm allows a favourable apical control of the <jats:styled-content style="fixed-case">MTA</jats:styled-content>. Clinical cases completed using this methodology are presented.</jats:p></jats:sec><jats:sec><jats:title>Key learning points</jats:title><jats:p> <jats:list list-type="bullet"> <jats:list-item><jats:p>MTA placement in teeth with wide apices was facilitated by using de‐sheathed Thermafil carriers, to create an appropriate seal and stable platform for Gutta‐percha backfilling or subsequent fibre post placement.</jats:p></jats:list-item> <jats:list-item><jats:p>The use of de‐sheathed Thermafil carriers of different sizes allows predictable placement of pre‐formed MTA plugs.</jats:p></jats:list-item> <jats:list-item><jats:p>Gauging of Thermafil carriers enhances control of the condensation phase to limit the extrusion of MTA.</jats:p></jats:list-item> </jats:list> </jats:p></jats:sec>