Skip to main content

Advertisement

SpringerLink
Log in

MTA versus Ca(OH)2 in apexification of non-vital immature permanent teeth: a randomized clinical trial comparison

  • Original Article
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objectives

The aim of this prospective randomized clinical trial was to compare mineral trioxide aggregate (MTA) with calcium hydroxide (CH) as materials for inducing root apex closure in immature necrotic permanent incisors.

Methods

The design of this study has been extensively described in the authors’ previous report. Children (n = 30), aged from 6 to 18 years and presenting a non-vital permanent incisor, were treated. Half of the group received treatment using MTA, the other half with CH. At recall visits after 6 and 12 months, the presence or absence of a calcified apical barrier was assessed using clinical and radiographic examinations. The anonymised radiographs were evaluated by two independent investigators. Statistical analyses were performed using a Fischer’s test (p < 0.05 was used as the threshold for statistical significance).

Results

Presence of a mineralized barrier was observed for 43.8 % of the CH group and 64.7 % of the MTA group at the 6-month examination. After 12 months, these figures were respectively 50 and 82.4 % (p < 0.07). For both groups, pain and tenderness to percussion had disappeared at the 3-month examination.

Conclusion

Neither material showed a statistically significant difference at the 6-month examination. At the 12-month examination, the MTA group displayed better results in terms of apical closure. In the CH group, four out of 15 teeth exhibited coronal or radicular fractures after 12 months.

Clinical relevance

Apexification using MTA seems preferable to CH in order to early achieve the coronoradicular filling and to limit the risk of root fracture.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Krasner P, Rankow HJ (1995) New philosophy for the treatment of avulsed teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 79(5):616–623

    Article  PubMed  Google Scholar 

  2. Andreasen FM (2001) Pulpal healing following acute dental trauma: clinical and radiographic review. Pract Proced Aesthet Dent 13(4):315–322, quiz 324

    PubMed  Google Scholar 

  3. Cvek M (2007) Endodontic management and the use of calcium hydroxide in traumatized permanent teeth. In: Textbook and color atlas of traumatic injuries to the teeth, 4th edn. Blackwell, Oxford, pp 598–657

  4. Andreasen JO, Farik B, Munksgaard EC (2002) Long-term calcium hydroxide as a root canal dressing may increase risk of root fracture. Dent Traumatol 18(3):134–137

    Article  PubMed  Google Scholar 

  5. Simon S, Rilliard F, Berdal A, Machtou P (2007) The use of mineral trioxide aggregate in one-visit apexification treatment: a prospective study. Int Endod J 40(3):186–197

    Article  PubMed  Google Scholar 

  6. Bakland LK, Andreasen JO (2012) Will mineral trioxide aggregate replace calcium hydroxide in treating pulpal and periodontal healing complications subsequent to dental trauma? A review. Dent Traumatol 28(1):25–32

    Article  PubMed  Google Scholar 

  7. Tate AR (2012) Calcium hydroxide or mineral trioxide aggregate may be used for the apexification of immature teeth. J Evid Based Dent Pract 12(1):24–25

    Article  PubMed  Google Scholar 

  8. Beslot-Neveu A, Bonte E, Baune B, Serreau R, Aissat F, Quinquis L, Grabar S, Lasfargues J-J (2011) Mineral trioxyde aggregate versus calcium hydroxide in apexification of non vital immature teeth: study protocol for a randomized controlled trial. Trials 12:174

    Article  PubMed Central  PubMed  Google Scholar 

  9. Orstavik D, Kerekes K, Eriksen HM (1986) The periapical index: a scoring system for radiographic assessment of apical periodontitis. Endod Dent Traumatol 2(1):20–34

    Article  PubMed  Google Scholar 

  10. Cvek M (1992) Prognosis of luxated non-vital maxillary incisors treated with calcium hydroxide and filled with gutta-percha. A retrospective clinical study. Endod Dent Traumatol 8(2):45–55

    Article  PubMed  Google Scholar 

  11. Ørstavik D, Qvist V, Stoltze K (2004) A multivariate analysis of the outcome of endodontic treatment. Eur J Oral Sci 112(3):224–230

    Article  PubMed  Google Scholar 

  12. Mendoza AM, Reina ES, García-Godoy F (2010) Evolution of apical formation on immature necrotic permanent teeth. Am J Dent 23(5):269–274

    PubMed  Google Scholar 

  13. Damle SG, Bhattal H, Loomba A (2012) Apexification of anterior teeth: a comparative evaluation of mineral trioxide aggregate and calcium hydroxide paste. J Clin Pediatr Dent 36(3):263–268

    Article  PubMed  Google Scholar 

  14. Pradhan DP, Chawla HS, Gauba K, Goyal A (2006) Comparative evaluation of endodontic management of teeth with unformed apices with mineral trioxide aggregate and calcium hydroxide. J Dent Child (Chic) 73(2):79–85

    Google Scholar 

  15. Batur YB, Erdemir U, Sancakli HS (2013) The long-term effect of calcium hydroxide application on dentin fracture strength of endodontically treated teeth. Dent Traumatol 29(6):461–464

    Article  PubMed  Google Scholar 

  16. Twati WA, Wood DJ, Liskiewicz TW, Willmott NS, Duggal MS (2009) An evaluation of the effect of non-setting calcium hydroxide on human dentine: a pilot study. Eur Arch Paediatr Dent 10(2):104–109

    Article  PubMed  Google Scholar 

  17. Wang R, Weiner S (1998) Human root dentin: structural anisotropy and Vickers microhardness isotropy. Connect Tissue Res 39(4):269–279

    Article  PubMed  Google Scholar 

  18. Kawamoto R, Kurokawa H, Takubo C, Shimamura Y, Yoshida T, Miyazaki M (2008) Change in elastic modulus of bovine dentine with exposure to a calcium hydroxide paste. J Dent 36(11):959–964

    Article  PubMed  Google Scholar 

  19. Shabahang S, Torabinejad M (2000) Treatment of teeth with open apices using mineral trioxide aggregate. Pract Periodontics Aesthet Dent 12(3):315–320, quiz 322

    PubMed  Google Scholar 

  20. Giuliani V, Baccetti T, Pace R, Pagavino G (2002) The use of MTA in teeth with necrotic pulps and open apices. Dent Traumatol 18(4):217–221

    Article  PubMed  Google Scholar 

  21. Pace R, Giuliani V, Pini Prato L, Baccetti T, Pagavino G (2007) Apical plug technique using mineral trioxide aggregate: results from a case series. Int Endod J 40(6):478–484

    Article  PubMed  Google Scholar 

  22. Sarris S, Tahmassebi JF, Duggal MS, Cross IA (2008) A clinical evaluation of mineral trioxide aggregate for root-end closure of non-vital immature permanent incisors in children-a pilot study. Dent Traumatol 24(1):79–85

    Article  PubMed  Google Scholar 

  23. Mente J, Leo M, Panagidis D, Ohle M, Schneider S, Lorenzo Bermejo J, Pfefferle T (2013) Treatment outcome of mineral trioxide aggregate in open apex teeth. J Endod 39(1):20–26

    Article  PubMed  Google Scholar 

  24. Nolla CM (1960) The development of the permanent teeth, J Dent Child: 254–266

  25. Nayar S, Bishop K, Alani A (2009) A report on the clinical and radiographic outcomes of 38 cases of apexification with mineral trioxide aggregate. Eur J Prosthodont Restor Dent 17(4):150–156

    PubMed  Google Scholar 

  26. El-Meligy OAS, Avery DR (2006) Comparison of apexification with mineral trioxide aggregate and calcium hydroxide. Pediatr Dent 28(3):248–253

    PubMed  Google Scholar 

  27. Tavares PBL, Bonte E, Boukpessi T, Siqueira JF Jr, Lasfargues J-J (2009) Prevalence of apical periodontitis in root canal-treated teeth from an urban French population: influence of the quality of root canal fillings and coronal restorations. J Endod 35(6):810–813

    Article  PubMed  Google Scholar 

  28. Torabinejad M, Rastegar AF, Kettering JD, Pitt Ford TR (1995) Bacterial leakage of mineral trioxide aggregate as a root-end filling material. J Endod 21(3):109–112

    Article  PubMed  Google Scholar 

  29. Torabinejad M, Smith PW, Kettering JD, Pitt Ford TR (1995) Comparative investigation of marginal adaptation of mineral trioxide aggregate and other commonly used root-end filling materials. J Endod 21(6):295–299

    Article  PubMed  Google Scholar 

  30. Torabinejad M, Higa RK, McKendry DJ, Pitt Ford TR (1994) Dye leakage of four root end filling materials: effects of blood contamination. J Endod 20(4):159–163

    Article  PubMed  Google Scholar 

  31. Chala S, Abouqal R, Rida S (2011) Apexification of immature teeth with calcium hydroxide or mineral trioxide aggregate: systematic review and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 112(4):e36–e42

    Article  PubMed  Google Scholar 

  32. Garcia-Godoy F, Murray PE (2012) Recommendations for using regenerative endodontic procedures in permanent immature traumatized teeth. Dent Traumatol 28(1):33–41

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was funded by Assistance Publique-Hôpitaux de Paris (AP-HP). The authors thank Bruno Baune (AP-HP), Raphaël Serreau, Fawzia Aissat, Laurent Quinquis and Sophie Grabar for their valuable help with this study (Centre de recherche clinique CIC-URC Necker Cochin Paris, URC Tarnier 89 rue d’Assas 75006 Paris, France and Unité de Biostatistique et Epidémiologie, Hôpital Cochin, 27 rue du Faubourg Saint Jacques, 75014 Paris, France).

Conflict of interests

The authors declare that they have no competing interests.

Author information

Authors and Affiliations

  1. Department of Conservative Dentistry and Endodontics, Paris Descartes University, Sorbonne Paris Cité, INSERM UMR_S 1138, Cordeliers Research Center and Bretonneau Hospital, AP-HP, Paris, France

    Eric Bonte

  2. Department of Conservative Dentistry and Endodontics, Paris Descartes University and Bretonneau Hospital, AP-HP, Paris, France

    Aurélie Beslot & Jean-Jacques Lasfargues

  3. Department of Conservative Dentistry and Endodontics, EA2496 Pathologies, Imaging and Biotherapies of the Tooth, Paris Descartes PRES Sorbonne Paris Cité and Charles Foix Hospital, AP-HP, Paris, France

    Tchilalo Boukpessi

  4. Hôpital Bretonneau, Service d’Odontologie, 23 rue Joseph de Maistre, 75018, Paris, France

    Jean-Jacques Lasfargues

Authors
  1. Eric Bonte
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aurélie Beslot
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tchilalo Boukpessi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jean-Jacques Lasfargues
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jean-Jacques Lasfargues.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bonte, E., Beslot, A., Boukpessi, T. et al. MTA versus Ca(OH)2 in apexification of non-vital immature permanent teeth: a randomized clinical trial comparison. Clin Oral Invest 19, 1381–1388 (2015). https://doi.org/10.1007/s00784-014-1348-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-014-1348-5

Keywords

Search

Navigation