Comparison of clinical outcomes for 40necrotic immature permanent incisorstreated with calcium hydroxide ormineral trioxide aggregate apexification/apexogenesis

Abstract

Background/Purpose: Traumatic injury often results in pulp necrosis of immature permanent incisors in children. This study compared clinical outcomes for 40 necrotic immature permanent incisors treated with calcium hydroxide [Ca(OH)2] or mineral trioxide aggregate (MTA) apexification/apexogenesis. Methods: Forty necrotic open-apex incisors from 40 children aged 6.5-10 years were divided evenly into four groups with each group containing teeth of similar type and similar root apex width in patients of similar age. Group 1 incisors were treated with ultrasonic filing and MTA placement; Group 2 were treated with ultrasonic filing and Ca(OH)2 medication; Group 3 were treated with hand filing and MTA placement; and Group 4 were treated with hand filing and Ca(OH)2 medication. Results: Group 1 incisors needed the shortest mean duration (5.4±1.1 weeks) for apical hard tissue barrier formation, followed by Group 3 incisors (7.8±1.8 weeks), Group 2 incisors (11.3±1.3 weeks), and Group 4 incisors (13.1±1.5 weeks). Group 1 incisors had a significantly shorter mean elongated root length (2.1±0.2mm) after treatment than Group 2 incisors (3.5±0.3mm, p<0.001), and Group 3 incisors had a significantly shorter mean elongated root length (2.1±0.1mm) after treatment than Group 4 incisors (3.7±0.3mm, p<0.001). Conclusion: Necrotic open-apex incisors treated with ultrasonic filing plus MTA placement need the shortest mean duration for apical hard tissue barrier formation. For elongation of apical root length, Ca(OH)2 apexification/apexogenesis is better than MTA apexification/apexogenesis, regardless if either ultrasonic or hand filing are used.