Comparative Efficacy of Bioceramics Apexification in Periradicular Healing and Root-end Calcific Tissue Repair in Immature Traumatized Permanent Anterior Teeth

Abstract

Aim: To compare the efficacy of bioceramics [Biodentine (BD) and mineral trioxide aggregate (MTA)] apexification in periradicular healing and root-end calcific tissue repair in immature traumatized permanent anterior teeth as compared to calcium hydroxide [Ca(OH)2] apexification. Materials and method: A total of 33 (N) traumatized nonvital immature permanent teeth in 21 children between the age-group of 8–16 years, fulfilling the inclusion criteria, were selected. They were randomized into three equal groups (n = 11) each for treatment by apexification. In the study groups, MTA and BD were compacted as apical plug barriers. The conventional method of apexification by placing Ca(OH)2 paste in the root canal space was used in the control group. The recall was done at 1, 3, 6, and 9 months clinically and at 3, 6, and 9 months radiographically to check for healing by improved periapical index (PAI) scores and induction of calcific tissue repair and/or continued root formation apical to the placed materials. Statistical assessment was done using Statistical Package for the Social Sciences (SPSS) version 15.0 analytical software. Results: Success was 100% at the final follow-up (p < 0.001) according to clinical parameters. The resolution of the periradicular radiolucency took minimum time in the BD group, followed by the MTA group. Calcific repair and/or increase in apical length was observed in 100% of teeth in both groups at 6 months compared to only 40% of teeth in control group Ca(OH)2 with resultant radiopaque hard tissue barrier apical to placed material plug. Conclusion: BD, followed by MTA, has superior properties for inducing periradicular healing and calcific tissue repair than Ca(OH)2 for apexification. For conclusive inferences regarding better efficacy, a larger sample size with a prolonged follow-up period needs to be taken on. Clinical significance: To preserve the young permanent teeth from trauma, apexification is the treatment of choice. Ca(OH)2 has been used as a gold standard for apexification procedures. However, newer materials such as MTA and BD have superior properties, are less time-consuming, have better handling properties and faster results compared to Ca(OH)2 in terms of periradicular healing and induction of root-end calcific repair by the formation of hard tissue.