MTA versus Ca(OH)2 in apexification of non-vital immature permanent teeth: a randomized clinical trial comparison
Tóm tắt
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. 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). 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. 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. Apexification using MTA seems preferable to CH in order to early achieve the coronoradicular filling and to limit the risk of root fracture.
Tài liệu tham khảo
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
Andreasen FM (2001) Pulpal healing following acute dental trauma: clinical and radiographic review. Pract Proced Aesthet Dent 13(4):315–322, quiz 324
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
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
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
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
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
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
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
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
Ørstavik D, Qvist V, Stoltze K (2004) A multivariate analysis of the outcome of endodontic treatment. Eur J Oral Sci 112(3):224–230
Mendoza AM, Reina ES, García-Godoy F (2010) Evolution of apical formation on immature necrotic permanent teeth. Am J Dent 23(5):269–274
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
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
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
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
Wang R, Weiner S (1998) Human root dentin: structural anisotropy and Vickers microhardness isotropy. Connect Tissue Res 39(4):269–279
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
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
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
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
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
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
Nolla CM (1960) The development of the permanent teeth, J Dent Child: 254–266
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
El-Meligy OAS, Avery DR (2006) Comparison of apexification with mineral trioxide aggregate and calcium hydroxide. Pediatr Dent 28(3):248–253
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
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
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
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
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
Garcia-Godoy F, Murray PE (2012) Recommendations for using regenerative endodontic procedures in permanent immature traumatized teeth. Dent Traumatol 28(1):33–41