Treatment of immature teeth with nonvital pulps in adults: a prospective comparative clinical study comparingMTAwith Ca(OH)₂

Abstract

Aim To evaluate and compare the influence of various predictors on outcomes of apexification using either mineral trioxide aggregate (MTA) or calcium hydroxide (CH) in permanent immature anterior teeth with necrotic pulps and periapical lesions of adults. Methodology Ninety immature teeth with necrotic pulps and periapical lesions on adult patients (aged 18–40 years) were treated with MTA (45 teeth) or CH (45 teeth) between 2015 and 2018. Patients of both groups were recalled for follow‐up examinations after the first intervention at 1,3,6 and 12 months for the first year, every 6 months for the second year and every year thereafter until the end of the study (median 32.3 months). The treatment outcome based on clinical and radiographic criteria was assessed by calibrated examiners and dichotomized as ‘healed+healing’ or ‘not healed’. The age, gender, stage of root development, preoperative signs and symptoms of apical periodontitis and size of periapical lesion were recorded. The cumulative success proportion and mean time were analysed with the Kaplan–Meier test. The generalized logrank statistic was used to describe prognostic clinical variables. Fisher's exact test was applied for the evaluation of the healing rates. Results Thirty‐nine of the 45 teeth treated with MTA were available for recall. Of these, 29 teeth (74%) revealed calcific apical barrier formation with complete resolution of periapical lesions, 7 teeth (18%) were healing, and 3 teeth (8%) had persistent disease. Thirty‐four of the 45 teeth in the CH group were available for recall. Of these, 27 teeth (79%) had complete healing of periapical lesions and had calcific barrier formation, 4 teeth (12%) were healing, and the remaining 3 teeth (9%) had not healed. The survival rate of teeth treated with MTA was similar to the survival rates observed in teeth treated with CH (90% and 91%, respectively, P > 0.05). The generalized logrank statistic revealed that the cumulative success rate of both materials was not significantly different (P > 0.05). None of the tested predictors had an influence on the treatment outcomes of teeth in both groups (P > 0.05). Conclusions Apexification with both MTA and CH was associated with similar treatment outcomes. MTA may be proposed as a material for apexification treatment in immature teeth of adult patients due to the shorter treatment time associated with its use.

What is the best long-term treatment modality for immature permanent teeth with pulp necrosis and apical periodontitis?

“…In the MTA study group, three of the included studies reported similar time of medication—i.e. one to four weeks—with the exception of a prolonged time frame in one of the control groups where the final treatment was postponed until a complete apical calcific barrier was observed radiographically and confirmed clinically (Kandemir Demirci et al 2019 ). Two of the MTA studies did not provide data about the total medication time (Demiriz and Hazar 2017 ; Mente et al 2013 ).…”

“…The results showed that the included studies in both groups were heterogeneous regarding the outcome measurements. Only three studies reported Cvek’s stage of root development at baseline—one study in the RET group (Chan et al 2017 ) and two studies in the MTA group (Kandemir Demirci et al 2019 ; Bucher et al 2016 ). Based on the comparison of the mean age values between the two study groups, we assumed that RET studies included teeth with a lower stage of root development than the MTA studies (mean age RET 8.33 years; mean age MTA 18.39 years) (Table 7 ).…”

“…Only two of the included studies were randomised clinical trials—one of the RET studies (Ulusoy et al 2019 ) and one of the MTA study group (Kandemir Demirci et al 2019 )—and the majority of the studies lacked control groups. Therefore, we could not use statistical meta-analysis models to estimate the effect size (Dixon-Woods et al 2006 ).…”

“…That is, four of the five included MTA studies were retrospective so the data for sensitivity testing before treatment might have been unavailable. Standardised examination methods, including sensitivity testing at baseline, were used in a MTA study with a RCT design (Kandemir Demirci et al 2019 ). In fact, the retreatment cases and cases with irreversible pulpitis were also included in the MTA treatment group (Ree and Schwartz 2017 ).…”

“…Traumatic dental injuries leading to pulp necrosis and apical periodontitis were the most common reason for treatment in both RET and MTA study groups. Exhaustive data about the specific type of trauma injury were reported in five of the included studies (Bucher et al 2016 ; Ree and Schwartz 2017 ; Kandemir Demirci et al 2019 ; Chan et al 2017 ; Ulusoy et al 2019 ), and two studies did not state the cause for the treatment (Demiriz and Hazar 2017 ; Mente et al 2013 ). In both study groups, the overall trauma frequency varied between 46 and 100% (Table 9 ).…”