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

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.