Comparison of MTA versus Biodentine in Apexification Procedure for Nonvital Immature First Permanent Molars: A Randomized Clinical Trial

Yasser Alsayed Tolibah, Chaza Kouchaji, Thuraya Lazkani, Ibrahim Ali Ahmad, Ziad D Baghdadi, Yasser Alsayed Tolibah, Chaza Kouchaji, Thuraya Lazkani, Ibrahim Ali Ahmad, Ziad D Baghdadi

Abstract

This study aimed to evaluate the radiological and clinical outcomes of Biodentine apical plugs compared to mineral trioxide aggregate (MTA) in treating immature molars with apical lesions in children.

Materials and methods: Thirty immature roots of 24 permanent lower first molars with apical lesions were randomly divided into two groups: group 1 (15 roots) treated with MTA apical plugs and group 2 (15 roots) treated with Biodentine apical plugs. Treatment radiological outcomes were assessed using the periapical index (PAI) scale after 6 and 12 months of treatment. The presence or absence of apical calcified barrier (ACB) was assessed after 12 months of treatment. The visual analog scale (VAS) was used to compare the postoperative pain between the two groups after 1, 3, 7, and 14 days of treatment. PAI scores between the two groups were compared using the Mann-Whitney U test, the presence or absence of the ACB was compared using the chi-square test, and the VAS scores were compared using the t-test. The statistical significance threshold was set at 0.05.

Results: There were no statistically significant differences in the PAI between the two groups at 6 and 12 months postoperatively. After 12 months, four cases in the Biodentine group showed ACB formation, whereas ACB was not found in any case treated with MTA. The VAS scores were statistically lower in the MTA group on the first day after treatment. Nevertheless, these scores were not statistically significantly different after 3, 7, and 14 days of treatment between the two groups.

Conclusions: Biodentine can be used as an apical plug to treat immature permanent molars with apical lesions in a single visit in children. Biodentine showed favorable outcomes in apical lesions healing, which was comparable to MTA but with a decreased treatment time associated with its use.

Keywords: Biodentine; MTA; PAI; VAS; apexification; apical plugs.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Pulp chamber after caries removed and access cavity refined.
Figure 2
Figure 2
Determining the working length radiographically.
Figure 3
Figure 3
Pulp chamber after activation of hypochlorite in root canals.
Figure 4
Figure 4
Apexification using MTA as an apical plug: (A) preoperative; (B) after placement of the apical plug; (C) postoperative; (D) 6 months follow-up; (E) 12 months follow-up.
Figure 5
Figure 5
Apexification using Biodentine as an apical plug: (A) preoperative; (B) after placement of the apical plug; (C) postoperative; (D) 6 months follow-up; (E) 12 months follow-up. The arrow demonstrates the formation of apical barrier.
Figure 6
Figure 6
Flow chart for the study.

References

    1. Hargreaves K.M., Berman L.H. Cohen’s Pathways of the Pulp. 11th ed. Elsevier; Saint Louis, MO, USA: 2016. pp. 913–951.
    1. Sheehy E.C., Roberts G.J. Use of calcium hydroxide for apical barrier formation and healing in non-vital immature permanent teeth: A review. Br. Dent. J. 1997;183:241–246. doi: 10.1038/sj.bdj.4809477.
    1. Felippe M.C.S., Felippe W.T., Marques M.M., Antoniazzi J.H. The effect of the renewal of calcium hydroxide paste on the apexification and periapical healing of teeth with incomplete root formation. Int. Endod. J. 2005;38:436–442. doi: 10.1111/j.1365-2591.2005.00959.x.
    1. Andreasen J.O., Farik B., Munksgaard E.C. Long-term calcium hydroxide as a root canal dressing may increase risk of root fracture. Dent. Traumatol. 2002;18:134–137. doi: 10.1034/j.1600-9657.2002.00097.x.
    1. Binnie W.H., Rowe A. A Histological Study of the Periapical Tissues of Incompletely Formed Pulpless Teeth Filled with Calcium Hydroxide. J. Dent. Res. 1973;52:1110–1116. doi: 10.1177/00220345730520052001.
    1. Camilleri J. Bioceramic Materials in Clinical Endodontics. Springer; Cham, Switzerland: 2020. Current Classification of Bioceramic Materials in Endodontics; pp. 1–6.
    1. Chung S.H., Chun K.A., Kim H.-Y., Kim Y.-S., Chang J. Periapical Healing in Single-visit Endodontics under General Anesthesia in Special Needs Patients. J. Endod. 2019;45:116–122. doi: 10.1016/j.joen.2018.10.020.
    1. Camilleri J. Biodentine™. The Dentine in a Capsule or More? [(accessed on 1 January 2022)]. Available online: .
    1. Bachoo I.K., Seymour D., Brunton P. A biocompatible and bioactive replacement for dentine: Is this a reality? The properties and uses of a novel calcium-based cement. Br. Dent. J. 2013;214:E5. doi: 10.1038/sj.bdj.2013.57.
    1. Kaur M. MTA versus Biodentine: Review of Literature with a Comparative Analysis. J. Clin. Diagn. Res. 2017;11:ZG01–ZG05. doi: 10.7860/JCDR/2017/25840.10374.
    1. Solanki N.P., Venkappa K.K., Shah N.C. Biocompatibility and sealing ability of mineral trioxide aggregate and biodentine as root-end filling material: A systematic review. J. Conserv. Dent. 2018;21:10–15. doi: 10.4103/JCD.JCD_45_17.
    1. Johnson E.W. Visual Analog Scale (VAS) Am. J. Phys. Med. Rehabil. 2001;80:717. doi: 10.1097/00002060-200110000-00001.
    1. Orstavik D., Kerekes K., Eriksen H.M. The periapical index: A scoring system for radiographic assessment of apical periodontitis. Dent. Traumatol. 1986;2:20–34. doi: 10.1111/j.1600-9657.1986.tb00119.x.
    1. Chauhan A., Saini S., Dua P., Mangla R. Rotary Endodontics in Pediatric Dentistry: Embracing the New Alternative. Int. J. Clin. Pediatr. Dent. 2019;12:460–463. doi: 10.5005/jp-journals-10005-1679.
    1. Peeters H.H., Suardita K., Mooduto L., Gutknecht N. Extrusion of Irrigant in Open Apex Teeth with Periapical Lesions Following Laser-Activated Irrigation and Passive Ultrasonic Irrigation. Iran. Endod. J. 2018;13:169–175. doi: 10.22037/IEJ.V13I2.17150.
    1. Amulya V., Rani V.S., Prakash T.J., Ranjani A.S., Gayathri C., Chandrasekhar V. Evaluation of biocompatibility of a new root canal irrigant Q MixTM2 in 1- An in vivo study. J. Conserv. Dent. 2013;16:36–40. doi: 10.4103/0972-0707.105296.
    1. Mohammadi Z., Giardino L., Palazzi F., Shalavi S., Alikhani M.Y., Giudice G.L., Davoodpour N. Effect of sodium hypochlorite on the sub-stantivity of chlorhexidine. Int. J. Clin. Dent. 2013;6:173–178.
    1. Attik G.N., Villat C., Hallay F., Pradelle-Plasse N., Bonnet H., Moreau K., Colon P., Grosgogeat B. In vitrobiocompatibility of a dentine substitute cement on human MG63 osteoblasts cells: Biodentine™ versus MTA®. Int. Endod. J. 2014;47:1133–1141. doi: 10.1111/iej.12261.
    1. Hiremath G.S., Kulkarni R.D., Naik B.D. Evaluation of minimal inhibitory concentration of two new materials using tube dilution method: An in vitro study. J. Conserv. Dent. 2015;18:159–162. doi: 10.4103/0972-0707.153056.
    1. Jovanović L.Z., Bajkin B.V. Scanning electron microscopy analysis of marginal adaptation of mineral trioxide aggregate, tricalcium silicate cement, and dental amalgam as a root end filling materials. Microsc. Res. Tech. 2021;84:2068–2074. doi: 10.1002/jemt.23762.
    1. Nepal M., Shubham S., Tripathi R., Khadka J., Kunwar D., Gautam V., Gautam N. Spectrophotometric analysis evaluating apical microleakage in retrograde filling using GIC, MTA and biodentine: An in-vitro study. BMC Oral Health. 2020;20:37. doi: 10.1186/s12903-020-1025-9.
    1. Abbas A., Kethineni B., Puppala R., Birapu U.C., Raghavendra K.J., Reddy P. Efficacy of Mineral Trioxide Aggregate and Biodentine as Apical Barriers in Immature Permanent Teeth: A Microbiological Study. Int. J. Clin. Pediatr. Dent. 2020;13:656–662. doi: 10.5005/jp-journals-10005-1853.
    1. Torabinejad M., Chivian N. Clinical applications of mineral trioxide aggregate. J. Endod. 1999;25:197–205. doi: 10.1016/S0099-2399(99)80142-3.
    1. Kumari S., Mittal A., Dadu S., Dhaundiyal A., Abraham A., Yendrembam B. Comparative evaluation of physical and chemical properties of calcium silicate-based root-end filling materials (Mineral trioxide aggregate and biodentine): Anin vitrostudy. Indian J. Dent. Sci. 2018;10:197. doi: 10.4103/IJDS.IJDS_42_18.
    1. Han L., Okiji T. Bioactivity evaluation of three calcium silicate-based endodontic materials. Int. Endod. J. 2013;46:808–814. doi: 10.1111/iej.12062.
    1. Jung S., Mielert J., Kleinheinz J., Dammaschke T. Human oral cells’ response to different endodontic restorative materials: An in vitro study. Head Face Med. 2014;10:1–9. doi: 10.1186/s13005-014-0055-4.
    1. Miller A.A., Takimoto K., Wealleans J., Diogenes A. Effect of 3 Bioceramic Materials on Stem Cells of the Apical Papilla Proliferation and Differentiation Using a Dentin Disk Model. J. Endod. 2018;44:599–603. doi: 10.1016/j.joen.2017.12.018.
    1. Apexification of Traumatically Injured Teeth: A Comparison between Biodentine and Mineral Trioxide Aggregate. Int. J. Sci. Res. (IJSR) 2017;6:1181–1184. doi: 10.21275/ART20178908.
    1. Yadav A., Chak R.K., Khanna R. Comparative Evaluation of Mineral Trioxide Aggregate, Biodentine, and Calcium Phosphate Cement in Single Visit Apexification Procedure for Nonvital Immature Permanent Teeth: A Randomized Controlled Trial. Int. J. Clin. Pediatr. Dent. 2020;13:S1–S13. doi: 10.5005/jp-journals-10005-1830.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit