Calcium hydroxide or MTA for apex formation in immature permanent teeth


Pulp necrosis  in immature teeth arrests root development so apical closure cannot be achieved. Root canal treatment of these teeth is a challenge. Procedures to encourage apexification have long been the treatment of choice success in preserving damaged immature teeth.  A range of  materials have been recommended to induce apexification in teeth with immature apices.  This review aims to compare the efficacy of calcium hydroxide and mineral trioxide aggregate (MTA) for root-end induction in immature roots.

Searches were conducted in English and French of the Medline and Scopus databases for controlled trials comparing calcium hydroxide with MTA for the apexification of immature permanent teeth study. Methodological quality was assessed with the Jadad score.

Two studies (31 participants, 50 teeth) were included. They found no significant difference between the two interventions in terms of clinical success or apical barrier formation.

They concluded:

Calcium hydroxide and MTA may be suitable materials for the treatment of the immature teeth.  However, more studies evaluating the factors influencing success and failure in teeth should be conducted.

Chala S, Abouqal R, Rida S. 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. 2011 Jul 19. [Epub ahead of print] PubMed PMID: 21778090.

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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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