Comparison of Mineral Trioxide Aggregate and Calcium Hydroxide as Pulpotomy Agents in Young Permanent Teeth (Apexogenesis)

Author(s): Omar A.S. El Meligy, David R. Avery
Journal: Pediatric Dentistry
Volume (number): Volume 28: number 5
Month, Year: Scientific Article 2006
Major topic: pulpotomy agents
Minor topic(s): Comparison of MTA and Calcium Hydroxide as pulpotomy agents
Type of Article: Scientific Article
Main Purpose(s): To compare mineral trioxide aggregate with calcium hydroxide clinically and radiographically as a pulpotomy agent in immature permanent teeth (apexogenesis).
Overview of method of research: Fifteen children, each with at least 2 immature permanent teeth requiring pulpotomy (apexogenesis) were selected. The children were within the age range of 6 to 12 years. In one group pulpotomies were performed with calcium hydroxide and the other pulpotomies with MTA were done. Clinical and radiographic evaluations were performed after 3, 6, and 12 months.
Findings: Follow-up evaluations revealed failure due to pain and swelling detected at 6 and 12 months postoperative evaluations in only 2 teeth treated with calcium hydroxide. The remaining 28 teeth appeared to be clinically and radiographically successful 12 months postoperatively. Calcific metamorphosis was a radiographic finding in 2 teeth treated with calcium hydroxide and 4 teeth treated with MTA. So in conclusion, after a 12 month postoperative period, MTA proved very effective as a successful pulpotomy agent for apexogenesis in young permanent teeth, MTA is a suitable replacement for calcium hydroxide as a pulpotomy agent for the apexogenesis procedure, and there was no statistically significant difference in the 2 treatment groups.
Key points/Summary: Because of the alkalinity of CH it is so caustic that when placed in contact with vital pulp tissue, the reaction produces a superficial necrosis of the pulp. MTA on the other hand has been shown to provide an enhanced nonresorbable seal over the vital pulp and is much more biocompatible with the pulp. MTA is a powder consisting of tricalcium silicate, dicalcium silicate, tricalcium aluminate, calcium sulfate dehydrate and bismuth oxide. It has been shown to have a superior sealing ability to amalgam, zinc oxide-eugenol, or IRM. Apexogenesis = a vital pulp therapy procedure performed to encourage continued physiological development and formation of the root end. Apexification = a method to induce a calcified barrier in a root with an open apex or the continued apical development of an incomplete root in a tooth with a necrotic pulp. When placing the MTA it is important to allow the MTA to cure completely before placing a definitive restoration on the treated tooth. Therefore it is necessary to schedule two treatment appointments relatively close together: the first to perform the pulpotomy and place the MTA, and the second to complete the tooth restoration after the MTA has cured.
Assessment of article: Excellent article