Do you miss me??? - Comparison of Apexification with Mineral Trioxide Aggregate and Calcium Hydroxide

Meghan Sullivan Walsh October 22, 2010

Literature Review - St. Joseph/LMC Pediatric Dentistry

Comparison of Apexification With Mineral Trioxide Aggregate and Calcium Hydroxide

Resident: Meghan Sullivan Walsh

Program: Lutheran Medical Center- Providence

Article Title: Comparison of Apexification with Mineral Trioxide Aggregate and Calcium Hydroxide

Authors: Omar A.S. El Meligy, BDS, MSc, PhD; David Avery, DDS, MSD

Journal: Pediatric Dentistry

Volume (number), Year, Page #’s; 28:3, 2006, pages 248-253

Major Topic: Comparing success of MTA vs. Calcium Hydroxide used for Apexification

Overview of Method of Research: 30 traumatized or carious, necrotic teeth requiring root-end closure on 15 children were used for this study. Each child had two teeth requiring apexification. In each child one tooth was placed in control group 1 and the second tooth placed in group 2. In Group 1, 15 teeth were treated with Ca (OH)2 powder and an IRM seal. In Group 2, 15 teeth were first disinfected with Ca (OH)2 paste for one week, rinsed and then filled with MTA powder and sterile water, a moist cotton pellet and IRM. The children were then recalled at 3, 6, and 12 month intervals for clinical and radiographic success.

Findings: The clinical and radiographic success rates for Ca(OH)2 and MTA were 87% and 100% respectively. Of the 15 teeth in control group 1 there were two failures. At 6 months these two teeth showed widened lamina dura and periapical radioleucencies. These teeth were re-treated and at 12 months still showed signs of a persistent radioleucency.

Key Points: Summary:

While Calcium Hydroxide may be today’s material of choice for apexification, there are some disadvantages to this material. Some of these disadvantages include variability of treatment time, unpredictability of apical closure, difficulty in patient follow-up and delayed treatment. MTA has shown a diversity when it comes to applications in dentistry. With regards to apexification, studies have shown that MTA induces hard tissue formation more than Ca(OH)2, allows for bone healing and elimination of clinical symptoms. MTA shows superior biocompatibility in the oral cavity, prevents micro leakage and promotes regeneration of the original tissues when it is placed in contact with the dental pulp or periradicular tissues. All of the 15 teeth treated with MTA were successful at the 12 month follow-up visit. MTA, however, does have the disadvantage of being difficult to work with as well as expensive.

Assessment of the Article: The believe the strength of this research was that fact that the comparing treatments were performed on two teeth with similar dental pathologies in the same oral environment. While the author recognizes that the sample size was small, I believe these result are very close to accurate. We are discovering many uses for MTA and are seeing extremely successful results. Perhaps the cost will decrease as more practitioners start using MTA. I do find it unfortunate that many dentists choose not to use an extremely successful and predictable material due to cost.