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Title Prognosis Of MTA Apexification Versus Calcium Hydroxide Apexification
Clinical Question Does MTA apexification render better long-term prognosis than calcium hydroxide apexification for treatment of dens in dente in permanent dentition from children or adolescents?
Clinical Bottom Line When performed correctly, apexification with MTA and calcium hydroxide on permanent dentition with dens in dente and open apices both have similarly good long-term prognosis. However, given that MTA is more biocompatible and that it can be performed in one visit, MTA apexification is the treatment of choice.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 16360600 Jaramillo/2006Children to adolescent with dens in dente and open apex permanent dentition.Case Study
Key resultsBoth MTA apexification and long-term calcium hydroxide techniques had good outcome in a 5-year follow up for treating dens in dente (dens invaginatus) cases. Both cases were cleaned with antimicrobial irrigants during preparation. For MTA apexification, calcium hydroxide was placed inter-appointment for 2 weeks. For long-term calcium hydroxide treatment, the paste was replaced at 2 weeks, then monthly for 14 months, at which time the root had fully formed and was therefore conventionally obturated with gutta percha.
Evidence Search (("Dens in Dente"[Mesh] AND "Root Canal Therapy"[Mesh]) AND "mineral trioxide aggregate "[Substance Name]) AND "Calcium Hydroxide"[Mesh] AND ("humans"[MeSH Terms] AND English[lang] AND ("infant"[MeSH Terms] OR "child"[MeSH Terms] OR "adolescent"[MeSH Terms]))
Comments on
The Evidence
Conclusions drawn from this article are based on 2 case studies to compare the two techniques and the author’s; expert opinion on the topic. MTA is newer and has been proven to be very biocompatible, so it is expected that apexification with MTA would be successful. The present case study demonstrated that both methods are successful treatments for permanent teeth with dens in dente and open apices. The authors mentioned that if patient recall is a concern, then MTA apexification is preferred since calcium hydroxide apexification requires multiple follow up visits. However, MTA apexification does not allow for continued root development like long-term calcium hydroxide treatments.
Applicability Both techniques may be applicable for treatment of patients with dens in dente or any teeth with an immature root that results in open apices at the time of treatment. However, MTA has been shown to be very biocompatible and less toxic to the body than calcium hydroxide, so calcium hydroxide apexification is much more technique sensitive than MTA to prevent adverse events.
Specialty/Discipline (Endodontics) (General Dentistry) (Pediatric Dentistry)
Keywords MTA apexification, calcium hydroxide, dens in dente
ID# 830
Date of submission: 05/05/2011spacer
E-mail quang@livemail.uthscsa.edu
Author Phuong Quang
Co-author(s) e-mail
Faculty mentor/Co-author Peter T. Gakunga, BDS, MS, PhD
Faculty mentor/Co-author e-mail GAKUNGA@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments on the CAT
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by Nicholas Aboud (San Antonio) on 12/01/2017
A PubMed and TRIP search was performed in November 2017. No new evidence exists specific to apexification effect on dens in dente prognosis. New research should be directed towards apexification using MTA as well as other materials, as well as the effects of other therapies (obturation, pulpal regeneration, others) on dens in dente prognosis.

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