Title Mineral Trioxide Aggregate (MTA) Plugs and Regenerative Endodontic Procedures Provide Equally Successful Outcomes for Patients with Necrotic Pulps in Immature Teeth
Clinical Question In young patients with immature teeth and necrotic pulps, do regenerative endodontic procedures (REPs) have higher success rates compared to mineral trioxide aggregate (MTA) plugs?
Clinical Bottom Line Both MTA plugs and REPs have been shown to provide highly successful outcomes for patients with necrotic pulps in immature teeth, with no significant difference in success rates.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
28822564Torabinejad/2017144 studies (543 teeth treated with MTA, 455 treated with REP); 10 RCTs in meta-analysisMeta-Analysis
Key results144 studies (61 in the MTA plug group and 85 in the REP group) met the inclusion criteria. Most studies were case reports or cases series. Only 10 randomized clinical trials were identified, and these were selected for meta-analysis. The authors defined success as lack of clinical symptoms and complete radiographic healing of periapical lesions. Survival was defined as retention of tooth at follow up. The pooled success rate for MTA was 94.6% (95% confidence interval [CI], 90.2%–99.1%) and for REP was 91.3% (95% CI, 84.5%–98.2%). Pooled survival rate for MTA was 97.1% (95% CI, 93.7%–100%) and for REP was 97.8% (95% CI, 94.8%–100%). The average follow-up time per tooth in the studies selected for the meta-analysis was 19.9 months for the MTA studies and 16.7 months for the REP studies. There was no significance difference between groups in survival or success.
Evidence Search “regenerative endodontic treatment” “immature necrotic teeth” “MTA apexification” “mta plug” “immature teeth” – Filtered for meta-analysis
Comments on
The Evidence
Validity: This is a well-designed and well-executed systematic review and meta-analysis. There was broad inclusion criterion, which resulted in the bulk of the included studies being case reports or case series (72% in the MTA plug group and 86% in the REP group). This results in a low level of evidence. However, there were 10 RCTs (6 for MTA, 4 for regenerative endodontics) on which subset analysis was carried out for success and survival. Success and survival were clearly defined. There were only 2 studies (1 RCT, 1 retrospective cohort study) that directly compared MTA plug and regenerative endodontics. The meta-analysis revealed no statistically significant difference in survival rates (P = 1.00) or success rates (P = .58) between the two groups. There was a great deal of heterogeneity among the RCTs, mainly in the regenerative studies. This is potentially due to either clinical heterogenicity or methodologic heterogenicity. Perspective: There is a lack of high-quality studies that directly compare MTA apical plug and REP. There is a need for multicentered randomized control trials with long-term follow ups. Based on the available evidence there is no statistical difference between MTA plug or regenerative endodontics in terms of success and survival for immature teeth with pulp necrosis. Regenerative endodontics give the potential to continue development of root length and width and therefore should be considered as the first-choice treatment when possible. If regenerative endodontics does fail, an MTA plug can be placed.
Applicability Clinicians encounter young patients with open apices and necrotic pulps routinely. Historically the treatment option was an MTA plug/apical barrier. However, clinicians now have a procedure (REP) option that aims to develop root length while providing a similar success rate.
Specialty (Endodontics) (General Dentistry) (Pediatric Dentistry) (Restorative Dentistry)
Keywords MTA, regenerative endodontics, open apex, immature tooth, necrotic tooth
ID# 3356
Date of submission 11/12/2018
E-mail Patelb1@livemail.uthscsa.edu
Author Biraj Patel
Co-author(s) e-mail
Faculty mentor Nikita Ruparel
Faculty mentor e-mail ruparel@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?)
None available
Comments and Evidence-Based Updates on the CAT
None available