COMPARATIVE ANALYSIS OF CALCIUM HYDROXIDE, MTA AND BIODENTINE IN FORMATION AN APICAL BARRIER IN IMMATURE PERMANENT TEETH WITH CHRONIC APICAL PERIODONTITIS
Introduction. Chronic apical periodontitis is one of the major problems in pediatric endodontics, resulting in delayed development and root formation of permanent teeth. Apexification is an important treatment for immature permanent teeth with open apex.
Aim: Literature analysis on the issue of calcium hydroxide, MTA and Biodentine effectiveness in the clinical and radiological success of apexification of necrotic immature permanent teeth.
Search strategy. The search was carried out in the databases PubMed, Web of Science, Scopus, eLibrary, Cochrane Library, Google Scholar, Research Gate: randomized controlled trials, prospective and retrospective studies in English and Russian, dated 2012 - 2022. Key words were used for the following sections: pathology: "apical periodontitis", "immature permanent teeth"; treatment: "apexification"; medicaments: "calcium hydroxide", "MTA", "Biodentine"; studies: "randomized controlled trial". A total of 7 full-text studies were included in the analysis.
Results. Literature analysis revealed that Biodentine is the most effective according to clinical and radiological results. It reduces the number of patients’ visits up to one visit. It has the best performance characteristics, as well as setting time is about 12 minutes. As a result, one-stage root canal obturation is possible. MTA has less favorable outcomes, causing staining of tooth enamel. However, the presence of MTA modifications like white MTA diminished these shortcomings. Calcium hydroxide is a reasonable and quite effective solution for apexification. To this day, calcium hydroxide is widely used both abroad and in the Republic of Kazakhstan.
Conclusions. Between three apexification materials presented, Biodentine and MTA are the most clinically and radiologically effective materials. Calcium hydroxide remains as the drug of choice, although it has several disadvantages.
Madina A. Kurmanalina1, Aigul M. Sumanova2,
Violetta R. Detochkina2, Zhanara A. Shabanbayeva2,
1 NJSC «West Kazakhstan Marat Ospanov Medical University», Aktobe, Republic of Kazakhstan;
2 NJSC «Astana Medical University». Astana, Republic of Kazakhstan.
1. Абдыбекова А.К., Алдашева М.А. Современные средства для временной обтурации корневых каналов (обзор литературы) // Вестник Казахского Националь-ного медицинского университета. 2020. №.2. С. 193-198.
2. Уткина Е.И. и др. Гистологические преимущества биосиликатных цементов как материалов для витальной терапии пульпы // West Kazakhstan Medical Journal. 2022. №. 3 (64). С. 147-150.
3. Abbas A. et al. Efficacy of mineral trioxide aggregate and Biodentine as apical barriers in immature permanent teeth: a microbiological study // International Journal of Clinical Pediatric Dentistry. 2020. Т.13. №.6. С. 656-662.
4. Adl A., Javanmardi S., Abbaszadegan A. Assessment of tooth discoloration induced by Biodentine and white mineral trioxide aggregate in the presence of blood // Journal of Conservative Dentistry: JCD. 2019. Т. 22. №.2. С. 164-168.
5. Aeran H., Sharma M., Tuli A. Biodentine: Material of choice for apexification // International Journal of Oral Health Dentistry. 2021. Т. 7. №.1. С. 54-56.
6. Alazrag M.A. et al. Marginal adaptation, solubility and biocompatibility of TheraCal LC compared with MTA-angelus and Biodentine as a furcation perforation repair material // BMC Oral Health. 2020. Т.20. №.1. С. 298-309.
7. Al-Hiyasat A.S., El-Farraj H.S., Alebrahim M.A. The effect of calcium hydroxide on dentine composition and root fracture resistance of human teeth: An in vitro study // European Journal of Oral Sciences. 2021. Т.129. №.4. С. 98-107.
8. Al-Nazhan S. et al. Outcomes of furcal perforation management using Mineral Trioxide Aggregate and Biodentine: a systematic review // Journal of Applied Oral Science. 2022. Т. 30. C.30-38.
9. Alqahtani A.R. et al. Efficacy of calcium hydroxide and resin-modified calcium silicate as pulp-capping materials: A retrospective study // Gen. Dent. 2020. Т. 68. С. 50-54.
10. Aly M.M. et al. Clinical and radiographic evaluation of Biodentine and Mineral Trioxide Aggregate in revascularization of non‐vital immature permanent anterior teeth (randomized clinical study) // International journal of paediatric dentistry. 2019. Т. 29. №. 4. С. 464-473.
11. Annamalai S. et al. Apexification and repair of root fracture with mineral trioxide aggregate–A case report with 5-year follow-up // Journal of Pharmacy & Bioallied Sciences. 2021. Т. 13. №. Suppl 1. С. S881-S885.
12. Arıcan B., Sesen Uslu Y., Sarıalioğlu Güngör A. Resistance to fracture of simulated external cervical resorption cavities repaired with different materials // Australian Endodontic Journal. 2023. Т.49. №.1. С.174-182.
13. Ballikaya E., Güngör H.: The Use of Mineral Trioxide Aggregate in The Treatment of Horizontal Root Fractures: A Case Presentation and Literature Update // Selcuk Dental Journal. 2021. Т. 8. №. 3. С. 850-858.
14. Bansal R. et al. Evaluation of marginal adaptation of MTA, Biodentine, and MTA plus as root-end filling materials—an SEM study // Dental Journal of Advance Studies. 2019. Т. 7. №. 01. С. 006-011.
15. Baranwal H. C. et al. New Approach in the Management of Vertical Root Fracture with the Help of Biodentine and CBCT // Case Reports in Dentistry. 2020. – Т. 10. С.95-100.
16. Benetti F. et al. Cytotoxicity and biocompatibility of a new bioceramic endodontic sealer containing calcium hydroxide // Brazilian oral research. 2019. Т. 33. C.42-49.
17. Bhavana V. et al. Evaluation of antibacterial and antifungal activity of new calcium-based cement (Biodentine) compared to MTA and glass ionomer cement // Journal of conservative dentistry: JCD. 2015. Т.18. №.1. С. 44-46.
18. Bonte E. et al. MTA versus Ca (OH) 2 in apexification of non-vital immature permanent teeth: a randomized clinical trial comparison // Clinical oral investigation. 2015. Т.19. С. 1381-1388.
19. Cervino G. et al. Mineral trioxide aggregate applications in endodontics: A review // European journal of dentistry. 2020. Т.14. №.04. С. 683-691.
20. Corbella S. et al. Apexification, apexogenesis and regenerative endodontic procedures: a review of the literature // Minerva stomatologica. 2014. Т. 63. №.11-12. С. 375-389.
21. Cosme-Silva L. et al. Hypertension affects the biocompatibility and biomineralization of MTA, High-plasticity MTA, and Biodentine® // Brazilian oral research. 2019. Т. 33. С.60-70.
22. da Fonseca T.S. et al. Biodentine and MTA modulate immunoinflammatory response favoring bone formation in sealing of furcation perforations in rat molars // Clinical Oral Investigations. 2019. Т. 23. С. 1237-1252.
23. Damle S.G. et al. Clinical and radiographic assessment of mineral trioxide aggregate and calcium hydroxide as apexification agents in traumatized young permanent anterior teeth: A comparative study // Dental research journal. 2016. Т. 13. №.3. С. 284-291.
24. Damle S., Bhattal H., Loomba A. Apexification of anterior teeth: a comparative evaluation of mineral trioxide aggregate and calcium hydroxide paste // Journal of Clinical Pediatric Dentistry. 2012. Т. 36. №.3. С. 263-268.
25. Darak P. et al. Comparative evaluation of fracture resistance of simulated immature teeth and its effect on single visit apexification versus complete obturation using MTA and Biodentine // Journal of Family Medicine and Primary Care. 2020. Т. 9. №. 4. С. 2011-2015.
26. Dong X., Xu X. Bioceramics in Endodontics: Updates and Future Perspectives // Bioengineering. 2023. Т. 10. №. 3. С. 354-384.
27. Duman C. et al. Comparison of Three Different Biomaterials Used In In Vitro Molar Apexification Models. – 2022. С.434-442.
28. El-Mal E.O.A., et al. A comparative study of the physicochemical properties of hesperidin, MTA-Angelus and calcium hydroxide as pulp capping materials // The Saudi Dental Journal. 2019. Т. 31. №. 2. С. 219-227.
29. Eraković M. et al. Anti‐inflammatory and immunomodulatory effects of Biodentine on human periapical lesion cells in culture // International endodontic journal. 2020. Т. 53. №. 10. С. 1398-1412.
30. Eram A. et al. Finite element analysis of immature teeth filled with MTA, Biodentine and Bioaggregate // Computer methods and programs in biomedicine. – 2020. Т. 190. – С.56-62.
31. Flanagan T.A. What can cause the pulps of immature, permanent teeth with open apices to become necrotic and what treatment options are available for these teeth // Australian Endodontic Journal. 2014. Т.40. №3. С.95-100.
32. Galal M. et al. Solubility, pH change, and calcium ion release of low solubility endodontic mineral trioxide aggregate // Bulletin of the National Research Centre. – 2020. Т. 44. №.1. С. 42-47.
33. Gandolfi M. G. et al. Calcium silicate and calcium hydroxide materials for pulp capping: biointeractivity, porosity, solubility and bioactivity of current formulations // Journal of applied biomaterials & functional materials. 2015. Т. 13. №.1. С. 43-60.
34. Guerrero F. et al. Apexification: A systematic review // Journal of conservative dentistry: JCD. 2018. Т. 21. №.5. С. 462-465.
35. Hoffmann J.B. et al. Effect of different periods of calcium hydroxide dressing on the fracture resistance of root dentin // General dentistry. 2021. Т. 69. №. 5. С. 67-71.
36. Ince Yusufoglu S. et al. Evaluation of different Apexification treatments of teeth with immature apices and apical periodontitis on the fractal dimensions of trabecular bone // Australian Endodontic Journal. 2021. Т.47. №.2. С. 163-169.
37. Jordal K., Valen A., Orstavik D. Periapical status of root-filled teeth in Norwegian children and adolescents // Acta Odontologica Scandinavica. 2014. Т.72. №.8. С. 801-805.
38. Joshi K. et al. Comprehensive Assessment Of Intracoronal Stains Induced Via Triple Antibiotic Paste, Mineral Trioxide Aggregate And Calcium Hydroxide Powder Combined With Aquatic Solution Of Chlorhexidine–An In Vitro Study // Journal of Pharmaceutical Negative Results. 2022. С. 1871-1876.
39. Kandemir Demirci G. et al. Treatment of immature teeth with nonvital pulps in adults: a prospective comparative clinical study comparing MTA with Ca (OH) 2 // International Endodontic Journal. 2020. Т. 53. №.1. С. 5-18.
40. Kim S.Y., Lee S.M., Lee J.H. Initial cytotoxicity of mineral trioxide aggregate (MTA) during setting on human mesenchymal stem cells // Advances in Materials Science and Engineering. 2019. Т. 2019. С. 104-111.
41. Kostyiuk I. et al. Experimental study the anti-inflammatory and osteo-regenerative qualities of the paste based on symphytum officinale tincture and calcium hydroxide // Pharmacia. 2021. Т. 68. №.3. С. 585-590.
42. Li C. et al. Apexification management of mandibular second premolar with a blunderbuss apex and periapical lesion of an adult patient // Case reports in dentistry. 2019. – Т. 2019. C.42-46.
43. Martens L., Cauwels R. Biodentine TM Applications in Traumatology and Fractures // Biodentine™: Properties and Clinical Applications. 2022. С. 103-120.
44. Mathew A.I. et al. Comparative Evaluation of Mineral Trioxide Aggregate Obturation Using Four Different Techniques - A Laboratory Study // Materials. 2021. Т. 14. – №. 11. С. 126-137.
45. Mente J. et al. Treatment outcome of mineral trioxide aggregate in open apex teeth // Journal of endodontics. 2013. Т. 39. №.1. С. 20-26.
46. Miller A.A. et al. Effect of 3 bioceramic materials on stem cells of the apical papilla proliferation and differentiation using a dentin disk model // Journal of endodontics. 2018. Т. 44. №. 4. С. 599-603.
47. Mondelli J.A.S. et al. Biocompatibility of mineral trioxide aggregate flow and Biodentine // International endodontic journal. 2019. Т. 52. №. 2. С. 193-200.
48. Mousavi S. A. et al. Comparison of sealing ability of ProRoot mineral trioxide aggregate, Biodentine, and ortho mineral trioxide aggregate for canal obturation by the fluid infiltration technique // Dental research journal. 2018. Т. 15. №. 5. С. 307-312.
49. Muhamad A.H. et al. Management of open apex in permanent teeth with calcium hydroxide paste // Int J Dent Health Sci. 2016. Т. 44. №.8. С. 697-730.
50. Muna Saleem Khalaf Apexification of Traumatically Injured Teeth: A Comparison between Biodentine and Mineral Trioxide Aggregate // Int. J. Sci. Res. (IJSR) - 2017. № 6. C. 1181–1184.
51. Mustafa M. et al. Evaluation of Fractured Resistance Using MTA & Biodentine in Apexification v/s Obturation in Simulated Immature Teeth-An In-Vitro Study. – 2019.C.493-497.
52. Mutluay M., Mutluay A.T. Sealing efficiency of MTA, accelerated MTA, Biodentine and RMGIC as retrograde filling materials // Balkan Journal of Dental Medicine. 2021. Т. 25. №.3. С.159-165.
53. Nik-Azis N.M., et al. Iatrogenic Extrusion of Calcium Silicate Cements on Teeth Associated with Large Periapical Lesion: A Case Report with 12-Month Follow-up // Journal of Dentistry Indonesia. 2022. Т. 29. №. 2. С. 154-159.
54. Nikhil V., Jha P., Suri N.K. Effect of methods of evaluation on sealing ability of mineral trioxide aggregate apical plug //Journal of conservative dentistry: JCD. 2016. Т. 19. №. 3. С. 231-243.
55. Pace R. et al. Mineral trioxide aggregate as apical plug in teeth with necrotic pulp and immature apices: a 10-year case series // Journal of endodontics. 2014. Т.40. №.8. – С. 1250-1254.
56. Pham C. L. et al. Effect of Overlying Material on Final Setting of Biodentine® in Primary Molar Pulpotomies // Pediatric Dentistry. 2019. Т. 41. №.2. С. 140-145.
57. Pius A. et al. Evaluation and comparison of the marginal adaptation of an epoxy, calcium hydroxide-based, and bioceramic-based root canal sealer to root dentin by SEM analysis: An in vitro study // Cons Dent Endod J. 2019. Т. 4. С. 6-13.
58. Reddy S. et al. 100 years of Calcium Hydroxide in Dentistry: A review of literature // Indian Journal of Forensic Medicine & Toxicology. 2020. Т. 14. №. 4. С. 1203-1219.
59. Sahu S. et al. In vitro evaluation of apical leakage of three bioceramic materials using glucose leakage model in a simulated open apex // SRM Journal of Research in Dental Sciences. 2023. Т. 14. №.1. С. 11-16.
60. Scelza M.Z. et al. Biodentine TM is cytocompatible with human primary osteoblasts // Brazilian Oral Research. 2017. Т. 31. C.81-88.
61. Seirawan M. Y. et al. Coronal discoloration related to bioceramic and mineral trioxide aggregate coronal barrier in non-vital mature teeth undergoing regenerative endodontic procedures // Dent. 2020. Т. 11. С. 52-60.
62. Shaik I. et al. Comparison of the success rate of mineral trioxide aggregate, endosequence bioceramic root repair material, and calcium hydroxide for apexification of immature permanent teeth: Systematic review and meta-analysis // Journal of pharmacy & bioallied sciences. 2021. – Т. 13. №. Suppl 1. С. S43-S47.
63. Shalini Maria S. Comparison of the Potential Discolouration effect of MTA Angelus, Endocem MTA and Neo MTA on natural teeth: An in vitro study : дис. – Ragas Dental College and Hospital, Chennai, 2020. 137 c.
64. Sharma A., Sharma L., et al. Molecular signaling pathways and essential metabolic elements in bone remodeling: An implication of therapeutic targets for bone diseases // Current Drug Targets. 2021. Т.22. №.1. С.77-104.
65. Sherwood A.I. et al. Biodentine: A unique bio-active endodontic material with versatile uses // J Dental Health Oral Res. 2020. Т. 1. №. 2. С. 206-221.
66. Shokouhinejad N. et al. Effect of irrigation solutions on the coronal discoloration induced by mineral trioxide aggregate cements containing different radiopacifiers // Dental Research Journal. 2020. Т.17. №.6. С.447-451.
67. Silva W. O., Gonçalves H. R., Rodrigues R. C. V. Use of Calcium Hydroxide Between Visits in Endodontic Treatment // Seven Editora. 2023. С. 1266-1285.
68. Singla S. et al. Comparative Efficacy of Bioceramics Apexification in Periradicular Healing and Root-end Calcific Tissue Repair in Immature Traumatized Permanent Anterior Teeth // World Journal of Dentistry. 2022. Т.13. №.S2. S194-S202.
69. Sneha D. et al. Management of a complicated horizontal root fracture in a 12-year-old child using mineral trioxide aggregate: A case report. 2022.T.8 (2). C.104-107.
70. Spagnuolo G. Bioactive dental materials: the current status // Materials. 2022. Т. 15. №.6. С. 2016. C.16-19.
71. Staffoli S. et al. Regenerative endodontic procedures using contemporary endodontic materials // Materials. 2019. Т. 12. №. 6. С. 908-936.
72. Talabani R.M., Ali A.J., Abdulkareem B.N. Clinical and radiographic evaluation of pulpal and periradicular tissue // International Journal of Pharmaceutical Sciences and Research. 2016. Т. 7. №. 12. С. 5072-5076.
73. Talabani R.M., Garib B.T., Masaeli R. Bioactivity and physicochemical properties of three calcium silicate-based cements: An in vitro study // BioMed Research International. 2020. Т. 2020. C.30-40.
74. Tang H. et al. 3D-bioprinted recombination structure of Hertwig’s epithelial root sheath cells and dental papilla cells for alveolar bone regeneration // International Journal of Bioprinting. 2022. Т.8. №.3. C. 140-150.
75. Teja K.V. et al. Management of external root resorption with Biodentine and platelet-rich fibrin matrix: A case report with 3 year follow up // Saudi Endodontic Journal. 2021. Т. 11. №. 3. С. 405-411.
76. Tolibah Y.A. et al. Comparison of MTA versus Biodentine in apexification procedure for nonvital immature first permanent molars: a randomized clinical trial // Children. 2022. Т. 9. №. 3. С. 410. C.410-420.
77. Torabinejad M. et al. Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview–part II: other clinical applications and complications // International endodontic journal. 2018. Т.51. №.3. С.284-317.
78. Vanelli M.I. et al. Bone metabolism in periapical lesions: literature review // Journal of Research in Dentistry. 2022. Т.10. №. 3. C.10-17.
79. Villa D.M. et al. Use of Biodentine as an alternative treatment in horizontal radicular fractures: clinical case report // Universidad y Sociedad. 2021. Т.13. S2. С.282-288.
80. Wikström A. et al. What is the best long-term treatment modality for immature permanent teeth with pulp necrosis and apical periodontitis? // European Archives of Paediatric Dentistry. 2021. Т. 22. С. 311-340.
81. Xiao W. et al. Modified pulpotomy procedure in immature permanent teeth with apical periodontitis: a randomised controlled trial // BMJ open. 2022. Т.12. №. 12. – С. 714-722.
82. Yasin R., Al-Jundi S., Khader Y. Effect of mineral trioxide aggregate and Biodentine™ on fracture resistance of immature teeth dentine over time: in vitro study // European Archives of Paediatric Dentistry. 2021. С. 603-609.
83. Yassen G.H. et al. The effect of medicaments used in endodontic regeneration on root fracture and microhardness of radicular dentine // International endodontic journal. 2013. Т. 46. №.7. С. 688-695.
84. Yuan-lin Z.U.O., Chao-hui L.I. Study on clinical efficacy and patients' satisfaction of MTA apical barrier technique in treatment of young permanent teeth with periapical inflammation // Shanghai Journal of Stomatology. 2017. Т. 26. №. 3. С. 297-301.
85. Zafar K., Jamal S., Ghafoor R. Bio-active cements-Mineral Trioxide Aggregate based calcium silicate materials: a narrative review // JPMA. The Journal of the Pakistan Medical Association. 2020. Т. 70. №. 3. С. 497-504.
86. Žižka R. et al. Assessment of Mineral Trioxide Aggregate Setting in Simulated Root Canal with Different Root Canal Wall Thickness: In Vitro Study // Applied Sciences. 2021. Т. 11. №. 4. С. 1727-1742.
References: [1-2]
1. Abdybekova A.K., Aldasheva M.A. Sovremennye sredstva dlya vremennoi obturatsii kornevykh kanalov (obzor literatury) [State-of-the-art medications for temporary root canals obturation (literature review)]. Vestnik Kazakhskogo Natsional'nogo meditsinskogo universiteta [Vestnik KazNMU]. 2020. №.2. pp. 193-198. [in Russian]
2. Utkina E.I. i dr. Gistologicheskie preimushhestva biosilikatnyh cementov kak materialov dlja vital'noj terapii pul'py [Histological advantages of biosilicate cements as materials for vital pulp therapy]. West Kazakhstan Medical Journal. 2022. №. 3 (64). pp. 147-150. [in Russian].
Number of Views: 205
Category of articles:
Reviews
Bibliography link
Kurmanalina M.A., Sumanova A.M., Detochkina V.R., Shabanbayeva Zh.A. Comparative analysis of calcium hydroxide, MTA and Biodentine in formation an apical barrier in immature permanent teeth with chronic apical periodontitis // Nauka i Zdravookhranenie [Science & Healthcare]. 2023, (Vol.25) 4, pp. 258-269. doi 10.34689/SH.2023.25.4.031Related publications:
INTERRELATION OF INTRAABDOMINAL HYPERTENSION AND MARKERS OF GASTROINTESTINAL TRACT INJURY IN PATIENTS WITH MULTIORGAN DYSFUNCTION
DRUG-INDUCED LIVER INJURY AND GENDER DIFFERENCES
QUALITY OF LIFE IN PRIMARY BILIARY CHOLANGITIS AND ITS ASSESSMENT
DIAGNOSTIC AND THERAPEUTIC LAPAROSCOPY FOR ABDOMINAL INJURIES. REVIEW
METHODS FOR SCHOOL-AGE CHILDREN NUTRITIONAL STATUS ASSESSMENT: FOCUS ON ANTHROPOMETRIC PARAMETERS. A REVIEW.