Comparison of MTA versus Biodentine in Apexification Procedure for Nonvital Immature First Permanent Molars: A Randomized Clinical Trial.

This study aimed to evaluate the radiological and clinical outcomes of Biodentine apical plugs compared to mineral trioxide aggregate (MTA) in treating immature molars with apical lesions in children. MATERIALS AND METHODS: Thirty immature roots of 24 permanent lower first molars with apical lesions were randomly divided into two groups: group 1 (15 roots) treated with MTA apical plugs and group 2 (15 roots) treated with Biodentine apical plugs. Treatment radiological outcomes were assessed using the periapical index (PAI) scale after 6 and 12 months of treatment. The presence or absence of apical calcified barrier (ACB) was assessed after 12 months of treatment. The visual analog scale (VAS) was used to compare the postoperative pain between the two groups after 1, 3, 7, and 14 days of treatment. PAI scores between the two groups were compared using the Mann-Whitney U test, the presence or absence of the ACB was compared using the chi-square test, and the VAS scores were compared using the t-test. The statistical significance threshold was set at 0.05. RESULTS: There were no statistically significant differences in the PAI between the two groups at 6 and 12 months postoperatively. After 12 months, four cases in the Biodentine group showed ACB formation, whereas ACB was not found in any case treated with MTA. The VAS scores were statistically lower in the MTA group on the first day after treatment. Nevertheless, these scores were not statistically significantly different after 3, 7, and 14 days of treatment between the two groups. CONCLUSIONS: Biodentine can be used as an apical plug to treat immature permanent molars with apical lesions in a single visit in children. Biodentine showed favorable outcomes in apical lesions healing, which was comparable to MTA but with a decreased treatment time associated with its use.

Efficacy of Mineral Trioxide Aggregate and Biodentine as Apical Barriers in Immature Permanent Teeth: A Microbiological Study.

AIM: To compare the bacterial leakage of mineral trioxide aggregate (MTA) and biodentine when used as an apical plug in immature permanent teeth. MATERIALS AND METHODS: It was a randomized double-blind in vitro study. A total of 60 teeth were divided into 2 groups of MTA and biodentine, which were further divided into 2 subgroups (n = 30) each based on the apical plug thickness of 2 and 4 mm. The teeth were cleaned and shaped; root-end resection and canal preparation were done. Mineral trioxide aggregate and biodentine were mixed and filled as apical plugs of 2 or 4 mm thickness. Enterococcus faecalis was used to assess the bacterial leakage of the filled samples. STATISTICAL ANALYSIS: The comparison between the two groups was done by Chi-square test for categorical data. All p values <0.05 were considered as statistically significant. RESULTS: A 4 mm apical plug of biodentine showed the least amount of bacterial leakage followed by 2 mm MTA and 4 mm MTA. A 2 mm apical plug of biodentine showed the maximum bacterial leakage. But this was not statistically significant over a period of 3 months. There was a statistically significant difference (p value = 0.042) among the total number of samples that leaked in the 2 and 4 mm biodentine group. CONCLUSION: Mineral trioxide aggregate and biodentine had a similar apical sealing ability. The apical sealing ability of biodentine at 4 mm thickness was greater than 2 mm thickness. CLINICAL SIGNIFICANCE: The apical leakage of the materials used in apexification is one of the main causes of endodontic failures in immature necrotic teeth. Materials like MTA and biodentine have overcome various drawbacks of calcium hydroxide as apexification material. The thickness of the apical plug plays an important role in preventing any microorganism from entering the periapical area, hence maintaining an adequate seal. HOW TO CITE THIS ARTICLE: Abbas A, Kethineni B, Puppala R, et al. Efficacy of MTA and Biodentine as Apical Barriers in Immature Permanent Teeth: A Microbiological Study. Int J Clin Pediatr Dent 2020;13(6):656-662.

Behavior of mineral trioxide aggregate apical plugs and root fillings under cyclic loading.

AIM: The aim of the present study was to develop a methodology for constant monitoring of the resistance to fluid flow during functional loading and to then compare the efficacy of 4-mm mineral trioxide aggregate (MTA) apical plugs and full-length MTA root fillings. METHODS: The root canals of 24 single-rooted teeth were instrumented and assigned into two groups: group 1 (filled with a 4-mm MTA apical plug and gutta percha) and group 2 (filled with MTA to cementoenamel junction level). All teeth were subjected to stepwise cyclic loading with a constant simulated interstitial pressure of 25 cm H2 O applied apically. A Flodec machine (De Marco Engineering, Geneva, Switzerland) constantly monitored the rate and direction of fluid flow. Student's t-test, Kruskal-Wallis test, Fisher's exact test, and Newcombe-Wilson test were used for statistical analysis, with P < 0.05. RESULTS: Crown fractures occurred in 21 teeth with no change in the rate of fluid flow. Three teeth (filled with full-length MTA) showed sudden change in the rate of fluid flow through the root canal after cyclic loading. CONCLUSIONS: The methodology reliably monitored fluid flow during cyclic loading. There was no difference between a 4-mm MTA apical plug and full-length MTA root filling after cyclic loading using a dynamic fluid-flow monitoring technique.