Abstract
Introduction: The objective of this systematic review was to compare the apexification techniques of calcium hydroxide (Ca(OH)2), or mineral trioxide aggregate (MTA), with the pulp regeneration technique, using cohort studies, and non-randomized and randomized clinical trials. Methods: The methodology was based on electronic research in the following databases: PubMed, MEDLINE, Google Scholar, SciELO, and LILACS. In addition, a manual search was carried out using the references that were listed in the articles found. Results: A total of 403 potentially eligible studies were found, with seven being included in the inclusion criteria of this systematic review. The seven studies involved a total of 312 teeth. The minimum time of a follow-up period was 12 months. The irrigation solution most used was sodium hypochlorite, for both of the apexification and revascularization techniques. The medication commonly chosen in the apexification groups was Ca(OH)2, with antibiotic triple paste in the revascularization groups. The clinical rate of success in the groups treated with revascularization varied from 76% to 100%, while in the groups treated with apexification, it ranged from 68% to 100%. Only two studies reached a success rate equal to 100%. Conclusions: Variable levels of evidence were observed in relation to the treatments. However, it was confirmed that revascularization is an excellent option since its outcomes produced a greater gain of thickness and root length, besides developing a decrease in the apical foramen.
Highlights
The objective of this systematic review was to compare the apexification techniques of calcium hydroxide (Ca(OH)2), or mineral trioxide aggregate (MTA), with the pulp regeneration technique, using cohort studies, and non-randomized and randomized clinical trials
The prolonged use of Ca(OH)[2] may promote a weakening of the dentin[3,4]. Another apexification protocol is based on the use of of mineral trioxide aggregate (MTA), in order to make an artificial apical barrier that allows for root canal filling in the same session[5]
The research questions that guided the following literature review were: “Does the revascularization technique, with a blood clot only, a blood clot and matrix, a blood clot plus a scaffold impregnated with a basic growth factor of fibroblasts, and a blood clot plus an absorbable collagen barrier, promote the best outcomes regarding periapical healing, an apical foramen closure, and an increased thickness in root length, with clinical success, if compared to the technique of apexification with Ca(OH)[2] or MTA, in human teeth with an incomplete root development and pulp necrosis?” and “Does revascularization demonstrate a higher survival rate in immature permanent teeth that exhibit necrotic pulp and an incomplete root development when compared to the apexification technique?”
Summary
The objective of this systematic review was to compare the apexification techniques of calcium hydroxide (Ca(OH)2), or mineral trioxide aggregate (MTA), with the pulp regeneration technique, using cohort studies, and non-randomized and randomized clinical trials. Apexification can be conducted in one or multiple visits This conventional method consists of successive exchanges of intracanal calcium hydroxide (Ca(OH)2), in order to promote an apical calcific barrier[2]. This technique presents some limitations, because it is a long-term therapy. The prolonged use of Ca(OH)[2] may promote a weakening of the dentin[3,4] Another apexification protocol is based on the use of of mineral trioxide aggregate (MTA), in order to make an artificial apical barrier that allows for root canal filling in the same session[5]. The clinical success of both variants of apexification is evident, these two protocols do not confer a dentin thickness gain, or a complete root development, resulting in a fragile and fracture susceptible tooth[6,7]
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