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Radiographic outcomes and prognostic factors in nonvital immature permanent teeth after apexification with modified calcium hydroxide paste: a retrospective study

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Abstract

Objective

To assess the radiographic outcomes and prognostic factors in nonvital immature permanent teeth after apexification with modified calcium hydroxide paste.

Materials and methods

Clinical and radiographic data were collected from 115 necrotic immature permanent teeth (71 caused by trauma and 44 caused by dens evaginatus) treated with apexification using a modified calcium hydroxide. Postoperative root morphology and changes in radiographic root area (RRA) on periapical radiographs were determined and statistically evaluated. Regression analysis was performed to identify factors associated with the outcomes of apexification.

Results

The average time for a calcified barrier formation was 10.66 ± 6.37 months. The root morphology after apexification with calcium hydroxide + iodoform paste was similar to that previously described after calcium hydroxide apexification. Compared with the trauma cases, the dens evaginatus cases revealed more type I (40.91% vs 16.9%) and less type II morphology (45.45% vs 67.61%). Although the changes in RRA were limited, the dens evaginatus cases showed greater increment of RRA than the trauma cases (4.12% ± 5.58% vs 0.70% ± 5.21%, P < 0.001). A significant association was found between the preoperative stage of root development and postoperative percentage change in RRA (P < 0.001).

Conclusions

Teeth caused by dens evaginatus had better outcomes after apexification than teeth caused by trauma. Early stages of root development were associated with superior radiographic outcomes.

Clinical relevance

Apexification provided reliable outcomes in the treatment of immature teeth with pulp necrosis and apical periodontitis, even though the root development is limited. Treatment decision should be made with comprehensive evaluation of prognostic factors.

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Funding

This study was supported by the Sun Yat-sen University Clinical Research 5010 Programme (No. 2019015).

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Author notes

  1. Hui Lu and Jiaxuan Lu contributed equally to this work.

Authors and Affiliations

  1. Guanghua School of Stomatology, Hospital of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-Sen University, Guangzhou, 510055, China

    Hui Lu, Jiaxuan Lu, Jiang Guo, Binghui Zeng, Qian Zeng, Wei Zhao & Jiacheng Lin

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  1. Hui Lu
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  2. Jiaxuan Lu
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  3. Jiang Guo
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  4. Binghui Zeng
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  6. Wei Zhao
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Contributions

Conceptualization: JCL and WZ; methodology: BZ; formal analysis and investigation: JG; validation: QZ; writing—original draft preparation: HL and JXL; writing—review and editing: JCL and WZ; funding acquisition: JCL; resources: JCL and WZ; supervision: JCL and WZ.

Corresponding authors

Correspondence to Wei Zhao or Jiacheng Lin.

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Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of Ethics Committee of the Affiliated Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China, and registered in ClinicalTrials.gov (ID: NCT01799187). All procedures were in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all participants and their parents included in this study.

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The authors declare no competing interests.

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Lu, H., Lu, J., Guo, J. et al. Radiographic outcomes and prognostic factors in nonvital immature permanent teeth after apexification with modified calcium hydroxide paste: a retrospective study. Clin Oral Invest 26, 5079–5088 (2022). https://doi.org/10.1007/s00784-022-04481-2

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  • DOI: https://doi.org/10.1007/s00784-022-04481-2

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