Mahidol study 1: comparison of radiographic and survival outcomes of immature teeth treated with either regenerative endodontic or apexification methods: a retrospective study

J Endod. 2012 Oct;38(10):1330-6. doi: 10.1016/j.joen.2012.06.028. Epub 2012 Aug 15.


Introduction: There are numerous challenges in treating immature permanent teeth with a diagnosis of pulp necrosis. Three general treatment options are calcium hydroxide apexification, mineral trioxide aggregate (MTA) apexification, and revascularization. The objective of this retrospective study was to evaluate radiographic and clinical outcomes of immature teeth treated with 1 of these 3 methods.

Methods: Clinical outcome data and radiographs were collected from 61 cases (ie, 22 calcium hydroxide apexification cases, 19 MTA apexification cases, and 20 revascularization cases). Both tooth survival and clinical success rates were analyzed. In addition, the preoperative and recall radiographs were analyzed to calculate the percentage increase in root width and length.

Results: The percentage change of root width was significantly greater in the revascularization group (28.2%) compared with the MTA apexification (0.0%) and calcium hydroxide apexification groups (1.5%). In addition, the percentage increase of root length was significantly greater in the revascularization group (14.9%) compared with the MTA (6.1%) and calcium hydroxide apexification groups (0.4%). Moreover, the survival rate of the revascularization-treated teeth (100%) and MTA apexification-treated teeth (95%) were greater than the survival rates observed in teeth treated with calcium hydroxide (77.2%).

Conclusions: In this study, revascularization was associated with significantly greater increases in root length and thickness in comparison with calcium hydroxide apexification and MTA apexification as well as excellent overall survival rates.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Adolescent
  • Aluminum Compounds / therapeutic use
  • Apexification / methods*
  • Calcium Compounds / therapeutic use
  • Calcium Hydroxide / therapeutic use
  • Child
  • Dental Pulp Necrosis / diagnostic imaging
  • Dental Pulp Necrosis / therapy*
  • Drug Combinations
  • Female
  • Humans
  • Male
  • Outcome Assessment, Health Care
  • Oxides / therapeutic use
  • Radiography
  • Regeneration
  • Retrospective Studies
  • Root Canal Filling Materials / therapeutic use
  • Root Canal Therapy / methods*
  • Silicates / therapeutic use
  • Statistics, Nonparametric
  • Tooth Root / blood supply*
  • Tooth Root / growth & development
  • Tooth Root / surgery
  • Vascular Surgical Procedures


  • Aluminum Compounds
  • Calcium Compounds
  • Drug Combinations
  • Oxides
  • Root Canal Filling Materials
  • Silicates
  • mineral trioxide aggregate
  • Calcium Hydroxide