Mineral trioxide aggregate as apical plug in teeth with necrotic pulp and immature apices: a 10-year case series

J Endod. 2014 Aug;40(8):1250-4. doi: 10.1016/j.joen.2013.12.007. Epub 2014 Apr 3.


Introduction: This 10-year study evaluated the clinical and radiologic outcomes of teeth with necrotic pulp, immature apices, and periapical lesions treated with the mineral trioxide aggregate (MTA) apical plug technique.

Methods: Seventeen single-rooted immature teeth with necrotic pulp and periapical lesion from 17 patients treated between January 2001 and December 2001 were included in this study. Apical obturation on all teeth included in the study was completed in 2 visits: first using calcium hydroxide as an interappointment intracanal medication and a second visit for the creation of the artificial apical barrier with MTA. The outcome, based on clinical and radiographic criteria, was assessed by 2 calibrated investigators using the periapical index (PAI). The Friedman test was used to verify the differences between baseline and the 1-, 5-, and 10-year PAI scores.

Results: Of the 17 patients treated, 1 patient dropped out at 5 years. At the 10-year follow-up, 15 teeth were healed (PAI ≤2), and 1 tooth had been extracted because of the presence of a longitudinal root fracture. The PAI score exhibited a significant decrease between baseline and 1 year and between 1 and 5 years. The difference between 5 and 10 years was not significant.

Conclusions: The apical plug with MTA was a successful and effective technique for long-term management of this group of teeth with necrotic pulps with immature root development and periapical lesions.

Keywords: Apical plug; mineral trioxide aggregate; necrotic teeth with immature apices.

MeSH terms

  • Aluminum Compounds / therapeutic use*
  • Apexification / methods*
  • Calcium Compounds / therapeutic use*
  • Calcium Hydroxide / therapeutic use
  • Dental Pulp Cavity / diagnostic imaging
  • Dental Pulp Cavity / pathology
  • Dental Pulp Necrosis / therapy*
  • Drug Combinations
  • Follow-Up Studies
  • Gutta-Percha / therapeutic use
  • Humans
  • Oxides / therapeutic use*
  • Periapical Diseases / therapy
  • Radiography
  • Root Canal Filling Materials / therapeutic use*
  • Root Canal Irrigants / therapeutic use
  • Root Canal Preparation / methods
  • Silicates / therapeutic use*
  • Sodium Hypochlorite / therapeutic use
  • Tooth Apex / diagnostic imaging
  • Tooth Apex / drug effects*
  • Treatment Outcome
  • Zinc Oxide-Eugenol Cement / therapeutic use


  • Aluminum Compounds
  • Calcium Compounds
  • Drug Combinations
  • Oxides
  • Root Canal Filling Materials
  • Root Canal Irrigants
  • Silicates
  • Zinc Oxide-Eugenol Cement
  • mineral trioxide aggregate
  • Kerr Pulp Canal Sealer
  • Gutta-Percha
  • Sodium Hypochlorite
  • Calcium Hydroxide