Assessment of bone quality of apical periodontitis treated with MTA plug and regenerative endodontic techniques

Aust Endod J. 2022 Dec;48(3):444-450. doi: 10.1111/aej.12697. Epub 2022 Oct 5.


Fractal analysis (FA) is a quantitative, objective and non-invasive method that facilitates the characterisation of the tissue architecture. This study aims to compare the periapical healing at 1-year follow-up by evaluating newly generated trabecular bone with FA after Mineral trioxide aggregate (MTA) plug and regenerative endodontic treatment (RET). A total of 55 asymptomatic teeth with a single-canal, open apex and periapical lesion, treated with MTA plug or RET, were evaluated retrospectively. After considering the inclusion/exclusion criteria, FA was conducted on 30 periapical images using the box-counting method. In both groups, a significant decrease was observed in the periapical lesion size at 1-year follow-up (p < 0.01). However, there was no significant difference between the MTA plug and RET (p > 0.01). Significantly higher fractal dimension values were detected at 1-year follow-up in both MTA plug and RET cases (p < 0.01). However, the difference was not significant between the groups (p > 0.01). Both procedures seem to improve periapical healing with a new resistant bone of similar density and complexity.

Keywords: MTA plug; fractal analysis; periapical bone quality; regenerative endodontic treatment.

MeSH terms

  • Aluminum Compounds / therapeutic use
  • Calcium Compounds / therapeutic use
  • Drug Combinations
  • Humans
  • Oxides / therapeutic use
  • Periapical Periodontitis* / diagnostic imaging
  • Periapical Periodontitis* / therapy
  • Retrospective Studies
  • Root Canal Filling Materials* / therapeutic use
  • Silicates / therapeutic use
  • Tooth Apex


  • Root Canal Filling Materials
  • Aluminum Compounds
  • Calcium Compounds
  • Silicates
  • Oxides
  • Drug Combinations