Comparison of the microleakage of mineral trioxide aggregate, calcium‑enriched mixture cement, and Biodentine orthograde apical plug

Poorandokht Refaei Refaei, Maryam Zare Jahromi, Abbas Ali Khademi Moughari


Background: One‑visit apexification is a treatment of choice in necrotic immature open apex
teeth. Calcium silicate base materials are suitable for this method. The purpose of this study was
to investigate and compare the sealing efficiency of Biodentine, mineral trioxide aggregate (MTA)
ProRoot, and calcium‑enriched mixture (CEM) cement orthograde apical plug using bacterial
leakage method.
Materials and Methods: In this in vitro study a total of 70 extracted maxillary incisors were
cleaned and shaped. A 1.1‑mm standardized artificially open apex was created in all samples.
The teeth were randomly divided into three experimental groups of 20, and two negative
and positive control groups of 5. In experimental groups, 4‑mm thick apical plugs of ProRoot
MTA, CEM cement, or Biodentine were placed in an orthograde manner. Negative control
samples were completely filled with MTA while positive control samples were left unfilled.
Sealing efficiency was measured by bacterial leakage method, and results were analyzed by
Kaplan–Meier and Chi‑square tests. The level of significance was set at 0.05.
Results: The highest number of turbidity was recorded for ProRoot MTA samples, while the lowest
for Biodentine. There was a significant difference in the number of turbidity between ProRoot MTA
and Biodentine groups (P < 0.001), but there was no significant difference between CEM cement
and Biodentine (P = 0.133) and ProRoot MTA (P = 0.055).
Conclusion: Within the limitation of this in vitro study, Biodentine showed promising results as a
substance with good‑sealing efficiency.


Apexification, biocompatible materials, calcium‑enriched mixture cement, dental leakage, mineral trioxide aggregate

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