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Randomized Controlled Trial
. 2025 Jul 21;15(1):26487.
doi: 10.1038/s41598-025-11407-x.

Clinical and radiographic evaluation of premixed bioceramic putty as an apical plug in nonvital immature anterior permanent teeth

Mohamed S Ghaly  1 , Nura I Abozena  1 , Rehab F Ghouraba  2 , Ibrahim A Kabbash  3 , Shaimaa S El-Desouky  4
Affiliations
Randomized Controlled Trial

Clinical and radiographic evaluation of premixed bioceramic putty as an apical plug in nonvital immature anterior permanent teeth

Mohamed S Ghaly et al. Sci Rep. .

Abstract

Achieving an apical seal is critical for apexification treatment of nonvital immature teeth. While this is commonly accomplished using biocompatible mineral trioxide aggregate (MTA), its limitations, such as prolonged setting time, discoloration, and challenging handling, have driven the search for alternative materials. This study aimed to compare the clinical and radiographic success of bioceramic putty Well-Root PT apical plug compared to MTA in the treatment of nonvital immature permanent incisors. Fifty immature nonvital maxillary permanent central incisors in thirty-eight children aged 8-11 years were randomly divided into two groups (25 teeth/group). Group I received MTA apical plugs, and Group II was treated with Well-Root PT apical plugs. Both groups were recalled at 6 and 12 months for clinical and radiographic evaluations. Statistical analysis was done for the gathered data. Both groups showed improved clinical signs and symptoms during all follow-up periods with no statistically significant difference. Regarding the periapical radiolucency (PAR) area, at twelve months, the mean PAR area in the Well-Root PT group was (0.14 ± 0.08) compared to (2.3 ± 0.9) in the MTA group, with highly statistically significant differences (p < 0.001). The mean periapical bone radiodensity in the Well-Root PT group was (178.2 ± 5.4) compared to (164.8 ± 9.4) in the MTA group at twelve-month follow-up, with highly statistically significant differences(p < 0.001). Well-Root PT, with its reduced technical sensitivity, demonstrates satisfactory clinical and radiographic success as an apical plug for nonvital immature permanent incisors compared to MTA.

Keywords: Apexification; Apical plugs; Mineral trioxide aggregate; Well-Root PT.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethical approval and consent to participate: The ethical committee (REC), Faculty of Dentistry, Tanta University approved this study with code (#R-PED-11-23-3074) in accordance with the Helsinki Declaration of 1964 and its modifications. Written informed consent was obtained from all participants and their legal guardians. Consent for publication: Not applicable.

Figures

Fig. 1
Fig. 1
Flowchart detailing the assignment and randomization of the pediatric patients during the study.
Fig. 2
Fig. 2
A: Preoperative intraoral peri-apical (IOPA) radiograph of upper left permanent central incisor. B: Immediate IOPA radiograph after MTA plug and gutta-percha obturation. C-D; Post-IOPA radiographs at 6 and 12 months.
Fig. 3
Fig. 3
A: Preoperative intraoral peri-apical (IOPA) radiograph of upper left permanent central incisor. B: Immediate IOPA radiograph after Well-Root PT plug and gutta-percha obturation. C-D; Post-IOPA radiographs at 6 and 12 months.
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