Revascularization versus apical barrier technique with mineral trioxide aggregate plug: A systematic review

Aim: To compare the clinical and radiographic outcomes observed in Necrotic Immature Permanent Teeth (NIPT) after revascularization or apexification with MTA-apical plug. Methodology: PubMed/MEDLINE, Web of science and Scopus were the databases used, up to July 30th, 2017, for article research. Independent reviewers read the titles and abstracts of all reports that met inclusion/exclusion criteria: prospective or retrospective clinical studies comparing the revascularization of root canal and apexification. Clinical success of therapies, deposition and thickening of lateral dentinal walls (root width) and the continuation of root development (root length) were investigated. Bias risk of included studies was assessed using the Cochrane risk of bias. Results: From 1642 records, five papers fulfilled all inclusion criteria. Overall, 91 teeth were submitted to revascularization and 64 teeth to apexification with MTA. The mean follow-up was 23.2 months in revascularization and 21.8 in apexification. Clinical success rate was of 87.9% in the revascularization group and 90.6% in the apexification group. An increase on lateral dentinal walls thickening was observed in most revascularization cases (13%) while MTA as apical plug suggest a mild resorption of the root (1.3%). High bias risk was observed on included studies. Conclusions: Apexification with MTA-apical plug provides similar clinical success to revascularization. However, radiographic measurements showed an improvement in thickening of lateral dentinal walls in most of the revascularization cases in addition to a higher dental development. However, these results should be interpreted with caution.