Randomized Trial of Bioceramic Apical Barrier Methods in Necrotic Immature Incisors: Effects on Pain, Extrusion, and Procedure Duration

TL;DR

This study compared three methods for treating dead baby teeth in children, finding that one method was faster and less painful but had a higher risk of material leakage.

Contribution

The study provides a direct comparison of three bioceramic apical barrier methods in children, focusing on pain, extrusion, and procedure time.

Findings

The SBS method caused the least postoperative pain and had the shortest procedure time.

The BPAP method had the lowest extrusion rates but caused more pain and took longer.

Apical size and child behavior were key factors influencing treatment outcomes.

Abstract

What are the main findings?
The Single Cone with Bioceramic Sealer (SBS) method yielded the lowest immediate postoperative pain and the shortest procedure duration, rendering it the most child-friendly approach, particularly for less cooperative patients.The Bioceramic Putty Apical Plug (BPAP) method demonstrated the lowest extrusion rates, but was associated with higher postoperative pain and significantly longer treatment times

The Single Cone with Bioceramic Sealer (SBS) method yielded the lowest immediate postoperative pain and the shortest procedure duration, rendering it the most child-friendly approach, particularly for less cooperative patients.

The Bioceramic Putty Apical Plug (BPAP) method demonstrated the lowest extrusion rates, but was associated with higher postoperative pain and significantly longer treatment times

What are the implications of the main findings?
The SBS technique may be advantageous for children who require quicker and less painful treatment sessions, though clinicians should carefully consider the higher risk of material extrusion.The BPAP approach may be the method of choice in cases with wide apices or when minimizing extrusion is critical, despite its drawbacks of increased treatment time and patient discomfort.

The SBS technique may be advantageous for children who require quicker and less painful treatment sessions, though clinicians should carefully consider the higher risk of material extrusion.

The BPAP approach may be the method of choice in cases with wide apices or when minimizing extrusion is critical, despite its drawbacks of increased treatment time and patient discomfort.

Objective: This randomized controlled trial evaluated postoperative pain (PP), bioceramic extrusion, and procedure duration in necrotic immature incisors treated with three apical barrier methods (ABMs): Bioceramic Putty Apical Plug (BPAP), Single Cone with Bioceramic Sealer (SBS), and Bioceramic Putty–Sealer Mixture (BPSM). Case-related factors influencing these outcomes were also examined. Methods: Ninety-nine children (8–11 years) with necrotic maxillary incisors and moderate periapical lesions were randomly assigned (1:1:1) to BPAP, SBS, or BPSM groups. Standardized protocols included calcium hydroxide dressing and XP-Endo Finisher irrigation. Pain (VAS) was recorded at 1-, 3-, 7-, and 14-day post-treatment. Extrusion (yes/no) and procedure duration were documented. Regression analyses identified predictors of outcomes. Results: At day 1, pain was highest in the BPAP group (mean 3.5) and lowest in the SBS group (mean 1.05; p < 0.001). Pain decreased substantially by day 3 and resolved in all groups by day 14. Extrusion was most frequent in SBS (60.6%) and least frequent in BPAP (21.2%; p = 0.002). Treatment duration was longest in BPAP (25.8 min) and shortest in SBS (12.6 min; p < 0.001). Regression showed that preoperative pain and pulpal diagnosis were the strongest predictors of postoperative pain. Apical size and ABM predicted extrusion, while apical size and child behavior significantly influenced duration. Conclusions: The apical barrier method had a significant impact on short-term outcomes. SBS offered reduced pain and shorter chair time but carried a higher risk of extrusion, while BPAP minimized extrusion but caused more pain and required more extended visits. Clinical selection should balance patient comfort, apical anatomy, behavior, and operator expertise. Longer-term outcomes on periapical healing remain to be evaluated.

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