Premixed Bioceramics Versus Mineral Trioxide Aggregate in Furcal Perforation Repair of Primary Molars: in Vitro and in Vivo Study

Objectives: The current study was carried out to (1) evaluate premixed bioceramic (BC) and mineral trioxide aggregate (MTA) sealing properties in a laboratory and (2) compare the performance of these two materials in repairing an immediate iatrogenic furcal perforation of primary molars both clinically and radiographically.

Materials And Methods: In vitro sections including eighty mandibular second primary molars were sorted into 4 equal groups: (1) an intact furcation area group, (2) an artificial perforation group (unrepaired), (3) an artificial perforation group repaired with MTA, and (4) an artificial perforation group repaired with premixed BC. The dye extraction method was used to assess the sealing ability of the material. Clinically, the study was designed as an equivalent parallel randomized controlled trial. Seventy-six mandibular second primary molars with immediate furcal perforation were sealed with MTA and premixed BC. Teeth were evaluated clinically and radiographically at 3, 6, and 12 months.

Results: Although the difference was statistically insignificant (p = 0.058), the premixed BC group had better sealing ability than the MTA group [mean difference = 0.020; 95% CI (-0.001, 0.040)]. Clinically and radiographically, the two materials had an equivalent success rate in the first 3 months [ARR = 0.05; 95% CI (-0.07, 0.17)] but inequivalent success rates at 6 and 12 months with premixed BC performing better than MTA.

Conclusions: The present findings confirm that premixed BC is a promising material that can be used to repair a furcal perforation of primary molars. Premixed BC has better sealing properties and better performance at the clinical and radiographic levels than MTA.

Clinical Relevance: (1) Accidental furcal perforation in primary molars is one of the worst problems that results in diminishing the lifetime expectancy of primary teeth if not properly treated. Though new BC repair materials have been introduced to enhance healing and tissue inductive properties, there is an obvious shortage in clinical trials covering this area. The present study is a premier study that assesses a recently introduced premixed BC material in the furcal perforation of primary teeth and compares its outcomes with those of the widely used MTA.

Trial Registration: ClinicalTrials.gov PRS reference #NCT04137861.