Fracture resistance of simulated immature teeth after apexification with calcium silicate-based materials

OBJECTIVE: To compare the fracture resistance of simulated immature teeth filled with an apical barrier of mineral trioxide aggregate (MTA), Biodentine, and calcium-enriched mixture (CEM). MATERIALS AND METHODS: Fifty-two single-rooted human maxillary central incisors were used. For standardization, the teeth were sectioned 6 mm above and 9 mm below the cementoenamel junction to simulate immature apex. Simulations of roots into immature apices were carried out using 1.5 mm diameter drills. The specimens were then randomly divided into three experimental groups (n = 13) and one control group (n = 13). In experimental groups, MTA, Biodentine, and CEM were placed to apical 4 mm of the simulated immature roots. The samples were stored at 37° C and 100% humidity for 1 week. A load was applied on the crown of all teeth at 135° to their long axis until fracture. The data were analyzed using one-way analysis of variance and Tukey post-hoc tests. RESULTS: No statistically significant differences were found among MTA, CEM, and Biodentine (P > 0.05), and these groups demonstrated higher fracture resistance than control group (P < 0.05). CONCLUSIONS: Using any of the MTA, Biodentine, and CEM as an apical plug and restoring with fiber post and composite resin increases the fracture resistance of immature teeth.