Effectiveness of Three Agents in Pulpotomy Treatment of Permanent Molars with Incomplete Root Development: A Randomized Controlled Trial

The aim of this study was to investigate and compare, radiographically and clinically, the impacts of calcium-silicate based-cement (CSBC), nano-hydroxyapatite and platelet-rich fibrin (PRF) as pulpotomy agents in permanent immature molars with incomplete root development. Sixty-three participants (63 permanent immature molars) were included in this study. The patients were randomly divided into three equal groups. Fast setting MTA (MM-MTA), nano-hydroxyapatite and platelet-rich fibrin were used as pulpotomy agents. The teeth were evaluated clinically and radiographically after 6 and 12 months by two blinded examiners. Apical closure and pulp canal obliteration percentages were recorded. The in vitro reaction of the tested materials after a 7-day immersion period of the different materials in phosphate-buffered solution was analyzed using scanning electron microscopy to associate the in vitro mineralization with in vivo pulp canal obliteration percentages. Data were analyzed using Chi-square and ANOVA tests (α = 0.05). No significant difference was found between the three tested groups in terms of clinical and radiographic success (p > 0.05). All cases demonstrated evidence of root growth, including complete apical closure or continued apical closure. At 12 months, complete apical closure was found among the MM-MTA group (50%), nano-hydroxyapatite group (55%) and platelet-rich fibrin group (60%) (p > 0.05). After 12 months, pulp canal obliteration was more observed in the MM-MTA and nano-hydroxyapatite groups than in the PRF group (p < 0.05). MM-MTA (auto-mixed), NHA (hand-mixed) and PRF (autologous) could be used as pulpotomy agents since they exhibit comparable high clinical and radiographic success rates. However, the fact that the groups managed with MM-MTA and NHA have a higher tendency to canal obliteration might indicate that PRF should be considered the first choice material as pulpotomy agent, as it would make retreatment considerably easier.