title: Interventions for treating traumatized necrotic immature permanent anterior teeth: inducing a calcific barrier & root strengthening.
abstract: BACKGROUND
  Apical barrier formation and root strengthening procedures have been extensively described in the literature. This systematic review attempts to establish where the effects of interventions using multi-visit apexification, single visit apical plug techniques and root strengthening procedures are consistent and where they may vary significantly.
  
  
  OBJECTIVE
  To evaluate the relative effectiveness of apexification and apical plug techniques as well as root strengthening procedures for treating traumatized necrotic immature permanent anterior teeth through a systematic review of randomized controlled trials. Reported immediate and/or long-term adverse events and effects of the materials and techniques are also evaluated.
  
  
  METHODS
  Structured electronic and hand search was performed with no restriction on the language of publication. Only randomized controlled trials comparing different apical barrier formation techniques and root strengthening procedures in traumatized necrotic immature anterior teeth were assessed.
  
  
  RESULTS
  Two hundred studies were identified but only two were suitable for inclusion. Included studies investigated multi-visit apexification techniques using calcium hydroxide and tricalcium phosphate. There were no eligible studies investigating root strengthening procedures or any other intervention for apical barrier formation in necrotic immature anterior teeth. No reliable information was available on long-term adverse effects of the reported interventions or cost implications.
  
  
  CONCLUSIONS
  Based on two included studies, there is weak evidence supporting the use of either calcium hydroxide or tricalcium phosphate for apical barrier formation in necrotic immature anterior teeth employing multi-visit apexification techniques. The evidence is insufficient to provide guidelines for practice. There was no reliable evidence on adverse events or long-term effects after the use of calcium hydroxide or tricalcium phosphate justifying caution in their use in apical barrier formation techniques.
authors.affiliation: Paediatric Dentistry Department, Bnied Al Gar Speciality Dental Centre, Kuwait. mohammad@alansary.co.uk
authors.forename: Mohammad A D
authors.initials: MA
authors.lastname: Al Ansary
authors.forename: Peter F
authors.initials: PF
authors.lastname: Day
authors.forename: Monty S
authors.initials: MS
authors.lastname: Duggal
authors.forename: Paul A
authors.initials: PA
authors.lastname: Brunton
mesh_terms: D001696:Biomechanical Phenomena; D002126:Calcium Hydroxide / Q000627:therapeutic use; D002130:Calcium Phosphates / Q000627:therapeutic use; D003481:Cuspid / Q000293:injuries*; D003790:Dental Pulp Necrosis / Q000628:therapy*; D003809:Dentin, Secondary / Q000187:drug effects* / Q000473:pathology; D006801:Humans; D007180:Incisor / Q000293:injuries*; D016032:Randomized Controlled Trials as Topic; D012387:Root Canal Filling Materials / Q000627:therapeutic use; D012390:Root Canal Therapy / Q000379:methods*; D019227:Tooth Apex / Q000187:drug effects; D014092:Tooth Root / Q000187:drug effects* / Q000473:pathology
chemical_list: D002130:Calcium Phosphates; D012387:Root Canal Filling Materials; C018392:tricalcium phosphate; D002126:Calcium Hydroxide