ArticleBMC oral health2026
Clinical outcomes and prognostic factors of extended calcium hydroxide medication followed by a bioceramic apical barrier in immature permanent teeth: a retrospective study.
Article in BMC oral health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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5 authors.
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Abstract
Managing non-vital immature permanent teeth with extensive periapical lesions remains a clinical challenge. This retrospective cohort study aimed to evaluate the clinical and radiographic outcomes of a staged protocol utilizing extended calcium hydroxide medication followed by a bioceramic apical barrier, and to identify prognostic factors influencing strict radiographic healing.Methods A total of 124 immature permanent teeth with necrotic pulps and open apices, treated at a single center between January 2021 and December 2024, were included. The protocol mandated intracanal calcium hydroxide dressing for a minimum of 1 month, periodically replaced until absolute canal dryness was achieved, followed by the placement of an iRoot BP Plus apical barrier. Periapical lesion areas were quantitatively measured on calibrated radiographs using ImageJ software. Outcomes were classified as strict success (asymptomatic with complete radiographic resolution), improved (asymptomatic and functional with a quantifiable reduction in radiolucency), or failed. Multivariate logistic regression was performed to identify independent predictors of non-strict success.Results Over a median follow-up of 12.0 months (interquartile range [IQR]: 8.0-25.0), the overall success rate (strict success + improved) was 96.8% (120/124), while the strict success rate was 83.1% (103/124). Mean periapical lesion area decreased significantly from 50.83 ± 47.71 mm² preoperatively to 4.93 ± 25.79 mm² at the final follow-up (P < 0.001). Multivariate analysis identified four independent predictors significantly associated with incomplete radiographic healing: anterior tooth location (Odds Ratio [OR] = 4.21, 95% CI: 1.38-12.75; P = 0.012), initial lesion area ≥ 50 mm² (OR = 3.87, 95% CI: 1.26-11.81; P = 0.018), apical foramen diameter ≥ 1 mm (OR = 3.54, 95% CI: 1.19-10.56; P = 0.024), and the presence of a sinus tract (OR = 3.96, 95% CI: 1.27-12.37; P = 0.018).Conclusions A staged protocol utilizing extended calcium hydroxide followed by an iRoot BP Plus apical barrier yields highly predictable outcomes for non-vital immature permanent teeth. While overall functional retention is highly successful, anterior tooth location, large initial lesions, wide apical foramina, and sinus tracts independently delay complete radiographic resolution.
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