BIOACTIVE CEMENTS MTA-HP AND ENDOSEQUENCE BC FOR CLOSURE OF APICAL DEFECTS: A COMPARATIVE MORPHOMETRIC AND HISTOLOGICAL STUDY OF REGENERATIVE POTENTIAL IN IMMATURE PERMANENT TEETH
Keywords:
bioactive cement; MTA-HP; EndoSequence BC; ProRoot MTA; apexification; CBCT morphometry; Runx2; pediatric endodonticsAbstract
The aim was to compare the regenerative potential of the bioactive cements MTA-HP, EndoSequence BC, and conventional ProRoot MTA in forming an apical “bioplug” in immature permanent teeth. The clinical part included thirty patients aged 8–15 years with single-rooted teeth and wide apices; each material was used in ten cases. After disinfection with 2.5% NaOCl and 17% EDTA, a 3–4 mm apical plug was created and the coronal portion obturated with gutta-percha; follow-up was 18 months. CBCT morphometry (Pixel Volume Histogram) determined the mean thickness of newly formed mineralized tissue; histology with Masson–Goldner staining and Runx2 immunohistochemistry assessed the degree of mineralization and osteogenic activity; nanoindentation measured the cements’ elastic modulus at 28 days. EndoSequence BC produced the thickest apical barrier (3.2 ± 0.5 mm; p < 0.05 vs. ProRoot MTA), whereas MTA-HP yielded the highest mineralization intensity (4.2 ± 0.3 points) and the greatest Runx2 expression. All materials exhibited an elastic modulus of 19.5–21.0 GPa, comparable to dentin, confirming mechanical compatibility. The results indicate that MTA-HP and EndoSequence BC outperform ProRoot MTA in apical plug quality; MTA-HP is optimal for dense biointegration, while EndoSequence BC is preferable for rapid volume replacement in wide apices. The study underscores the clinical importance of selecting the appropriate cement to optimize tissue regeneration and prevent infection relapse in high-risk children.
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