ABSTRACT Calcium hydroxide apexification has been used in the treatment of immature teeth with pulp necrosis and apical periodontitis for more than 50 years. However, the guidelines of the European Academy of Paediatric Dentistry (EAPD) and the American Association of Endodontists (AAE) ‘Clinical recommendations for a regenerative procedure’ recommend against calcium hydroxide apexification. The American Association of Endodontists “Clinical considerations for a regenerative procedure” do not list calcium hydroxide apexification as a treatment option for immature teeth with pulp necrosis. This review analyses the strength of the science that led to calcium hydroxide no longer being recommended by the EAPD and AAE regenerative guidelines. Many differences in the studies and failure to include adequate controls have resulted in inconsistent outcomes between studies. Furthermore, prior in vitro studies have assessed narrow mechanical properties of teeth without a theoretical fracture mechanics model. Cvek's concerns regarding the thinness of the dentinal walls remain as a primary risk for tooth fracture with Class 3 root development fractured with an incidence of 77% compared to a fracture incidence of just 2% for mature teeth. This review develops a simple fracture mechanics approach to the phenomenon of transverse root fracture that provides a theoretical framework to why fragile roots are more likely to fracture when compared to mature teeth. Furthermore, the effect of the varying size access cavities has not been previously considered. Systematic reviews and clinical studies do attest to the success of all approaches for the treatment of immature teeth with pulp necrosis. Calcium hydroxide apexification is one of the recommended treatments in the International Association of Dental Traumatology guidelines. However, mineral trioxide aggregate (MTA) and hydraulic calcium silicate cements (HCSC's) may provide better outcomes and have the convenience for the patient of a shorter treatment time. Regenerative endodontic treatment (RET) is recommended when the tooth roots are very immature with Cvek Class 1–3 root development. However, the treatment of immature teeth with pulp necrosis remains a clinical challenge as does the risk of tooth fracture.

Bill Kahler

Michael V. Swain

Dental Traumatology

牙科创伤学是一本国际期刊，旨在传达与成人和儿童牙科创伤学相关的所有领域的科学和临床进展。这包括以下主题：- 流行病学、社会方面、教育、诊断 - 美学/修复/修复 - 循证创伤学和研究设计 - 口腔和颌面外科/移植/植入 - 儿科和正畸 - 预防和运动牙科 - 牙髓和牙周ASPECTS 该杂志旨在促进临床医生、教育工作者、研究人员和其他对牙科创伤学领域感兴趣的人之间的交流。

Dental Traumatology is an international journal dedicated to disseminating scientific and clinical advancements related to dental traumatology in both adults and children. It covers various topics, including epidemiology, social aspects, education, diagnosis, aesthetics and restoration, evidence-based traumatology and research design, oral and maxillofacial surgery, transplantation and implants, pediatric and orthodontic considerations, prevention and sports dentistry, as well as pulp and periodontal aspects. The journal aims to facilitate communication among clinicians, educators, researchers, and others interested in the field of dental traumatology.

《Dental Traumatology》是一本国际期刊，旨在传达与成人和儿童牙科创伤学相关的各个领域的科学和临床进展。主要涵盖以下主题：流行病学、社会因素、教育、诊断、美学与修复、循证创伤学与研究设计、口腔与颌面外科、移植与植入、儿科与正畸、预防与运动牙科、牙髓与牙周等方面。该期刊旨在促进临床医生、教育工作者、研究人员及其他对牙科创伤学领域感兴趣的专业人士之间的交流。

Category	Quartile
医学	3
医学, 牙科与口腔外科	3

The Calcium Hydroxide Controversy: Does Calcium Hydroxide Weaken Teeth?

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Journal Info

Category	Quartile
DENTISTRY, ORAL SURGERY & MEDICINE	2