Clinical outcomes of calcium silicate-based cements with or without calcium chloride as an orthograde apical barrier: a randomised controlled clinical trial

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Arpakorn Jummun
Danuchit Banomyong
Sittichoke Osiri
Supachai Sutimuntanakul


Objective: Calcium chloride has been used as an accelerator to reduce the setting time, dissolution, and leakage of calcium silicate-based cement materials. Its use has increased successful treatment outcomes. The aim of this study was to evaluate and compare the treatment outcomes of two calcium silicate-based cements with or without calcium chloride (Bio-MA or ProRoot® MTA) as orthograde apical barrier materials in teeth with open apices.

Materials and Methods: Sixty teeth in patients (8–67 years old) were recruited at the Endodontic Clinics of Dental Hospital, Faculty of Dentistry (Phayathai Campus) and Mahachakri Sirindhorn Dental Hospital (Salaya Campus), Mahidol University, Bangkok, Thailand. The teeth were randomly divided into two groups, i.e., Bio-MA or ProRoot® MTA material; the apical barrier was created using standard treatment protocols. Patients were recalled least 6 months after treatment. The treatment outcome was assessed as healed, healing, or disease, based on the clinical and radiographic evaluations. Healed and healing cases were grouped as success. The outcomes of the two materials were analysed and compared using the chi-square test and risk ratio for non-inferiority test.

Results: Fifty-five of 60 teeth, 28 in the Bio-MA group and 27 in the ProRoot® MTA group, were recalled, with a 94.9% recall rate and a median recall period of 17 months (range 6–38 months). Overall, healed and healing cases were 76.4% and 23.6%, respectively with no disease found. The Bio-MA group demonstrated 78.6% healed and 21.4% healing. Whereas, 74.1% healed and 25.9% healing were reported in the ProRoot® MTA group. There was no significant difference in the outcomes between Bio-MA and ProRoot® MTA used as an orthograde apical barrier (p>0.05). The non-inferiority analysis indicated that Bio-MA tended to be non-inferior, but the risk ratio was inconclusive.

Conclusion: Clinical outcomes of calcium silicate-based cements with or without calcium chloride in an orthograde apical barrier were highly successful with no significant difference between the materials.


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Jummun A, Banomyong D, Osiri S, Sutimuntanakul S. Clinical outcomes of calcium silicate-based cements with or without calcium chloride as an orthograde apical barrier: a randomised controlled clinical trial. M Dent J [Internet]. 2023 Aug. 24 [cited 2023 Dec. 6];43(2):73-86. Available from:
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