Discoloration potential after regenerative treatment of mature teeth with pulp necrosis and apical periodontitis using Biodentine compared with mineral trioxide aggregate: A randomized controlled clinical trial

Aim: This randomized study aimed to evaluate the extent of discoloration after regenerative treatment using Biodentine compared to mineral trioxide aggregate (MTA) when used as a coronal plug material in mature anterior teeth affected by pulp necrosis and apical periodontitis. Methods: Thirty-six patients with mature single-canaled teeth with necrotic pulp and apical periodontitis were included. Patients were randomly assigned into two groups ( n = 18) for each group. Both groups received the same treatment on the first visit. Regenerative treatment using the blood clot technique was performed after 2 weeks, with either Biodentine or MTA used as the coronal plug material. The material used was randomly assigned to the teeth. Then, the tooth color was recorded using a color shade guide and digital photo, considered baseline color and baseline photo. The primary outcome was tooth discoloration, assessed by monitoring color change throughout a follow-up period of 6, 9, 12, and 18 months and compared with the baseline color. A digital photo was taken at each follow-up visit. Results: Within the biodentine group, two patients were lost to follow-up, and none (0%) out of 16 patients showed postoperative tooth discoloration, while within the MTA group, three patients were lost to follow-up, and 2 (13.3%) out of 15 patients showed slight postoperative tooth discoloration. There was no significant difference between the two groups ( P = 0.226), risk ratio (95% confidence interval) = 0.19 (0.01, 3.63). Conclusion: Regenerative treatment using blood clot technique with MTA or Biodentine as coronal plug materials showed comparable color stability and could be used in anterior teeth where esthetics is a concern.