Review The restoration of permanent immature anterior teeth, root filled using MTA: A review Shalin Desai, Nicholas Chandler * Department of Oral Rehabilitation, University of Otago, School of Dentistry, Dunedin, New Zealand 1. Introduction The clinical management of trauma is an integral part of general dental practice in many countries. The general protocol for fractured, non-vital anterior teeth involves root canal treatment followed by protective permanent restorations for the coronal structure followed by review. Special situations arise in young patients when the pulps of anterior teeth lose vitality with resultant arrested development of the roots. The open and sometimes divergent apical morphology and weak root dentine wall makes endodontic procedures challenging, and presents restorative problems. It is important to preserve these weakened teeth in young patients. More definitive treatment options, such as implant-supported crowns or fixed prostheses, may not be feasible until craniofacial growth is complete, which can be up to the age of 25 years. 1 Missing, fractured or aesthetically poor anterior teeth and restorations may have detrimental effects on nutrition as well as psychology and personality development. 2 Several case reports have discussed methods for pulp space revascularization and apical tissue regeneration to continue root development and produce root-end closure. 3–5 However, it is common practice to use long-term calcium hydroxide dressings to promote formation of a hard apical barrier at the open apex of immature teeth to allow condensation of a gutta percha (GP) root filling. 6 Recent studies suggest using mineral trioxide aggregate (MTA) as an apical plug, which reduces the duration of the calcium hydroxide dressing and overall treatment. 7–9 journal of dentistry 37 (2009) 652–657 article info Article history: Received 23 February 2009 Received in revised form 12 May 2009 Accepted 21 May 2009 Keywords: Immature teeth Composite resin Endodontics Root canal posts Open apex abstract Objectives: Immature anterior teeth are at high risk of root fracture following root canal treatment. The literature was explored to determine the current status for post-endodontic restorative management of these teeth. Data and sources: The authors explored multiple search engine databases to November 2008. Experiments included in the review involved simulated human or animal immature teeth with mineral trioxide aggregate as an apical plug. The experiments were designed to assess and compare the fracture strength of teeth restored with various materials. Studies that did not fulfil inclusion criteria were omitted from the review. Study selection: Four in vitro studies fulfilled selection criteria and were systematically reviewed. All studies differed in sources of teeth, their simulated immature tooth model and mode of force application. Clinical Implications: Current evidence, mostly from laboratory studies, suggests the use of composite resin materials placed deep into the coronal aspect of the root canal to impart superior fracture resistance. Further clinical research is needed to assess other reinforcing materials, which include a variety of post systems and luting agents. # 2009 Elsevier Ltd. All rights reserved. * Corresponding author at: Department of Oral Rehabilitation, School of Dentistry, University of Otago, P.O. Box 647, Dunedin 9054, New Zealand. Tel.: +64 3 479 7124; fax: +64 3 479 5079. E-mail address: nick.chandler@dent.otago.ac.nz (N. Chandler). available at www.sciencedirect.com journal homepage: www.intl.elsevierhealth.com/journals/jden 0300-5712/$ – see front matter # 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.jdent.2009.05.026