1. MENNATALLAH HESHAM EL-SHAABANY - Department of Pediatric Dentistry, Faculty of Dentistry, Sinai University, Arish, Egypt. 2. ASMAA ALI ABOU EL-SOUD - Department of Pediatric and Preventive Dentistry and Dental Public Health, Faculty of Dentistry, Suez Canal University, Ismailia, Egypt. 3. GIHAN GAMAL EL-DIN EL-DESOUKY - Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Suez Canal University, Ismailia, Egypt. 4. GHADA ABDUL-HAMID ELBAZ - Department of Pediatric and Preventive Dentistry and Dental Public Health, Faculty of Dentistry, Suez Canal University, Ismailia, Egypt.
Background: Vital pulp therapy (VPT) via apexogenesis preserves pulpal vitality and promotes root maturation in immature permanent teeth. While Mineral Trioxide Aggregate (MTA) remains the benchmark medicament, novel bioactive agents such as melatonin offer anti-inflammatory, antioxidant, and dentinogenic benefits. This randomized clinical trial radiographically evaluated radicular dentin thickness and furcation dentin density in immature mandibular first permanent molars following apexogenesis using MTA, melatonin, or a combination of both. Methods: Forty-five young mandibular first permanent molars in children aged 6–8 years were randomly allocated (1:1:1) into three equal groups (n = 15 each): Group A (MTA), Group B (Melatonin), and Group C (MTA + Melatonin). Standardized apexogenesis procedures were performed under rubber dam isolation. Standardized digital periapical radiographs were obtained at baseline and at 1-, 3-, 6-, 9-, and 12-month recalls. Using ImageJ software, radicular dentin thickness (5 mm apical to the CEJ) and furcation dentin density (caibrated 256 grey-scale level) were measured. Data were analyzed using repeated-measures ANOVA and non-parametric tests (p < 0.05). Results: All groups exhibited progressive, statistically significant increases in radicular dentin thickness (p < 0.01) and furcation dentin density (p < 0.001) over 12 months. At 12 months, distal root dentin thickness increased by 18.9% (MTA), 15.1% (Melatonin), and 22.3% (Mixed), and mesial root dentin thickness increased by 20.0% (MTA), 21.7% (Melatonin), and 27.4% (Mixed), while furcation dentin density increased by 27.5%, 27.3%, and 25.1%, respectively. Intergroup comparisons revealed no statistically significant differences in the percentage change of dentin thickness or furcation density across all three groups. Conclusion: Melatonin demonstrates comparable bio-inductive efficacy to MTA in promoting root edification and furcation dentin deposition, making it a viable alternative or additive for apexogenesis in immature permanent teeth.
Apexogenesis, Dentin Density, Melatonin, Mineral Trioxide Aggregate, Vital Pulp Therapy.