All composite restorations on maxillary incisors of this patient were renewed at the 2012 follow-up (Figure 5). Figure 1 Preoperative radiograph of Case 5 (right Ku-0059436 central incisor) and Case 6 (left central incisor). Figure 2 2010 follow-up radiograph of Case 5 and Case 6. Note presence of periapical lesion development around incomplete root formation and absence of dentin bridge formation beneath MTA of Case 5. Also, note complete root formation and evident dentin bridge … Figure 3 2012 Control radiograph of Case 5 after apexification and root canal treatment. Note the uncertain healing around Case 5. Figure 4 2012 Control radiograph of Case 5 after apexification and root canal treatment. Note the uncertain periapical healing around Case 5. Figure 5 Intraoral photograph after renewal of composite restorations of Cases 5 and 6 at 2012.

The remaining 4 teeth (including exposed molar and left central incisor of patient #5) were assessed as vital cases at the 2010 and 2011 follow-ups (mean time of follow-up was 55 months at 2011). There was no pulpal or periapical pain reported by the patients. Teeth did not respond consistently to pulp tests. No signs of periapical inflammatory changes were present clinically or radiographically in any of these cases. There were radiographic signs of apical root completion in these cases. Dentin bridge formations were detected clearly adjacent to MTA in 3 fractured maxillary incisors radiographically (Figures 6�C8). There were no radiographic signs of pulp tissue obliteration and internal resorption in all 4 cases.

Clinically, severe discoloration on crown segments was observed in all teeth. All composite restorations showed insufficient marginal adaptation and color changes on marginal enamel walls at the follow-ups. Figure 6 Preoperative radiograph of Case 2 (right central incisor). Note that the left central incisor had also crown fracture Figure 8 Intraoral photograph at 2011 follow-up of Case 2. Note severe discoloration in the right incisor. DISCUSSION Four immature teeth (including the molar case) treated with MTA were healthy after a mean time recall 55 months at the year 2011. In the control radiographs of these 4 cases, there was complete formation of root apices and visible dentin bridge formation in three incisor cases. These successful cases may indicate that MTA could induce pulp healing with dentin bridge formation and maintain root development.

There are several MTA pulpotomy case reports involving immature root formation in the literature.15�C18 Karabucak et al15 observed that MTA pulpotomy was successful in two immature central incisors after 12 and 18 months of a clinical trial. El Meligy and Avery16 compared CH and MTA pulpotomies in 30 immature permanent teeth for one year. They found that all 15 MTA cases were successful, while 2 CH cases displayed Brefeldin_A periapical inflammation.