The present randomized investigation sought to compare the magnitude of color alteration following regenerative therapy employing Biodentine against mineral trioxide aggregate (MTA), each serving as a coronal plug material in fully developed anterior teeth diagnosed with pulp necrosis and apical periodontitis. 36 individuals presenting with mature single-canaled teeth affected by necrotic pulp and apical periodontitis took part in the study. Participants were randomly assigned to two arms, each comprising 18 subjects (n = 18). An identical initial therapeutic intervention was administered to both arms. After 2 weeks, a regenerative approach using the blood clot technique was performed; either Biodentine or MTA served as the coronal plug, with material type randomly assigned to each tooth. The shade of each tooth was subsequently captured using a shade guide and a digital image, both of which served as the baseline record. The principal outcome measure was tooth discoloration, determined by tracking shade shifts at follow-up time points of 6, 9, 12, and 18 months relative to baseline. A digital photograph was obtained at every scheduled follow-up appointment. Among those receiving Biodentine, 2 individuals were lost to follow-up, and postoperative discoloration was absent in 0% (0 of 16) of the remaining patients. In the MTA arm, 3 individuals were lost to follow-up, and minor postoperative discoloration was noted in 13.3% (2 of 15) of patients. The comparison between arms did not reach statistical significance (P = 0.226), with a risk ratio (95% confidence interval) equal to 0.19 (0.01, 3.63). Regenerative treatment using the blood clot method, with either MTA or Biodentine as the coronal plug material, demonstrated comparable stability of tooth shade and appears suitable for adoption in anterior teeth, where esthetic outcomes are a clinical priority.
