When a tooth has an open apex due to dental trauma or caries, it becomes challenging to achieve a successful root filling during endodontic treatment.

Injuries resulting from trauma are frequently observed during childhood and in toddlers, with a higher susceptibility for upper front teeth to experience fractures.

The closing of the root apex occurs approximately three years after tooth eruption. In cases where the apex remains open due to injury, there may be the presence of residual living pulp tissues and some enduring apical papilla cells in the surrounding periapical tissue.

Apexification, the preferred non-surgical approach for treating necrotic immature permanent teeth, has seen various materials used over time.

Initially, the widely accepted method involved using calcium hydroxide combined with camphorated monochlorophenol to stimulate the development of the apical barrier, as proposed by Kaiser in 1964.

Nevertheless, this substance took nearly 5 to 20 months to create the necessary hard tissue barrier.

Numerous materials have been developed, assessed, and established to achieve optimal results in advanced clinical performance. Mineral trioxide aggregate (MTA) was pioneered by Mahmoud Torabinejad at Loma Linda University in California, USA. Its introduction to the dental field was initially documented by Lee and colleagues in 1993.

Mineral trioxide aggregate (MTA) serves multiple purposes in dentistry, such as functioning as a reparative substance for repairing perforations, as well as being employed in procedures like pulp capping, pulpotomy, creating an apical barrier in cases with open apex, and for retrograde filling.

There have been recent developments in the apexification procedure, where MTA serves as a primary solid block. The gap created due to material shrinkage after placement is now filled with apatite-like deposits that form during MTA maturation. This enhances MTA’s ability to resist friction against root canal walls. MTA stands out for its excellent biocompatibility, reduced cytotoxicity due to its alkaline pH, and has garnered significant attention for its superior sealing capabilities, biocompatibility, regenerative potential, and antibacterial properties. Its formulation containing calcium and phosphate ions promotes the attraction of bone-forming cells and creates a favorable environment for cementum deposition.

Moreover the cost of 1 gram of Pro-Root MTA (USA) is 10000/- , whereas the cost of 1gram E-MTA is 4000/- which is a more economical option. Considering the affordability of the treatment by the patients and Indian Dentists, it is essential to carry out trials comparing the efficacy of new material with the conventional one.

Numerous clinical studies on the use of MTA in apexification can be found in the literature. Limited literature is available comparing E-MTA with Pro Root MTA. The present study aims to evaluate the clinical and radiographic success of E MTA with Pro Root MTA as apexification agents in permanent immature incisors and molars.