Aim: This in vitro study aimed to compare the fracture resistance of simulated immature permanent teeth restored with apical plugs of mineral trioxide aggregate (MTA), Biodentine, and bone cement. Methods: Forty-eight single-rooted human maxillary central incisors were selected and decoronated 6 mm above and 9 mm below the cementoenamel junction to simulate the immature teeth. Based on weight and homogeneity, the samples were distributed into three experimental groups (n = 12) and one control group (n = 12). In all the experimental group samples, a peeso reamer size 5 was stepped out 1 mm beyond the apex to enlarge the apices to a diameter of 1.5 mm. Apical plugs of MTA Plus (Prevest DenPro Limited, India), Biodentine (Septodont, France), and Bone cement (Surgical Simplex P, Stryker, Australia) were placed to 4 mm, and obturation was done using gutta-percha and AH Plus® sealer (Dentsply DeTrey, Konstanz, Germany). The force was applied at 45° angulation until fracture, using the universal testing machine. The results were analyzed using a one-way analysis of variance followed by Tukey’s post hoc test at a 95% confidence level. Results: The Biodentine group showed a statistically higher fracture resistance value than the MTA Plus and bone cement group (P = 0.014 and P = 0.016, respectively). No statistically significant difference was reported between MTA Plus and the bone cement group. Conclusion: Within the limitations of this study, using Biodentine as an apical plug increases the fracture resistance of immature teeth. Bone cement can be used as a viable alternative to MTA.

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