Apexification and regeneration procedures in young permanent teeth

Abstract

Management of necrotic young permanent teeth with incomplete root development represents a significant clinical challenge in pediatric dentistry due to open apices, thin dentinal walls, and increased susceptibility to fracture. Preserving or restoring root development is critical for improving the long-term prognosis of these teeth. Over recent decades, apexification and regenerative endodontic procedures (REPs) have emerged as the primary treatment strategies for addressing pulp necrosis in immature permanent teeth. Apexification aims to induce the formation of a calcified apical barrier that allows effective obturation of the root canal system. Traditionally, calcium hydroxide has been widely used for this purpose, demonstrating high success rates in resolving apical pathology. However, prolonged treatment duration, increased risk of root fracture, and lack of continued root development are important limitations. To overcome these drawbacks, single-visit apexification using bioceramic materials such as mineral trioxide aggregate (MTA) has gained popularity, offering predictable apical barrier formation, reduced treatment time, and favorable clinical outcomes. Regenerative endodontic procedures represent a biologically based treatment approach designed to promote continued root maturation by harnessing the regenerative potential of stem cells from the apical papilla, growth factors, and suitable scaffolds. REPs aim not only to resolve infection but also to facilitate root lengthening, thickening of dentinal walls, apical closure, and reestablishment of vitality-related responses. Clinical studies have reported high survival and success rates for REPs, particularly in teeth with short roots and wide apical openings. This review provides a comprehensive comparison of apexification and regenerative endodontic procedures, focusing on their biological principles, clinical protocols, indications, advantages, and limitations. Emphasis is placed on evidence-based decision-making to guide clinicians in selecting the most appropriate treatment modality based on individual case characteristics. Understanding the strengths and shortcomings of each approach is essential for optimizing clinical outcomes and preserving young permanent teeth in pediatric patients.

How to cite this article:

Yılmaz UY, Eskici M, Kerimoğlu C, Bezgin T. Apexification and regeneration procedures in young permanent teeth. J Med Dent Invest. 2025;6:e250065. https://doi.org/10.5577/jomdi.e250065