Royal Dental College

Apexogenesis is a vital pulp therapy procedure aimed at preserving pulpal vitality in immature permanent teeth to enable continued root development and apical closure. It is commonly indicated in cases of pulp exposure due to caries or trauma where the pulp remains vital. Traditional materials such as calcium hydroxide and mineral trioxide aggregate (MTA) have demonstrated clinical success; however, their limitations—including poor handling characteristics, discoloration potential, high solubility, and prolonged setting time—have prompted the development of newer biomaterials. Recent advancements include tricalcium silicate–based materials such as Bio dentine, BioAggregate, TheraCal LC, Super MTA Paste, and EndoSequence Root Repair Material (ERRM), which offer improved biocompatibility, enhanced sealing ability, shorter setting times, and better mechanical properties. Calcium phosphate–based materials and natural biomolecules like acemannan further enhance regenerative potential through their osteoconductive and bioinductive properties. Nanotechnology has introduced adjuncts such as silver nanoparticles, graphene-based materials, and hydroxyapatite nanoparticles, which exhibit strong antimicrobial effects while promoting cellular proliferation, angiogenesis, and dentinogenesis. In addition, bioceramic sealers and advanced scaffold systems, including hydrogels and 3D-printed matrices, support stem cell differentiation and controlled growth factor delivery, contributing to more predictable regenerative outcomes. Despite these advancements, challenges such as high cost and limited long-term clinical evidence persist. Future developments in smart biomaterials and tissue engineering are expected to further improve the success and predictability of apexogenesis.