Materials and Techniques for Apexification and Regenerative Endodontics in Immature Permanent Teeth: A Systematic Review
Prabha Shristha, Vijay Kumar Shakya, Rajeev Kumar Singh, Promila VermaAbstract
Background:
Managing immature permanent teeth with necrotic pulps or incomplete root formation presents clinical challenges. Traditional apexification using calcium hydroxide and mineral trioxide aggregate (MTA) has been the standard; however, regenerative endodontic procedures (REPs) have emerged as biologically driven alternatives that promote continued root development. Evaluating materials and techniques is essential for evidence-based clinical decisions.
Aim:
This study aims to evaluate and compare the effectiveness of different materials and techniques used in apexification and regenerative endodontics for immature permanent teeth.
Methodology:
A systematic review registered in PROSPERO 2025 CRD420251170785. A literature search was conducted in PubMed, Scopus, Web of Science and Cochrane Library databases. Clinical trials,
Results:
Forty-seven studies (22 randomised controlled trials, 15 cohort studies and 10 systematic reviews) were analysed. MTA and Biodentine showed the highest success rates (85%–96%) due to superior sealing, biocompatibility and stimulation of hard tissue formation. Calcium hydroxide yielded moderate outcomes (70%–85%) but required longer treatment and showed higher fracture risk. Resin-modified glass ionomer and zinc oxide eugenol were less effective (50%–70%) owing to poor sealing and solubility. REPs achieved 75%–90% success, supporting root maturation, but remained technique-sensitive.
Conclusion:
Bioceramic materials, particularly MTA and Biodentine, offer superior outcomes in managing immature permanent teeth. Regenerative techniques are promising, yet long-term studies are needed to establish predictability.