Clinical Outcomes of Apexification Techniques in the Management of Immature Teeth

Immature teeth are developing permanent teeth with incomplete root formation, characterized by an open apex, thin dentinal walls, and underdeveloped root length. It results from pulp necrosis that may be caused by dental trauma, dental caries, or apical periodontitis. Apexification has been the treatment of choice for immature teeth for years. Apexification techniques include apexification with calcium hydroxide and apexification with apical plug using mineral trioxide aggregate (MTA) or biodentine and other bioceramics. Regenerative endodontic therapy is another treatment option for immature teeth. These treatment modalities are associated with various success rates and various clinical outcomes. This review aims to evaluate clinical outcomes of different apexification techniques in the management of immature teeth. Apexification aims to resolve symptoms of periapical disease, heal periapical lesions radiographically, and form a calcified tissue barrier at the apex. Long-term calcium hydroxide apexification has been used for years; however, it involves disadvantages, such as long treatment duration and high risk of contamination. The apical plug technique has become preferred by clinicians due to its short treatment duration and favorable clinical outcomes, especially with Bodentine, which does not lead to tooth discoloration, unlike MTA. Regenerative endodontic procedures have shown similar overall success and survival to apexification, but better root length and dentin wall thickness. Future studies should focus on comparing success rates, clinical outcomes, and safety of different treatment modalities for immature teeth based on large population studies.