Vital Pulp Therapy and Apical Barrier Formation: An Insight into Apexogenesis and Apexification

AbstractBackground: Immature permanent teeth present unique clinical challenges when pulp vitality is lost or compromised. The thin dentinal walls, wide-open apex, and incomplete root development complicate endodontic treatment. Two biologically distinct approachesapexification and apexogenesis-form the cornerstone of management. Apexification aims to induce apical closure in non-vital teeth, while apexogenesis seeks to preserve pulp vitality and promote continued root maturation.Aim: To provide a comprehensive review of apexification and apexogenesis, detailing the biological principles, clinical protocols, materials, prognosis, and recent advances, including regenerative endodontics.Methods: Literature was reviewed from PubMed, Scopus, and ScienceDirect databases (1960-2025) using keywords “apexification,” “apexogenesis,” “immature permanent teeth,” “regenerative endodontics,” and “MTA.” Studies included clinical trials, systematic reviews, meta-analyses, and key case reports.Results: Multi-visit calcium hydroxide apexification, though historically successful, has been largely replaced by single-visit mineral trioxide aggregate (MTA) and bioceramic apical plugs. Apexogenesis remains the gold standard for vital immature teeth, yielding thicker dentinal walls and reduced fracture risk. Regenerative protocols, guided by the American Association of Endodontists (AAE), offer promising pulp–dentin complex regeneration in necrotic immature teeth.Conclusion: Case selection is the critical determinant of success. Contemporary materials and biologically driven protocols have improved outcomes, reduced treatment times, and expanded the therapeutic possibilities for immature permanent teeth.Keywords: Apexification, Apexogenesis, Immature permanent teeth, Regenerative endodontics, Mineral trioxide aggregate, Bioceramic materials.