Bioceramic Materials for Rootend Modification in Necrosed Immature Permanent Teeth: A Narrative Review

The endodontic management of immature permanent teeth with open apices that subsequently become necrotic presents a significant clinical and research challenge. Such cases are problematic due to the difficulty in achieving effective disinfection, proper apical closure, and long-term sealing of the root canal system. Over the years, various treatment approaches have been introduced to address this issue and promote apical closure and repair. These include apexification with calcium hydroxide, the use of Mineral Trioxide Aggregate (MTA), and, more recently, the application of advanced bioceramic materials, which have shown promising outcomes in root-end modification. These modern bioceramics include MTA, Biodentine®, which is used in successful root-end procedures due to the benefits of biocompatibility, sealing ability, and bioactivity. Issues include the long setting times, sensitivity towards handling, and high costs. This paper also reviews the more traditional apexification techniques and newer approaches like pulp revascularisation and regeneration against modern bioceramic materials. While these materials have had encouraging results, more clinical trials are needed to evaluate their long-term effectiveness.