apexogenesis

Apexogenesis is a dental procedure categorized as vital pulp therapy designed to preserve the vitality of the pulp in immature permanent teeth so that root development and apex formation can continue. The goal is to maintain a living pulp tissue to allow natural lengthening of the root and closure of the root apex.

The procedure is typically performed as a partial pulpotomy when the pulp exposure is recently injured or carious but the pulp remains vital. After local anesthesia and isolation with a rubber dam, the inflamed coronal pulp tissue is removed while preserving the remaining radicular pulp. If satisfactory hemostasis is achieved, a biocompatible medicament such as mineral trioxide aggregate or calcium hydroxide is placed over the pulp tissue, and a durable restoration is used to seal the tooth. The aim is to create a hermetic seal and monitor the tooth for ongoing root development and pulp vitality.

Indications include immature permanent teeth with a localized pulp exposure where vitality can be preserved to promote continued root maturation. Contraindications include necrotic pulp, irreversible pulpitis, extensive structural damage, or persistent periapical infection. Successful outcomes depend on accurate diagnosis, strict asepsis, minimal bacterial contamination, and a reliable coronal seal.

Apexogenesis contrasts with apexification, which is used to treat non-vital immature teeth by inducing an apical barrier rather than preserving vitality. When performed appropriately with modern biomaterials, apexogenesis offers favorable prognosis by permitting natural root formation and stronger tooth structure.