Systematic Review of Biocompatible Materials in Endodontic Apexification for Immature Teeth

Abstract

Background: Endodontic treatment presents challenges, especially in cases of open tooth apices resulting from trauma or pulpal pathology, which can create divergent or flared root walls, often referred to as "blunderbuss" or "non-blunderbuss" canals. Conventional root canal procedures for open apices risk material extrusion. Furthermore, there is limited documented research on apexification materials and methods in South Asian countries, highlighting a gap in the field. In 2004, Dr. S Banchs and Trope introduced a regenerative protocol using minimal instrumentation, extensive irrigation, and antibiotic paste, followed by a blood clot scaffold or alternatives like platelet-rich plasma/fibrin to promote tissue regeneration.

Aim: This paper aims to provide a comprehensive review of the various materials and techniques used in apexification procedures in South Asian countries.

Materials and Methods: This systematic review, covering January 2000 to August 2023, involved an extensive computerized search of apexification procedures in South Asia. Articles were sourced from Google Scholar and PubMed using keywords and Boolean operators. After applying inclusion and exclusion criteria, eight articles were selected, thoroughly read, and analyzed in relation to the review question.

Results: Three primary materials—Calcium Hydroxide, MTA, and Biodentine—were frequently used in apexification procedures. Among these, Biodentine showed superior performance, while Calcium Hydroxide remained the gold standard for apexification in teeth with shorter roots.

Conclusion: The studies reviewed indicate that Biodentine is preferred for apexification in South Asia. However, further research is needed within the region to expand understanding of apexification procedures and assess newer materials.