rdcjournalRoyal Dental College JournalE-Volume 8 Issue 1MultidisciplinaryEnglishJanuary- DecemberNNY20250613Pediatric and Preventive Dentistry Advanced Biomaterials in Apexogenesis: A ReviewEnglishY00Anagha AMoorthy1EnglishNAnjanaG2EnglishYAnoopHarris3EnglishYAmruthaJoy3EnglishYApexogenesis is a vital pulp therapy procedure aimed at preserving pulpal vitality in immature permanent teeth to enable continued root development and apical closure. It is commonly indicated in cases of pulp exposure due to caries or trauma where the pulp remains vital. Traditional materials such as calcium hydroxide and mineral trioxide aggregate (MTA) have demonstrated clinical success; however, their limitations—including poor handling characteristics, discoloration potential, high solubility, and prolonged setting time—have prompted the development of newer biomaterials. Recent advancements include tricalcium silicate–based materials such as Bio dentine, BioAggregate, TheraCal LC, Super MTA Paste, and EndoSequence Root Repair Material (ERRM), which offer improved biocompatibility, enhanced sealing ability, shorter setting times, and better mechanical properties. Calcium phosphate–based materials and natural biomolecules like acemannan further enhance regenerative potential through their osteoconductive and bioinductive properties. Nanotechnology has introduced adjuncts such as silver nanoparticles, graphene-based materials, and hydroxyapatite nanoparticles, which exhibit strong antimicrobial effects while promoting cellular proliferation, angiogenesis, and dentinogenesis. In addition, bioceramic sealers and advanced scaffold systems, including hydrogels and 3D-printed matrices, support stem cell differentiation and controlled growth factor delivery, contributing to more predictable regenerative outcomes. Despite these advancements, challenges such as high cost and limited long-term clinical evidence persist. Future developments in smart biomaterials and tissue engineering are expected to further improve the success and predictability of apexogenesis.EnglishApexogenesis, bio dentine, bio ceramics, Calcium phosphate cement, Nanomaterials, Regenerative endodontics, tricalcium silicatehttps://rdcjournal.org/abstract?id=277References1619REFERENCE 1. American Association of Endodontists. Glossary of Endodontic Terms. 8th ed. Chicago (IL): American Association of Endodontist; 2013. 2.American Academy of Pediatric Dentistry. Pulp therapy for primary and immature permanent teeth. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: AAPD; 2025:487-96. 3.Frank AL. Therapy for the divergent pulpless tooth by continued apical formation. J Am Dent Assoc. 1966 Jan;72(1):87and;ndash;93. doi: 10.14219/jada.archive.1966.0017. 4.Torabinejad M, Parirokh M. Mineral trioxide aggregate: a comprehensive literature reviewand;ndash;Part II: Leakage and biocompatibility investigations. J Endod. 2010 Feb;36(2):190and;ndash;202 doi: 10.1016/j.joen.2009.09.010. 5. Islam R, Islam MR, Tanaka T, Alam MK, Ahmed HM, Sano H. Direct pulp capping procedures and;ndash; Evidence and practice. Jpn Dent Sci Rev. 2023 Dec;59:48and;ndash;61. doi: 10.1016/j.jdsr.2023.02.002. 6. Hegde S, Sowmya B, Mathew S, Bhandi SH, Nagaraja S, Dinesh K. Clinical evaluation of mineral trioxide aggregate and biodentine as direct pulp capping agents in carious teeth. J Conserv Dent. 2017 Mar-Apr;20(2):91and;ndash;5. doi: 10.4103/0972-0707.212243. 7. Awawdeh L, Al-Qudah A, Hamouri H, Chakra RJ. Outcomes of vital pulp therapy using mineral trioxide aggregate or biodentine: a prospective randomized clinical trial. J Endod. 2018 Nov;44(11):1603and;ndash;9. doi:10.1016/.joen.2018.08.004. 8. JV Iyer, Kanodia SK, Parmar GJ, Parmar AP, Asthana G, Dhanak NR. Comparative evaluation of different direct pulp capping agents in carious tooth: An in vivo study. J Conserv Dent. 2021 May-Jun;24:283and;ndash;7. doi: 10.4103/jcd.jcd_71_21. 9. Peskersoy C, Luka).rcanin J, Turkun M. Efficacy of different calcium silicate materials as pulp-capping agents: randomized clinical trial. J Dent Sci 2021 Mar;16:723and;ndash;31. doi: 10.1016/j.jds.2020.08.016. 10. Zhang W, Li Z, Peng B. Assessment of a new root canal sealerand;rsquo;s apical sealing ability. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Jun;107(6):79 82.doi:10.1016/j.tripleo.2009.02.024. 11. Ma J, Shen Y, Stojicic S, Haapasalo M. Biocompatibility of two novel root repair materials. J Endod. 2011 Jun;37(6):793-8. doi: 10.1016/j.joen.2011.02.029. 12. Chen I, Salhab I, Setzer FC, Kim S, Nah HD. Differential expression of odontogenic genes in human pulp cells after pulp capping with calcium silicate cements. Materials. 2021 Aug;14(16):4661. 13. Candeiro GTM, Correia FC, Duarte MAH, Ribeiro-Siqueira DC, Gavini G. Evaluation of radiopacity, pH, release of calcium ions, and flow of a bioceramic root canal sealer. J Endod. 2012;38(6):842-5. 14. Zhang H, Shen Y, Ruse ND, Haapasalo M. Antibacterial activity of endodontic sealers by modified direct contact test against Enterococcus faecalis. J Endod. 2009 July;35(7):1051-5. doi: 10.1016/j.joen.2009.04.022. 15. Song M, Kim S, Kim E. A prospective randomized controlled study of mineral trioxide aggregate and super ethoxy-benzoic acid as root-end filling materials in endodontic microsurgery. J Endod. 2012 Jul;38(7):875-9. doi: 10.1016/j.joen.2012.04.008. 16. Parirokh M, Torabinejad M. Mineral trioxide aggregate: A comprehensive literature reviewand;mdash;Part III: Clinical applications, drawbacks, and mechanism of action. J Endod. 2010 Mar;36(3):400-13. 17. Peng W, Liu W, Zhai W, Jiang L, Li L, Chang J, et al. Effect of tricalcium silicate on the proliferation and odontogenic differentiation of human dental pulp cells. J Endod. 2011 Sep;37(9):1240-6. doi: 10.1016/j.joen.2011.05.035. 18. Dorozhkin SV. Calcium orthophosphate cements for biomedical applications. J Mater Sci. 2008 May;43(9):3028and;ndash;3057. doi:10.1007/s10853-008-2527-z. 19. Ginebra MP, Canal C, Espanol M, Pastorino D, Montufar EB. Calcium phosphate cements as drug delivery materials. Adv Drug Deliv Rev. 2012 Sep;64(12):1090and;ndash;1110. doi: 10.1016/j.addr.2012.01.008. 20. Khorasani M, Nikoui V, Safaralizadeh R, et al. Acemannan: A promising biomaterial in endodontics and regenerative dentistry. J Endod. 2020;46(10):1450and;ndash;1461. 21. Parirokh M, Torabinejad M. Mineral trioxide aggregate: a comprehensive literature reviewand;mdash;Part I: chemical, physical, and antibacterial properties. J Endod. 2010 Jan;36(1):16and;ndash;27. 22. Camilleri J. Sealers and obturation materials. In: Hargreaves KM, Berman LH, editors. Cohenand;rsquo;s Pathways of the Pulp, 12th ed. Elsevier; 2021. p. 613and;ndash;647. 23. Al-Haddad A, Cheung GS. Bioceramic-based root canal sealers: a review. Odontology. 2018;106:1and;ndash;13. doi: 10.1155/2016/9753210. 24. Al-Haddad A, Che Ab Aziz ZA. Bioceramic-Based Root Canal Sealers: A Review. Int J Biomater. 2016;2016:9753210. doi: 10.1155/2016/9753210. 25. Li WR, Xie XB, Shi QS, Duan SS, Ouyang YS, Chen YB. Antibacterial effect of silver nanoparticles on Staphylococcus aureus. Biometals. 2011 Feb;24:135and;ndash; 141. doi: 10.1007/s10534-010-9381-6. 26. Rai M, Yadav A, Gade A. Silver nanoparticles as a new generation of antimicrobials. Biotechnol Adv. 2009 Jan-Feb;27:76and;ndash;83. doi: 10.1016/j.biotechadv.2008.09.002. 27. Singh SP, Bhargava CS, Mishra A. Silver Nanoparticles: Biomedical applications, toxicity and safety issues. International Journal of Research in Pharmacy and Pharmaceutical Sciences. 2017 July;2(4):1-10. 28. Monteiro DR, Gorup LF, Takamiya AS, Ruvollo-Filho AC, de Camargo ER, Barbosa DB. The growing importance of materials that prevent microbial adhesion: antimicrobial effect of medical devices containing silver. Int J Antimicrob Agents. 2009 Aug;34(2):103-10. doi: 10.1016/j.ijantimicag.2009.01.017. 29. Guazzo R, Gardin C, Bellin G, Sbricoli L, Ferroni L, Ludovichetti FS, Piattelli A, Antoniac I, Bressan E,Zavan B. Graphene-Based Nanomaterials for Tissue Engineering in the Dental Field. Nanomaterials (Basel). 2018 May 20;8(5):349. doi: 10.3390/nano8050349. 30. Qi X, Jiang F, Zhiou M, Zhang W, Jiang X. Graphene oxide as a promising material in dentistry and tissue regeneration: A review. Smart materials in Medicine 2021;2:280-291. 31. Zhang K, Wang Y, Shi J, et al. Application of hydroxyapatite nanoparticles in vital pulp therapy: a review. J Mater Sci Mater Med. 2019;30:60. 32. Hanafy AK, Shinaishin SF, Eldeen GN, Aly RM. Nano Hydroxyapatite and;amp; Mineral Trioxide Aggregate Efficiently Promote Odontogenic Differentiation of Dental Pulp Stem Cells. Open Access Maced J Med Sci. 2018 Sep 23;6(9):1727-1731. doi: 10.3889/oamjms.2018.368.