Apexification and Apexogenesis

Traumatic dental injuries can occur at any time: while playing sports, as the result of a bad fall, or because of a car accident. When the injury happens to a child with teeth that are not fully developed, the tooth root may stop growing. If the pulp of an immature tooth is damaged during an accident, that tooth may be saved through one of two endodontic procedures: apexification or apexogenesis.

A normal tooth root is cone-shaped, with a root that tapers from the tooth’s crown to the closed tip of the root. When these teeth need to be treated endodontically, a normal root canal procedure is the most common and effective option.

However, there are certain teeth that do not have a closed root tip, resulting in what is called an “open apex.” These teeth are not fully developed, and still need time to grow and gain strength. Open apex teeth cannot be treated with conventional root canals, as the tip of the root cannot be sealed in the same way. The two options available to save a tooth with an open apex are apexification and apexogenesis.


Immature permanent teeth are the most common type of open-apex tooth. With apexification, a calcified barrier is encouraged to form over the open apex of the immature tooth. By removing unhealthy pulp and placing medication into the root, hard tissue forms near the root tip and acts a barrier for the root canal filling. When the barrier is fully formed, a traditional root canal and restoration can be completed.


Apexogenesis is one of the most current techniques to treat pulp exposure on a tooth with an open apex. It is a type of vital pulp therapy that treats an injured, immature permanent tooth. It allows for continued root formation and apical (root tip) closure. The two major agents used over the years to achieve apexogenesis are calcium hydroxide USP (CaOH) and mineral trioxide aggregate (MTA).

During this procedure, your endodontist will cover the exposed pulpal tissue with one of the agents listed above. This will allow the pulp to heal, preserving its vitality and encouraging the tooth to mature and strengthen naturally. If the pulp heals, no additional endodontic treatment is necessary.

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