Objective To evaluate the effect of Vitapex and mineral trioxide aggregate (MTA) combined with calcium hydroxide paste in pulp revascularization of necrotic pulps in young permanent teeth.Methods A total of 123 children who received treatment for pulp necrosis from January 2021 to January 2023 in our hospital were selected. All patients underwent pulp revascularization surgery and were divided into group A, group B, and group C based on the treatment, with 41 cases in each group. The group A was treated with Vitapex combined with calcium hydroxide paste, the group B with MTA combined with calcium hydroxide paste, and the group C with MTA combined with triple antibiotic paste. The treatment frequency, treatment duration, and direct costs were compared among the three groups. The postoperative pain levels of the three groups of children at 1 day, 1 week, and 1 month after surgery were compared using the Face, Legs, Activity, Cry, Consolability (FLACC) scale. Serum levels of inflammatory factors at 1 day and 1 week after surgery, levels of basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) in gingival crevicular fluid before and 6 months after surgery, and the root development and masticatory ability were compared.Results Compared to treatment groups B and C, group A had a higher average treatment frequency and longer treatment duration, but lower direct costs (P < 0.05). Comparisons of VAS scores at 1 day, 1 week, and 1 month after surgery in the three groups revealed that there were significant differences among these time points (P < 0.05) and the groups (P < 0.05), with lower VAS scores in the group C suggestive of a better analgesic effect (P < 0.05). The change trends of VAS scores were different among the three groups (P < 0.05). The differences of levels of CRP, IL-6 and IL-8 at 1 day and 1 week after surgery in the group C were greater than those in the groups A and B (P < 0.05). The differences of levels of bFGF and VFGF in gingival crevicular fluid before and after treatment in the group B were greater than those in groups A and C (P < 0.05). The differences of the root development indicators and masticatory efficiency before and after treatment in the group B were greater than those in groups A and C (P < 0.05).Conclusions Compared with the calcium hydroxide paste, the triple antibiotic paste has more advantages in ameliorating postoperative inflammation. However, the calcium hydroxide paste is superior to the triple antibiotic paste in promoting the root development and improving chewing and occlusion.