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<p>Immature permanent teeth with necrotic pulps present significant therapeutic challenges due to thin dentinal walls, wide-open apices, and poor fracture resistance. Apexification has traditionally been used to induce apical closure, but it does not promote further root development. Regenerative endodontic procedures (REPs) aim to restore biologic vitality and continue root maturation. This systematic review synthesizes randomized controlled trial (RCT) evidence comparing clinical and radiographic outcomes of REPs and apexification in young patients. A comprehensive search of PubMed, Cochrane Library, and ScienceDirect (2000–2025), supplemented by manual searches, was conducted following PRISMA 2020 guidelines (PROSPERO: CRD420251232516). Only RCTs involving immature necrotic permanent teeth treated with REP or apexification were included. Primary outcomes were root lengthening, dentinal wall thickening, and apical closure; secondary outcomes included periapical healing, survival, and adverse effects. Risk of bias was assessed using the Cochrane RoB 2.0 tool. Of 709 records screened, five RCTs (2014–2018) met inclusion criteria. Across all trials, REPs consistently produced greater root length increases, enhanced dentinal wall thickening, and superior or comparable apical closure relative to apexification. Stem cell-based REP achieved the most substantial maturation (mean root length gain ≈&#xa0;5&#xa0;mm). Periapical healing and tooth survival were uniformly high (≈&#xa0;100%) in both treatment groups. Adverse events were minimal and primarily limited to crown discoloration in TAP-based REP protocols. Based on the available randomized evidence, REPs demonstrate advantages over apexification in promoting root lengthening, dentinal wall thickening, and apical closure, while achieving similarly high periapical healing and tooth survival rates. These findings suggest that REPs represent a biologically favorable treatment option for immature necrotic permanent teeth. However, the limited number of RCTs, heterogeneity of REP protocols, and relatively short follow-up durations warrant caution.</p>

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Clinical outcomes of regenerative endodontic procedures compared with apexification in young immature necrotic teeth: a systematic review of randomized controlled trials

  • 期刊论文

  • 发表日期：

    2026年1月27日

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  • Muhammad Anas,
  • Muhammad Usman Sultan,
  • Sajid Ali,
  • Ihsan Ullah

摘要

Immature permanent teeth with necrotic pulps present significant therapeutic challenges due to thin dentinal walls, wide-open apices, and poor fracture resistance. Apexification has traditionally been used to induce apical closure, but it does not promote further root development. Regenerative endodontic procedures (REPs) aim to restore biologic vitality and continue root maturation. This systematic review synthesizes randomized controlled trial (RCT) evidence comparing clinical and radiographic outcomes of REPs and apexification in young patients. A comprehensive search of PubMed, Cochrane Library, and ScienceDirect (2000–2025), supplemented by manual searches, was conducted following PRISMA 2020 guidelines (PROSPERO: CRD420251232516). Only RCTs involving immature necrotic permanent teeth treated with REP or apexification were included. Primary outcomes were root lengthening, dentinal wall thickening, and apical closure; secondary outcomes included periapical healing, survival, and adverse effects. Risk of bias was assessed using the Cochrane RoB 2.0 tool. Of 709 records screened, five RCTs (2014–2018) met inclusion criteria. Across all trials, REPs consistently produced greater root length increases, enhanced dentinal wall thickening, and superior or comparable apical closure relative to apexification. Stem cell-based REP achieved the most substantial maturation (mean root length gain ≈ 5 mm). Periapical healing and tooth survival were uniformly high (≈ 100%) in both treatment groups. Adverse events were minimal and primarily limited to crown discoloration in TAP-based REP protocols. Based on the available randomized evidence, REPs demonstrate advantages over apexification in promoting root lengthening, dentinal wall thickening, and apical closure, while achieving similarly high periapical healing and tooth survival rates. These findings suggest that REPs represent a biologically favorable treatment option for immature necrotic permanent teeth. However, the limited number of RCTs, heterogeneity of REP protocols, and relatively short follow-up durations warrant caution.