Clinical efficacy and prognostic factors of regenerative endodontic procedure for immature permanent teeth with periapical periodontitis
Abstract
To investigate the clinical effects of regenerative endodontic procedures in the treatment of immature permanent teeth with periapical periodontitis and to analyze the factors influencing prognosis. Clinical data of 148 immature permanent teeth with periapical periodontitis treated at our hospital from January 2022 to December 2025 were retrospectively analyzed. The patients were equally divided into Group A (regenerative endodontic procedure, n = 74) and Group B (apexification, n = 74). Clinical efficacy, root development, periodontal parameters, gingival crevicular fluid VEGF levels, and complication rates were compared. All subjects underwent 6-month follow-up and were stratified into good and poor prognosis subgroups. Multivariate logistic regression was used to screen for prognostic factors. After 6 months of therapy, Group A achieved a superior overall response rate, thicker root canal walls, longer root lengths, lower SBI, PLI, and PD, elevated gingival crevicular fluid bFGF and VEGF levels, and fewer complications ( P < 0.05). All participants completed the 6-month follow-up and were categorized into poor-prognosis ( n = 26) and good-prognosis ( n = 122) cohorts. The poor-prognosis group had fewer regenerative endodontic procedure cases and larger apical lesion areas ( P < 0.05). Multivariate logistic regression identified treatment modality and apical lesion size as independent risk factors for an unfavorable prognosis ( P < 0.05). Regenerative endodontic procedures are associated with favorable short-term (6-month) outcomes in immature permanent teeth with apical periodontitis, including improved root development and repair, a more favorable periodontal microenvironment, increased levels of repair-related cytokines, and fewer complications. The treatment modality and extent of the apical lesion were associated with prognosis. Individualized treatment decisions should consider the apical lesion characteristics and clinical status of the affected tooth to optimize outcomes in pediatric patients.