Comparison of 2 kinds of endodontic treatments for pulp necrosis and infection in immature teeth following avulsion: A retrospective study.

The aim of this study was to explore the feasibility and efficacy of regenerative endodontic procedures (REPs) for treating avulsion injuries through a comparative retrospective analysis of avulsed immature permanent teeth treated with apexification (APEX) and REPs. Forty-nine teeth from 39 patients met the inclusion criteria and were divided into APEX (n = 25) and REP (n = 24) groups. Clinical and radiographic data were analyzed, with treatment outcomes categorized as "healed," "healing," or "disease." Quantitative radiographic analysis using ImageJ software measured percent changes in root length and thickness. Multivariable logistic regression identified predictors of ``disease'' treatment outcome. The APEX (n = 25) and REP (n = 24) groups demonstrated balanced baseline characteristics (all P > .05). Analysis identified several prognostic factors, with storage medium (P = .031), root development stage (P = .003), and periodontal healing (PH) type (P < .001) showing significant associations. Multivariable analysis identified PH as the only independent predictor of ``disease'' treatment outcome (P = .005), with both ankylosis-related resorption (adjusted odds ratio = 0.014, 95% confidence interval: 0.001-0.235, P = .003) and infection-related resorption (adjusted odds ratio = 0.053, 95% confidence interval: 0.007-0.415, P = .005) substantially reducing the odds of healing. In a limited subsample (n = 20), REPs suggested a strong trend toward faster apical closure (P = .021), with 85.7% of REP cases achieving closure within 12 to 18 months compared to 23.1% of APEX cases. Radiographic measurements showed minimal and comparable changes in root development between groups (P > .05). REPs represent a viable therapeutic alternative to APEX in the management of avulsed immature teeth and associated with a tendency toward earlier apical closure. Furthermore, the type of PH was identified as a critical prognostic factor, serving as a key indicator for predicting adverse treatment outcomes.