Clinical efficacy of regenerative endodontic treatment in immature permanent teeth with trauma or dens evaginatus: a retrospective cohort study.

OBJECTIVE: This study aimed to assess the clinical efficacy of regenerative endodontic treatment (RET) for immature permanent teeth with pulp necrosis and apical periodontitis due to trauma or dens evaginatus, and to analyze the factors influencing the success rate of RET. MATERIALS AND METHODS: A total of 140 immature permanent teeth were enrolled, including 70 traumatized anterior teeth and 70 premolars with dens evaginatus. Patient outcomes were evaluated based on clinical symptoms, complications, and radiographic findings. The primary outcome was the success rate defined by American Association of Endodontists (AAE). Differences between groups were analyzed using t-tests and Fisher’s exact test, and binary logistic regression was applied to determine factors affecting the success rate in the trauma group. RESULTS: After a mean follow-up period of (29.12 ± 16.59) months, the trauma group demonstrated a significantly lower success rate compared to the dens evaginatus group (T: 81.43% vs. D: 94.29%, p < 0.05). Statistically significant differences were also observed in periapical radiolucency (T: 85.71% vs. D: 97.14%, p < 0.05), root resorption (T: 17.14% vs. D: 1.43%, p < 0.05), root development type II (T: 21.43% vs. D: 7.14%, p < 0.05), and type III (T: 4.29% vs. D: 14.29%, p < 0.05), apical foramen diameter changes (T: 45.93 ± 29.41% vs. D: 58.53 ± 39.23%, p < 0.01), and root canal area changes (T: 37.87 ± 29.72% vs. D: 26.75 ± 22.71%, p < 0.05). CONCLUSIONS: Within the limitation of this study, regenerative endodontic treatment demonstrates a considerable success rate managing immature teeth with pulp necrosis or apical periodontitis. Etiology appears to affect the RET outcomes, with traumatized anterior teeth associated with less favorable clinical results compared to dens evaginatus cases. CLINICAL RELEVANCE: The findings highlight that etiology is a critical determinant of RET outcomes. This study lays the foundation for future research to investigate the underlying mechanisms responsible for the observed disparities between traumatic and dens evaginatus cases.