ArticleBiomaterial investigations in dentistry2026
Redefining regeneration: proposal of a radiographic outcome-based framework for evaluating regenerative endodontic procedures in immature necrotic teeth.
Article in Biomaterial investigations in dentistry, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: To propose a radiographic classification system for evaluating outcomes of regenerative endodontic procedures (REPs) in immature necrotic permanent teeth. Methods: A two-phase retrospective study was conducted. In Phase I, radiographs of 20 cases (2015-2018) were analyzed to identify patterns of apical closure, root lengthening, dentinal wall thickening, intracanal calcification, and periapical healing. Based on these findings, a six-class radiographic classification was proposed:Class 1: Apical closure with increased root length and dentin thickness;Class 2: Apical closure with increased root length only;Class 3: Apical closure with increased dentin thickness only;Class 4: Apical closure without changes in root length or dentin thickness;Class 5: Barrier formation within the canal or coronal to the root end;Class 6: No root dimensional changes with periapical healing of a documented pretreatment periapical radiolucency.In Phase II, the classification was applied to 54 immature single-rooted permanent teeth from 44 patients aged 8-13 years treated with REPs between 2019 and 2023. Baseline and latest available follow-up radiographs were evaluated by two blinded examiners. Reproducibility was assessed using Cohen's kappa, and associations with age and pre-treatment root stage were analyzed using Fisher's exact test. Results: Class 1 was most frequent. Partial intracanal calcification occurred in 35.18% of cases, with no complete canal obliteration. Age ( Conclusion: This proposed six-class radiographic framework demonstrated good internal reproducibility and may provide a structured basis for outcome reporting after REPs. Prospective multicenter validation is required.
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