{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T12:54:42Z","timestamp":1791464082151,"version":"4.3.4"},"reference-count":45,"publisher":"MJS Publishing, Medical Journals Sweden AB","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BIiD"],"abstract":"<jats:p>Purpose: To propose a radiographic classification system for evaluating outcomes of regenerative endodontic procedures (REPs) in immature necrotic permanent teeth.\nMethods: A two-phase retrospective study was conducted. In Phase I, radiographs of 20 cases (2015\u20132018) 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\u201313 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\u2019s kappa, and associations with age and pre-treatment root stage were analyzed using Fisher\u2019s exact test.\nResults: Class 1 was most frequent. Partial intracanal calcification occurred in 35.18% of cases, with no complete canal obliteration. Age (p = 0.215) and pre-treatment root stage (p = 0.872) were not significantly associated with outcome classes. Inter- and intra-examiner agreement were high (\u03ba = 0.82 and 0.86). All cases were accommodated within the six proposed categories, and no additional outcome classes were observed. 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.<\/jats:p>","DOI":"10.2340\/biid.v13.46956","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T12:05:08Z","timestamp":1791461108000},"page":"744-755","source":"Crossref","is-referenced-by-count":0,"title":["Redefining regeneration: proposal of a radiographic outcome-based framework for evaluating regenerative endodontic procedures in immature necrotic teeth"],"prefix":"10.2340","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5514-2482","authenticated-orcid":false,"given":"Ruchi","family":"Singhal","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7890-3715","authenticated-orcid":false,"given":"Akshita","family":"Bansal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0003-5272","authenticated-orcid":false,"given":"Shiwani","family":"Chawla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3788-5298","authenticated-orcid":false,"given":"Ritu","family":"Namdev","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1183","published-online":{"date-parts":[[2026,10,8]]},"reference":[{"key":"170676","unstructured":"Cvek M. Treatment of non-vital permanent incisors with calcium hydroxide. I. Follow-up of periapical repair and apical closure of immature roots. Odontol Revy. 1972;23(1):27\u201344."},{"key":"170677","doi-asserted-by":"crossref","unstructured":"Rafter M. Apexification: a review. Dental Traumatol. 2005;21(1):1\u20138.","DOI":"10.1111\/j.1600-9657.2004.00284.x"},{"key":"170678","doi-asserted-by":"crossref","unstructured":"Torabinejad M, Chivian N. Clinical applications of mineral trioxide aggregate. J Endod. 1999;25:197\u2013205.","DOI":"10.1016\/S0099-2399(99)80142-3"},{"key":"170679","doi-asserted-by":"crossref","unstructured":"Witherspoon DE, Small JC, Regan JD, Nunn M. Retrospective analysis of open apex teeth obturated with mineral trioxide aggregate. J Endod. 2008;34:1171\u20136.","DOI":"10.1016\/j.joen.2008.07.005"},{"key":"170680","doi-asserted-by":"crossref","unstructured":"Andreasen JO, Farik B, Munksgaard EC. 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Mahidol study 1: comparison of radiographic and survival outcomes of immature teeth treated with either regenerative endodontic or apexification methods: a retrospective study. J Endod. 2012;38(10):1330\u20136.","DOI":"10.1016\/j.joen.2012.06.028"},{"key":"170689","doi-asserted-by":"crossref","unstructured":"Lin J, Zeng Q, Wei X, Zhao W, Cui M, Gu J, et al. Regenerative Endodontics Versus Apexification in Immature Permanent Teeth with Apical Periodontitis: A Prospective Randomized Controlled Study. J Endod. 2017 Nov;43(11):1821-1827.","DOI":"10.1016\/j.joen.2017.06.023"},{"key":"170690","doi-asserted-by":"crossref","unstructured":"Priya B L, Singh N, Mangalam KK, Sachdev R, P A, Jain HN, et al. Success and Complication Rates of Revascularization Procedures for Immature Necrotic Teeth: A Systematic Review. Cureus. 2023 Dec 30;15(12):e51364.","DOI":"10.7759\/cureus.51364"},{"key":"170691","unstructured":"American Association of Endodontists. Clinical considerations for a regenerative procedure [Internet]. Chicago, IL: AAE; 2022 [cited 2026 May 17]. Available from: https:\/\/www.aae.org\/specialty\/publications-research\/research\/regenerative-database\/"},{"key":"170692","doi-asserted-by":"crossref","unstructured":"Galler KM, Krastl G, Simon S, Van Gorp G, Meschi N, Vahedi B, et al. European Society of Endodontology position statement: revitalization procedures. Int Endod J. 2016;49(8):717\u201323.","DOI":"10.1111\/iej.12629"},{"key":"170693","doi-asserted-by":"crossref","unstructured":"Tong HJ, Rajan S, Bhujel N, Kang J, Duggal M. Regenerative endodontic therapy in the management of nonvital immature permanent teeth: a systematic review \u2013 outcome evaluation and meta-analysis. J Endod. 2017;43(9):1453\u201364.","DOI":"10.1016\/j.joen.2017.04.018"},{"key":"170694","doi-asserted-by":"crossref","unstructured":"Torabinejad M, Nosrat A, Verma P, Udochukwu O. Regenerative endodontic treatment or mineral trioxide aggregate apical plug in teeth with necrotic pulps and open apices: systematic review and meta-analysis. J Endod. 2017;43(11):1806\u201320.","DOI":"10.1016\/j.joen.2017.06.029"},{"key":"170695","doi-asserted-by":"crossref","unstructured":"Estefan BS, El Batouty KM, Nagy MM, Diogenes A. Influence of age and apical diameter on the success of endodontic regeneration procedures. J Endod. 2016;42:1620\u20135.","DOI":"10.1016\/j.joen.2016.06.020"},{"key":"170696","doi-asserted-by":"crossref","unstructured":"Theekakul C, Banomyong D, Osiri S, Sutam N, Ongchavalit L, Jantarat J. Mahidol study 2: treatment outcomes and prognostic factors of regenerative endodontic procedures in immature permanent teeth. J Endod. 2024;50(11):1569\u201378.","DOI":"10.1016\/j.joen.2024.08.017"},{"key":"170697","doi-asserted-by":"crossref","unstructured":"Chen MH, Chen YJ, Ching CH, Chen CA. 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