Longitudinal periapical radiographic evaluation of apexification, vital pulpotomy, and revascularization in immature...

Immature permanent teeth pose therapeutic challenges due to immature root development; primary approaches include apexification, vital pulpotomy and revascularization, with few systematic imaging studies on their efficacy.

This study systematically compares the radiographic outcomes of apexification, vital pulpotomy, and pulp revascularization in managing immature permanent teeth, assessing root development and periapical healing to inform clinical decision-making.

This retrospective cohort analysis employed propensity score matching (PSM) to evaluate treatments for immature permanent teeth. Patients treated between January 2022 and December 2024 were categorized into three groups: apexification (n = 51), vital pulpotomy (n = 50), and revascularization (n = 51) after 1:1 nearest-neighbor matching. Primary outcomes were resolution of clinical signs and symptoms and periapical lesion healing; secondary outcomes were root development (increase in root length and canal wall thickness) and apical closure. Outcomes were assessed radiographically using pre- and postoperative periapical radiographs and cone-beam computed tomography (CBCT) at 6- and 12-month follow-ups.

After PSM, baseline characteristics were balanced (P > 0.05). At the 12-month follow-up, the revascularization group demonstrated significantly greater increases in both root length (1.8 ± 0.4 mm) and canal wall thickness (0.35 ± 0.05 mm) compared to the other interventions (P < 0.05). While apical closure rates were comparable between revascularization (88.2%) and vital pulpotomy (82.0%), both significantly outperformed apexification (56.9%, P < 0.01). Similarly, treatment success rates were higher in revascularization (88.5%) and vital pulpotomy (92.0%) than in apexification (76.5%, P < 0.05). Revascularization achieved superior periapical lesion healing (95.0%) versus both apexification (76.9%) and vital pulpotomy (72.0%) (P < 0.05). Complication rates showed no significant intergroup differences (P > 0.05).

Revascularization demonstrated superior efficacy in promoting root maturation, followed by vital pulpotomy and apexification. It is recommended to choose a personalized treatment plan according to the condition of the affected teeth.