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Redefining regeneration: proposal of a radiographic outcome-based framework for evaluating regenerative endodontic
Ruchi Singhal1, Akshita Bansal1, Shiwani Chawla1
1Department of Pediatric and Preventive Dentistry, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India.
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 (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 (κ = 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.
