Regenerative Endodontics| Volume 42, ISSUE 11, P1620-1625, November 2016

Influence of Age and Apical Diameter on the Success of Endodontic Regeneration Procedures

Published:September 09, 2016DOI:



      Treatment of immature permanent teeth with necrotic pulp and apical pathosis constitutes a challenge for endodontists. The present study was done to evaluate the effect of age and apical diameter on the regenerative potential of young permanent immature teeth with necrotic pulps.


      Immature necrotic permanent maxillary incisors (n = 40) of patients 9–18 years old were divided into 2 groups according to the treatment protocol: group Y (younger age group), 9–13 years and group O (older age group), 14–18 years. Each group was further subdivided into 2 subgroups according to apical diameter, subgroup (n) (narrower diameter) between 0.5 and 1 mm and subgroup (w) (wider diameter) equal to or greater than 1 mm. Revascularization procedures were performed for all patients. Follow-up was done for up to 12 months. Standardized radiographs were digitally evaluated for increase in root length and thickness and decrease in apical diameter.


      After the follow-up period, most of the cases demonstrated radiographic evidence of periapical healing. Group Y showed significant progressive increase in root length and width and decrease in apical diameter. Subgroup (w) representing wider apical diameter showed significant progress as well.


      It was found that revascularization procedures can be implemented in any age ranging from 9 to 18 years; however, younger age groups were better candidates for revascularization procedure than older ones. Regarding the apical diameter, regeneration procedures were successful with apical diameters as small as 0.5 mm. However, teeth with preoperative wider diameters (≥1 mm) demonstrated greater increase in root thickness, length, and apical narrowing.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Endodontics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Camp J.
        • Fuks A.
        Pediatric endodontics: endodontic treatment for the primary and young permanent dentition.
        in: Cohen S. Hargreaves K. Keiser K. Pathways of the Pulp. 9th ed. Mosby Elsevier, St Louis, MO2006: 822-882
        • 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: 27-44
        • Cvek M.
        • Sundstrom B.
        Treatment of non-vital permanent incisors with calcium hydroxide: V—histologic appearance of roentgenographically demonstrable apical closure of immature roots.
        Odontol Revy. 1974; 25: 379-391
        • Bose R.
        • Nummikoski P.
        • Hargreaves K.
        A retrospective evaluation of radiographic outcomes in immature teeth with necrotic root canal systems treated with regenerative endodontic procedures.
        J Endod. 2009; 35: 1343-1349
        • Yassen G.H.
        • Platt J.A.
        The effect of nonsetting calcium hydroxide on root fracture and mechanical properties of radicular dentine: a systematic review.
        Int Endod J. 2013; 46: 112-118
        • Andreasen J.
        • Farik B.
        • Munksgaard E.
        Long term calcium hydroxide as a root canal dressing may increase risk of root fracture.
        Dent Traumatol. 2002; 18: 134-137
        • Shabahang S.
        • Torabinejad M.
        • Boyne P.P.
        • et al.
        A comparative study of root end induction using osteogenic protein-1, calcium hydroxide and mineral trioxide aggregate in dogs.
        J Endod. 1999; 25: 1-5
        • Holden D.T.
        • Schwartz S.A.
        • Kirkpatrick T.C.
        • Schindler W.G.
        Clinical outcomes of artificial root end barriers with mineral trioxide aggregate in teeth with immature apices.
        J Endod. 2008; 34: 812-817
        • Witherspoon D.E.
        • Small J.C.
        • Regan J.D.
        • Nunn M.
        Retrospective analysis of open apex teeth obturated with mineral trioxide aggregate.
        J Endod. 2008; 34: 1171-1176
        • Huang G.T.
        Apexification: the beginning of its end.
        Int Endod J. 2009; 42: 855-866
        • Hargreaves K.
        • Law A.
        Regenerative endodontics.
        in: Hargreaves K. Cohen S. Pathways of the Pulp. 10th ed. Mosby Elsevier, St Louis, MO2011: 602-619
        • Murray P.E.
        • Garcia-Godoy F.
        • Hargreaves K.M.
        Regenerative endodontics: a review of current status and a call for action.
        J Endod. 2007; 33: 377-390
        • Iwaya S.
        • Ikawa M.
        • Kubota M.
        Revascularization of an immature permanent tooth with apical periodontitis and sinus tract.
        Dent Traumatol. 2001; 17: 185-187
        • Banchs F.
        • Trope M.
        Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol.
        J Endod. 2004; 30: 196-200
        • Windley W.
        • Teixeira F.
        • Levin L.
        • et al.
        Disinfection of immature teeth with triple antibiotic paste.
        J Endod. 2005; 31: 439-443
        • Thibodeau B.
        • Teixeira F.
        • Yamauchi M.
        • et al.
        Pulp revascularization of immature dog teeth with apical periodontitis.
        J Endod. 2007; 33: 680-689
        • Cotti E.
        • Mereu M.
        • Lusso D.
        Regenerative treatment of an immature, traumatized tooth with apical periodontitis: report of a case.
        J Endod. 2008; 34: 611-616
        • Jung I.Y.
        • Lee S.J.
        • Hargreaves K.M.
        Biologically based treatment of immature permanent teeth with pulpal necrosis: a case series.
        J Endod. 2008; 34: 876-887
        • Shah N.
        • Logani A.
        • Bhaskar U.
        • Aggarawal V.
        Efficacy of revascularization to induce apexification/apexogenesis in infected nonvital immature teeth: a pilot clinical study.
        J Endod. 2008; 34: 919-925
        • Chueh L.H.
        • Ho Y.C.
        • Kuo T.C.
        • et al.
        Regenerative endodontic treatment for necrotic immature permanent teeth.
        J Endod. 2009; 35: 160-164
        • Diogenes A.
        • Henry M.A.
        • Teixeira F.B.
        • Hargreaves K.M.
        An update on clinical regenerative endodontics.
        Endod Topics. 2013; 28: 2-23
        • Hargreaves K.M.
        • Diogenes A.
        • Teixeira F.B.
        Treatment options: biological basis of regenerative endodontic procedures.
        J Endod. 2013; 39: S30-S43
        • Nagy M.M.
        • Tawfik H.E.
        • Hashem A.A.
        • Abu-Seida A.M.
        Regenerative potential of immature permanent teeth with necrotic pulps after different regenerative protocols.
        J Endod. 2014; 40: 192-198
        • Lovelace T.W.
        • Henry M.A.
        • Hargreaves K.M.
        • Diogenes A.
        Evaluation of the delivery of mesenchymal stem cells into the root canal space of necrotic immature teeth after clinical regenerative endodontic procedure.
        J Endod. 2011; 35: 1343-1349
        • Sato I.
        • Kurihara-Ando N.
        • Kota K.
        • et al.
        Sterilization of infected root canal dentine by topical application of a mixture ciprofloxacin, metronidazole and minocycline in situ.
        Int Endod J. 1996; 29: 118-124
        • Hoshino E.
        • Kurihara-Ando N.
        • Sato I.
        • et al.
        In vitro antibacterial susceptibility of bacteria taken from infected root dentine to a mixture of ciprofloxacin, metronidazole and minocycline.
        Int Endod J. 1996; 29: 125-130
        • Galler K.M.
        • D'Souza R.N.
        • Federlin M.
        • et al.
        Dentin conditioning codetermines cell fate in regenerative endodontics.
        J Endod. 2011; 37: 1536-1541
        • Martin F.H.
        • Suggs S.V.
        • Langley K.E.
        • et al.
        Primary structure and functional expression of rat and human stem cell factor DNAs.
        Cell. 1990; 63: 203-211
        • Huang G.T.
        A paradigm shift in endodontic management of immature teeth: conservation of stem cells for regeneration.
        J Dent. 2008; 36: 379-386
        • Nakashima M.
        • Reddi A.H.
        The application of bone morphogenetic proteins to dental tissue engineering.
        Nat Biotechnol. 2003; 21: 1025-1032