Vol. 12, Issue 1, Part A (2026)

Background: Management of necrotic teeth differs substantially between mature and immature permanent teeth due to variations in root development, apical anatomy, and biological healing potential. Immature necrotic teeth present unique challenges, including open apices and thin dentinal walls, which limit conventional obturation techniques and increase fracture risk. Contemporary approaches such as apexification and regenerative endodontic procedures (REPs) have expanded treatment options.

Objective: To compare clinical and radiographic outcomes of endodontic management in mature versus immature necrotic permanent teeth in a study population of 100 patients.

Methods: A prospective comparative clinical study was conducted on 100 necrotic permanent teeth treated in a Department of Conservative Dentistry, Sher-E-Bangla Medical College Hospital, Barishal, Bangladesh from January 2024 to June 2025 over a period of 18 months. Fifty teeth with complete root formation (mature group) and fifty teeth with incomplete root formation (immature group) were included. Mature teeth were managed with conventional root canal therapy (RCT), while immature teeth were treated using apexification with calcium hydroxide or mineral trioxide aggregate (MTA), or regenerative endodontic procedures where indicated. Patients were followed for 12 months. Outcomes assessed included pain resolution, periapical healing, root development, apical closure, and complications.

Results: At 12 months, clinical success was achieved in 92% of mature teeth and 88% of immature teeth. Radiographic periapical healing was observed in 90% of mature teeth compared to 84% of immature teeth. In the immature group, apexification resulted in apical barrier formation in 82% of cases, while regenerative procedures showed continued root development in 76% of cases. Complication rates were higher in immature teeth, primarily due to cervical root fractures and delayed healing.

Conclusion: Both mature and immature necrotic teeth can be successfully managed with appropriate endodontic protocols. Conventional RCT remains highly predictable for mature teeth, whereas biologically based approaches such as apexification and regenerative endodontics offer favorable outcomes for immature teeth. Case selection and adherence to contemporary guidelines are critical for optimal results.