Correction, 2026-10-07. Three fixes from a same-day editorial cross-check. First, the “What it does not show” section originally said the non-randomized allocation meant “the comparison runs partly against the treatment it favors”; that had the direction backwards, since clinicians steered the better regenerative candidates toward the regenerative procedure, and the sentence now reads accordingly. Second, the provenance note originally said the source was “read from the journal’s JATS full text”; it was read from the publisher page’s extracted main text, and the note now says so. Third, an internal review questioned the byline detail “Siyu Bai” and the Chengdu and Changsha affiliations; both were verified against the publisher-deposited Crossref metadata for this DOI and stand as printed.
What was done
Huan Jiang, Siyu Bai and Ping Chen, at the Sichuan Hospital of Stomatology and two affiliated hospitals in Chengdu and Changsha, retrospectively analyzed clinical records of children with immature permanent teeth and apical periodontitis treated between January 2022 and December 2025 (ethics approval No. 2026010008). Of 217 records screened, 148 teeth in 148 children were included after exclusions; one tooth per patient. Seventy-four teeth received a regenerative endodontic procedure (induced apical bleeding to form a blood-clot scaffold, ProRoot MTA coronal seal, permanent restoration) and 74 received conventional apexification with repeated calcium hydroxide dressing until a radiographic apical barrier formed, then obturation. Allocation was not randomized: attending pediatric endodontists chose regenerative treatment for teeth they judged to have a favorable apical stem-cell microenvironment and apexification for cases judged at higher risk of regenerative failure. Follow-up ran 6 months from definitive restoration, with no losses; outcome assessors and radiographic measurers were blinded to group (intra- and inter-examiner ICCs 0.92 and 0.88 for the radiography).
What was measured, and what came out
The primary endpoint was a composite clinical-plus-radiographic efficacy grade at 6 months. The total effective rate (marked plus effective) was 90.54 percent (67/74) in the regenerative group versus 74.32 percent (55/74) in the apexification group, chi-squared 6.719, P = 0.009. Root canal wall thickness increased from 2.03 to 3.00 mm in the regenerative group versus 2.04 to 2.78 mm with apexification (between-group post-treatment P = 0.001), and root length increased from 8.08 to 8.76 mm versus 8.14 to 8.58 mm (P = 0.004). Complications (alveolar bone inflammatory absorption, root fracture, gingival abscess) occurred in 4.05 percent (3/74) versus 13.50 percent (10/74) of teeth, P = 0.042. Gingival crevicular fluid bFGF and VEGF at follow-up were also higher in the regenerative group (bFGF 40.66 +/- 4.43 versus 36.09 +/- 4.71 pg/ul, P < 0.001; VEGF 41.93 +/- 6.44 versus 38.18 +/- 4.57 pg/ul, P < 0.001), which the authors read as a more active angiogenic repair environment.
The prognostic analysis
Pooling both groups, 26 of 148 teeth landed in a poor-prognosis category and 122 in a good one. Apexification accounted for 19 of the 26 poor-prognosis teeth (73.08 percent) against 45.08 percent of the good-prognosis group, and mean apical lesion extent was larger in the poor group (3.11 +/- 0.43 mm versus 2.90 +/- 0.39 mm, P = 0.016). Multivariate logistic regression kept two independent factors: treatment modality (apexification versus regenerative procedure, OR 4.081, 95 percent CI 1.532 to 10.873, P = 0.005) and apical lesion extent (OR 4.980 per 1 mm, 95 percent CI 1.531 to 16.197, P = 0.008).
What it does not show
This is a single-center, retrospective, non-randomized cohort with a 6-month horizon and no prospective sample-size calculation. The allocation rule matters: clinicians steered the teeth they considered better regenerative candidates toward the regenerative procedure and sent the riskier cases to apexification, so the comparison starts tilted in favor of the regenerative arm. The authors flag the deviation from the AAE 2025 regenerative guidance: canals were irrigated with 3 percent hydrogen peroxide and saline rather than sodium hypochlorite, which may have changed both disinfection and stem-cell viability. Lesions were measured on 2D periapical films, not CBCT. And the composite “effective” grade rewards continued root development, an endpoint apexification is not designed to deliver, so part of the gap is built into what was scored. Long-term outcomes (fracture resistance, continued maturation, recurrence) are simply not in this dataset.
Where it sits in the field
The piece belongs to the pulp and dentin repair program (/programs/pulp-dentin-repair/): it is human clinical evidence, but retrospective and short-horizon, so it reinforces rather than upgrades the program’s tier of small human data. Its most transferable content is the prognostic signal, larger apical lesions predict worse 6-month outcomes regardless of technique, which is directly usable in treatment planning for immature necrotic teeth. It says nothing about a third dentition: this is rescue of existing immature roots, not generation of new teeth.
Where we differ from the coverage
There is no press coverage of this paper to differ from. Against the paper’s own presentation, the abstract’s phrase “the patients were equally divided” reads like balance was designed in; in fact the groups were clinician-selected on CBCT assessment, and the selection bias pointed toward apexification carrying harder cases. That the regenerative arm still showed better outcomes is suggestive, but the correct reading of this study is an association under confounded allocation, not a demonstrated superiority. The authors themselves make most of these caveats, which is to their credit.
Provenance: grounded in the full open-access text and all seven data tables of Jiang, Bai and Chen (2026), Frontiers in Medicine, DOI 10.3389/fmed.2026.1945140, read from the publisher page’s extracted main text; every number above was checked against that source. Method and sourcing standard at /method/.