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rev port estomatol med dent cir maxilofac . 2026;67(1):40-46 43

Figure 5. Thirteen-month follow-up radiograph Figure 6. Five-year follow-up radiograph obtained on
obtained on July 27, 2019. July 20, 2023.

appointments would be required. At the 13-month follow-up, coronal plug and the root apex was identified, along with a
the patient was asymptomatic, with radiographic evidence of slight increase in root length, complete periapical healing, and
bone formation in the periapical region (Figure 5). At subse- absence of clinical symptoms. According to classical stud-
quent follow-ups at 5 years (Figure 6) and 6 years (Figures 7 ies, 10,16 these findings constitute a well-established measure
and 8), the patient remained asymptomatic and radiographi- of clinical success, even in the absence of full root maturation.
10
cally free of signs of apical periodontitis. Additionally, imaging According to the classification proposed by Chen et al. ,
revealed the formation of a mineralized barrier between the the outcomes of regenerative endodontic treatment can be
apical plug and the remaining portion of the root, a slight grouped into five patterns: type 1, increased canal wall thick-
increase in dentinal wall thickness, and mild elongation of ness with continued root development; type 2, a blunted and
the treated tooth root. closed apex without significant root development; type 3, con-
tinued root development with a persistent open apical fora-
men; type 4, severe intracanal calcification; and type 5, a hard
Discussion and conclusions tissue barrier formed between the MTA plug and the root apex.
In the present case, radiographic evaluation from the 13-month
Endodontic treatment of teeth with incomplete root develop- follow-up onward demonstrated a radiopaque image sugges-
ment and apical periodontitis remains challenging because, tive of mineralized barrier formation in this region, consistent
despite the availability of traditional treatment techniques with the type-5 pattern.
17
such as apexification, none of these allows further root de- A similar outcome was reported by Nosrat et al. , reinforc-
velopment or an increase in radicular dentinal wall thick- ing the variability of clinical responses to regenerative thera-
ness. 1,15 pies and prompting a re-evaluation of the indications for tra-
This therapeutic modality was selected in the present case ditional techniques, such as apexification or conventional root
due to root immaturity, wide apical foramen, and extensive canal obturation. Nevertheless, despite this unpredictability,
periapical radiolucency, with the aim of promoting root devel- such variations might be attributed to differences in treatment
opment and preserving the affected tooth. However, after six protocols, stages of root development, pulpal conditions, and
years of follow-up, complete apical closure was not observed. the extent of periapical pathology. In the study by Nosrat et
12
Instead, the formation of a mineralized barrier between the al., the need for reintervention after six years was attributed