There are two main treatment options for immature teeth with necrotic pulp and apical periodontitis. Apexification creates a mineralized tissue barrier, while revitalization aims to regenerate vital tissue in the canal space. There is no conclusive evidence to determine the most effective procedure regarding root length and dentin wall thickness. The objective of this systematic review was to compare the outcomes of revitalization and apexification procedures in immature non-vital teeth in terms of root length and dentin wall thickness. A literature search was conducted using the PubMed, ScienceDirect, Google Scholar, and Embase databases. Articles relevant to the study topic were gathered according to the selection criteria, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The included studies had to be published in English, conducted over a six-year period, and compared the outcomes of revitalization and apexification procedures in immature non-vital teeth. Data were collected using appropriate keywords from the eligible studies. Six articles were included for qualitative and quantitative analysis. The eligible studies showed a low risk of bias. In all revitalization cases, the root length increased significantly (mean difference (MD) (%) = 5.91; 95% confidence interval (CI) = 2.39-9.43; p = 0.0010; MD (mm) = 2.43; 95% CI = 2.05-2.80; p < 0.00001). The dentin wall thickness was statistically significant in most cases (MD (%) = 10.94; 95% CI = 7.01-14.88; p < 0.00001), MD (mm) = 0.16; 95% CI = 0.07-0.25; p = 0.0007). The systematic review and meta-analysis showed both procedures to be credible treatment options for necrotic immature teeth. Apexification had a positive impact, to some extent, on the development of root length. Revitalization yielded a significantly greater increase in root length and root dentin wall thickness and appeared to be superior in promoting root development.

External inflammatory root resorption is a pathologic process that commonly develops following mechanical damage to the cementum during traumatic dental injury. This case report presents the long-term interdisciplinary management of an avulsed immature maxillary central incisor complicated by severe external inflammatory root resorption. A 10-year-old patient presented with bleeding gingival tissue adjacent to the maxillary right central incisor. The medical history revealed that three years earlier, the patient had sustained an avulsion of tooth #11, which had been subsequently replanted. Clinical and radiographic examinations confirmed severe external inflammatory root resorption. Initial treatment consisted of root canal obturation with mineral trioxide aggregate followed by composite crown restoration. However, after nineteen months, the resorption progressed rapidly, resulting in crown fracture. Consequently, a decoronation procedure was performed. A removable orthodontic appliance was then used to preserve the alveolar bone space for nine years. At the age of 20, the patient underwent dental implant placement and restoration with a zirconia crown. This interdisciplinary and staged treatment approach ensured both functional stability and satisfactory aesthetic outcomes throughout all phases of management.