Objectives <p>The present study evaluated clinically and radiographically the effectiveness of Regenerative endodontic procedures (REPs) using platelet-rich fibrin (PRF) versus induced bleeding (IB) in treating mature necrotic teeth.</p> Materials and methods <p>Fifty patients with necrotic mature teeth with periapical lesions were randomly divided into two groups, Group 1, IB (<i>n</i> = 25), and Group 2, PRF (<i>n</i> = 25). Treated teeth were assessed clinically and radiographically at 6 and 12 months. Survival rate, success rate, and clinical outcome measures were analyzed.</p> Results <p>Survival rate was 98% at the 12-month follow-up period, with no significant difference between the groups (<i>P</i>=0.166). A statistically significant increase in periradicular healing was found in both groups at 6 and 12 months, compared to that at baseline (<i>P</i>&lt; 0.001). A significant difference was found in final treatment success between the two groups (<i>p</i> = 0.0219). The IB group achieved a 100% success rate (23/23), while the PRF group showed a 75% success rate (18/24). The overall success rate was 85.4%.</p> Conclusions <p>All teeth treated with either IB or PRF survived throughout the follow-up period. The preliminary results of this study showed comparable clinical outcomes between the two treatment modalities, although teeth treated with IB showed higher overall success rate than those treated with PRF this should be interpreted within the framework of early phase clinical evidence as the study was not adequately powered to confirm superiority.</p> Clinical relevance <p>REPs may represent a viable treatment option for mature necrotic teeth, offering a biologically based approach that aims to restore tissue function. Longer follow-up as planned in the second phase of this study, will allow for a more definitive comparison between IB and PRF approaches.</p>