The management of nonvital immature permanent teeth poses quite a challenge. The apexification procedure is in use for long-term now but the treated teeth are more prone to fracture questioning the long-term prognosis of this technique. The introduction of regenerative procedures for the treatment of these teeth is quite favorable; however, despite the increasing use of regenerative endodontic therapy procedures, inconsistent results are seen in the root development. Conservation of Hertwig's epithelial root sheath may have a prime role and selecting the cases with viable root sheath may impact on the consistent positive results treated with regenerative procedures. This article aims to look at the database to find the role of etiology and its implication on Hertwig's epithelial root sheath in the outcome of regenerative endodontics.