Objective To explore the effect of CGF-guided pulp tissue regeneration surgery on root dimension changes and dental aesthetics in patients with pulp necrosis of young permanent teeth. Methods A total of 80 patients with pulp necrosis of young permanent teeth admitted to the Department of Stomatology, People's Hospital of Xinjiang Uygur Autonomous Region from June 2023 to June 2024 were selected as the research subjects, and they were divided into the control group and the study group by the random number table method, with 40 patients in each group. The control group was treated with conventional apexification, and the study group was treated with CGF-guided pulp tissue regeneration surgery. The root dimension changes, dental aesthetics, complication rate and patient satisfaction were compared between the two groups. Results The postoperative root length and RRA in the study group were better than those in the control group, and the apical foramen diameter was lower than that in the control group (P <0.05). The scores of tooth surface smoothness, tooth morphology, color and retention in the study group were lower than those in the control group (P <0.05). The incidence of complications in the study group was 7.50%, which was lower than 35.00% in the control group (P <0.05). The patient satisfaction in the study group was 95.00%, which was higher than 75.00% in the control group (P <0.05). Conclusion The application of CGF-guided pulp tissue regeneration surgery in pulp regeneration of young permanent teeth can effectively promote the continuous development of roots, improve the aesthetics of affected teeth, reduce the risk of complications, and improve patient satisfaction.