Regenerative endodontics: A review

Abstract

Oral health and function are critical components of a patient's overall quality of life. Pulp necrosis in immature permanent teeth, resulting from trauma, caries, or developmental anomalies, presents a significant clinical challenge. Traditionally, apexification has been the routine treatment; however, it fails to promote continued root development, often leaving teeth brittle and susceptible to fractures. This review examines regenerative endodontic procedures (REPs), which represent a paradigm shift toward biologically based treatments designed to replace damaged structures and cells of the pulp-dentin complex. The success of REPs relies on the interaction of three key components: stem cells, bioactive molecules (growth factors), and scaffolds. During these procedures, a blood clot is typically induced to act as a scaffold, facilitating the influx of undifferentiated stem cells, such as stem cells of the apical papilla (SCAPs). The review details current clinical protocols recommended by the American Association of Endodontists (AAE) and the European Society of Endodontology (ESE). Key technical aspects include the use of low-concentration sodium hypochlorite (1.5%) to maintain cell viability and EDTA to promote the release of growth factors from the dentin matrix. Intracanal medicaments, specifically triple antibiotic paste (TAP) and calcium hydroxide, are evaluated for their disinfection efficacy and impact on stem cell survival. While REPs demonstrate high success rates in terms of symptom resolution and apical healing, histological evidence suggests the resulting tissue is often a repair (bone or cementum-like) rather than true pulpal regeneration. Despite these challenges, REPs offer a promising therapeutic pathway for increasing root length and wall thickness, ultimately enhancing the long-term retention of immature permanent teeth.