Regenerative Endodontics: Current Concepts, Clinical Protocols, and Future Directions

Abstract

Regenerative endodontics is a paradigm shift in the treatment of immature permanent teeth with necrotic pulps that uses beyond apexification methods, biologically-based methods that repair the pulp-dentin complex. The recent theories have focused on the three components of tissue engineering that include stem cells, scaffolds, and signaling molecules and the importance of the apical papilla in the maturation and healing of roots. Standardized clinical protocols are currently based on conservative canal disinfection, the induction of a biological scaffold (platelet concentrates or blood clots), and bioactive material sealing. Even though good results have been obtained, such as periapical healing, increased root wall thickness, and sustained root growth, shortcomings remain with respect to the predictability of genuine regeneration of the pulp, the potential of tooth discoloration, and inconsistent responses of long-term vitality. Continued developments in biomaterials, gene therapy, stem cell therapies and nanotechnology have the potential to eliminate these challenges and make regenerative endodontics more clinically applicable.. Future directions aim toward predictable, personalized, and biologically driven treatment strategies that may redefine the standard of care in endodontics.