Regenerative endodontics is one of the most exciting developments in dentistry today and endodontists are at the forefront of this cutting-edge research. Regenerative endodontics uses the concept of tissue engineering to restore the root canals to a healthy state, allowing for continued development of the root and surrounding tissue. Endodontists’ knowledge in the fields of pulp biology, dental trauma, and tissue engineering can be applied to deliver biologically based regenerative endodontic treatment of necrotic immature permanent teeth resulting in continued root development, increased thickness in the dentinal walls and apical closure. These developments in the regeneration of a functional pulp-dentin complex have a promising impact on efforts to retain the natural dentition, the ultimate goal of endodontic treatment.
Regenerative endodontic therapy provides an alternative treatment approach that builds on the principles of regenerative medicine and tissue engineering. The aim of the therapy is to successfully treat these challenging cases by regenerating functional pulpal tissue utilizing protocols referred to as regenerative endodontic procedures (REPs).
Regenerative endodontic therapy has been defined as “biologically based procedures designed to replace damaged structures, including dentin and root structures, as well as cells of the pulp-dentin complex’’. In the immature tooth with pulpal necrosis, this optimally translates to complete restoration of pulpal function and subsequent completion of root development.
Regenerative endodontics often involves a two- or multi-step procedure. The first appointment is centered on proper access and disinfection of the pulp space. Upon confirming the absence of clinical signs and symptoms, the second appointment focuses on removing the antimicrobial medicament, releasing growth factors from the dentin (e.g., by irrigating with ethylenediaminetetraacetic acid (EDTA), delivering stem cells into the root canal by stimulating bleeding, creating a scaffold (e.g., blood clot or platelet-rich plasma), sealing the tooth by placing a pulp space barrier (e.g., MTA or resin-modified glass-ionomer) and permanent coronal restoration to prevent bacterial reinfection. At the second appointment, the use of local anesthetic without a vasoconstrictor may better facilitate stimulation of apical bleeding.