Regenerative Endodontics

Regenerative endodontic procedures (REPs) represent a paradigm shift in treating immature permanent teeth with pulp necrosis. Rather than traditional root canal treatment, REPs aim to regenerate pulp-like tissue within the root canal system, allowing continued root development and strengthening of the tooth structure. The procedure involves disinfecting the root canal system with irrigants and intracanal medicaments, then creating a scaffold — typically a blood clot induced by intentional overinstrumentation beyond the apex. The blood clot contains stem cells and growth factors that stimulate tissue regeneration. A bioceramic material is placed over the blood clot, followed by a permanent restoration. REPs have shown remarkable success in young patients with open apices, where continued root development (apexogenesis) is achieved. The regenerated tissue may include cementum-like tissue, bone-like tissue, and connective tissue, though true pulp regeneration remains an evolving goal. Research continues to explore the use of concentrated growth factors, stem cell therapies, and tissue engineering to improve predictability and outcomes.