Regenerative endodontic procedures[1] is defined as biologically based procedures designed to replace damaged structures such as dentin, root structures, and cells of the pulp-dentin complex.[2] This new treatment modality aims to promote normal function of the pulp. It has become an alternative to heal apical periodontitis. Regenerative endodontics is the extension of root canal therapy. Conventional root canal therapy cleans and fills the pulp chamber with biologically inert material after destruction of the pulp due to dental caries, congenital deformity or trauma. Regenerative endodontics instead seeks to replace live tissue in the pulp chamber. The ultimate goal of regenerative endodontic procedures is to regenerate the tissues and the normal function of the dentin-pulp complex.
Before this treatment modality is introduced, apexification procedures using either immediate placement of mineral trioxide aggregate[3] apical plug or long term-calcium hydroxide treatment[4] were traditionally used to treat immature permanent tooth. Although these treatments often resolve the signs and symptoms of pathosis, they provide little to no benefit for continued root development. Further root growth, normal pulpal nociception and immune defense are impeded in the procedure of apexification.
Regenerative endodontics in 10-year-old with necrotic pulp and incomplete root formation (left) then 1 year after treatment. Buccal aspect of apex (blue arrow), palatal aspect of apex (red arrow) and line of initial root formation (green line)
To replace live tissue, either the existing cells of the body are stimulated to regrow the tissue native to the area or bioactive substances inserted in the pulp chamber. These include stem cell therapy, growth factors, morphogens, tissue scaffolds and biologically active delivery systems.[5]
Closely related to the field of regenerative endodontics, are the clinical procedures apexification and apexogenesis. When the dental pulp of a developing adult tooth dies, root formation is halted leaving an open tooth apex. Attempting to complete root canal on a tooth with an open apex is technically difficult and the long-term prognosis for the tooth is poor.
Apexogenesis, (which can be used when the pulp is injured but not necrotic) leaves the apical one-third of the dental pulp in the tooth which allows the root to complete formation. Apexification, stimulates cells in the periapical area of the tooth to form a dentin-like substance over the apex. Both improve the long-term prognosis for a forming tooth over root canal alone.[6]
Necrotic pulp and open apex can be revitalized with platelet rich fibrin.[7]
^Murray, Peter E.; Garcia-Godoy, Franklin; Hargreaves, Kenneth M. (April 2007). "Regenerative endodontics: a review of current status and a call for action". Journal of Endodontics. 33 (4): 377–390. doi:10.1016/j.joen.2006.09.013. ISSN 0099-2399. PMID 17368324.
^Hargreaves, Kenneth M; Cohen, Stephen, eds. (2011). Pathways of the Pulp 10th Edition. St. Louis, Missouri, US: Mosby Elsevier. p. 602. ISBN 978-0-323-06489-7.
^Witherspoon, David E.; Small, Joel C.; Regan, John D.; Nunn, Martha (October 2008). "Retrospective analysis of open apex teeth obturated with mineral trioxide aggregate". Journal of Endodontics. 34 (10): 1171–1176. doi:10.1016/j.joen.2008.07.005. ISSN 1878-3554. PMID 18793914.
^Cvek, M. (April 1992). "Prognosis of luxated non-vital maxillary incisors treated with calcium hydroxide and filled with gutta-percha. A retrospective clinical study". Endodontics & Dental Traumatology. 8 (2): 45–55. doi:10.1111/j.1600-9657.1992.tb00228.x. ISSN 0109-2502. PMID 1521505.
^Hargreaves, Kenneth M; Cohen, Stephen, eds. (2011). Pathways of the Pulp 10th Edition. St. Louis, Missouri, US: Mosby Elsevier. pp. 602–618. ISBN 978-0-323-06489-7.
^Hargreaves, K. M.; Diogenes, A.; Teixeira, F. B. (2013). "Treatment options: Biological basis of regenerative endodontic procedures". Pediatric Dentistry. 35 (2): 129–140. PMID 23635981.
^Johns, DextonAntony; Vidyanath, S; Kumar, MRamesh; Shivashankar, VasundaraYayathi (2012). "Platelet Rich Fibrin in the revitalization of tooth with necrotic pulp and open apex". Journal of Conservative Dentistry. 15 (4): 395–8. doi:10.4103/0972-0707.101926. ISSN 0972-0707. PMC 3482758. PMID 23112492.
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