Healing from within: Redefining Endodontic Success through Regeneration

Regenerative endodontics represents a transformative approach in managing necrotic or infected pulp in immature permanent teeth by leveraging the principles of tissue engineering—Stem cells, Scaffolds, and Growth factors. Unlike traditional apexification or root canal therapy, regenerative endodontic procedures (REPs) aim to biologically restore the pulp–dentin complex, enabling continued root development and apical closure. This is crucial for immature teeth, which are structurally vulnerable due to thin dentinal walls and open apices. Case selection is critical for REP success, with ideal candidates being patients aged 6–17 years with immature permanent teeth, open apices (>1.1 mm), and no significant systemic health contraindications. Treatment protocols emphasize proper disinfection using low-concentration irrigants and medicaments, followed by scaffold placement (e.g., blood clot, PRF, or PRP) and coronal sealing with biocompatible materials such as Mineral trioxide aggregate (MTA). The regenerative triad’s advancement has led to the development of nanofibrous scaffolds and injectable hydrogels that mimic the extracellular matrix and support cell proliferation and angiogenesis. Innovations include antibiotic-loaded scaffolds, CD31+ and CD105+ stem cells, and mobilized DPSCs, all enhancing the clinical potential of REPs. Furthermore, exosomes and polyelectrolyte multilayer coatings offer novel, cell-free regenerative strategies. Clinically, REPs are particularly valuable in treating immature necrotic teeth where apexogenesis or apexification is impractical. Although current success rates hover around 60–70%, ongoing research into scaffold mechanics, stem cell biology, and biomolecular signaling is expected to optimize outcomes. Regenerative endodontics holds promising implications for preserving tooth vitality, particularly in pediatric dentistry and trauma-related cases.