Regenerative approaches in endodontic therapies of immature teeth

Regenerative therapies in endodontics have recently gained momentum in clinical dentistry primarily due to the availability of effective root canal disinfection protocols, biocompatible materials with enhanced marginal seal, and discovery of mesenchymal stem cells (MSCs) in the dental pulp. These constitute the “triad” of tissue engineering required for pulp regeneration, assembled to meet the unique needs of the pulp-dentin microenvironment. Endodontic regeneration may be offered to patients at varying levels, including direct and indirect pulp capping, partial and complete pulpotomy, apexogenesis, apexification, and revascularization procedures, all of which require the triad of pulp tissue preservation or engineering. Successful outcomes in revascularization, for example, depend on root canal disinfection employing irrigation and medicaments using biocompatible calcium silicate-based cements (CSCs) paired with adhesion-based restorations that ultimately promote recruitment of MSCs from the apical papillae. These regenerative procedures yield high success rates in treatment outcome, although they are not routinely performed in the day-to-day practice of dentistry. In this chapter, we discuss the rationale for endodontic regeneration procedures in the era of markedly successful conventional therapies, and we outline the procedural aspects of available regenerative endodontic therapies