| Regenerative endodontics has emerged as a promising alternative that fits mainly into the treatment of nonvital teeth, in which new pulp tissue, but not actual pulp dentin, is developed from undifferentiated cells. |
| Two strategies can be applied for pulp-dentin complex regeneration: cell-based transplantation therapy or the cell homing. |
| Regenerative Endodontics: Simplifying Pulp-Dentin Repair |
| Uses cell-based therapy or cell homing to restore nonvital teeth. Cell homing, a simpler, cost-effective approach, recruits endogenous cells via biological signals, avoiding the ethical and economic challenges of cell-based methods. This review explores clinical trials, highlighting the potential and limitations of cell homing. |
| Revolutionizing Endodontics: The Role of Cell Homing in Tooth Vitality Restoration |
| Cell homing in regenerative endodontics utilizes the body’s natural healing processes, inducing bleeding to recruit endogenous stem cells and growth factors for regenerating pulp-like tissue, restoring tooth vitality, and promoting continued root development in nonvital teeth. |
| Harnessing Stem Cells and Growth Factors for Pulp Regeneration |
| SCAPs and DPSCs are crucial for endodontic regeneration, capable of forming dentin and pulp-like tissues, while growth factors like TGF-β1 and VEGF promote cell migration, angiogenesis, and tissue repair, advancing the restoration of the pulp-dentin complex, particularly in immature teeth. |
| Biomaterials and Macrophages in Endodontic Regeneration |
| Biomaterials like fibrin and immune-modulating scaffolds support tissue regeneration by promoting cell survival and vascularization, while macrophages, through reprogramming, shift to an anti-inflammatory role that aids in tissue repair, as demonstrated with chitosan hydrogels and DPSC-derived exosomes in periodontitis treatment. |
| Salivary Mucins: A Promising Avenue for Regenerative Endodontics |
| Salivary mucins (MUC7 and MUC5B) play a vital role in hydration, infection protection, and immune modulation, with their potential for use in regenerative endodontics due to their ability to limit infections and modulate immune responses, making them promising candidates for future biomaterials. |
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| Clinical Trials in Regenerative Endodontics: Promising Outcomes and Challenges |
| Clinical trials on regenerative endodontics for necrotic teeth with immature apices show promising results, including root elongation and periapical healing, using various scaffolds and cell homing techniques. However, challenges remain, such as incomplete pulp regeneration, calcification, and abscesses, highlighting the need for further research and careful consideration of experimental protocols. |
| Key Findings |
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Regenerative Treatments for Immature Teeth with Pulpal Necrosis:
Randomized controlled trials show significant root development and dentin thickening in regenerative treatments for teeth with pulpal necrosis, especially in cases of dens evaginatus. However, traumatic teeth had less predictable outcomes, with minimal root growth and lower apical foramen healing rates. |
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Regenerative Treatment in Mature Teeth with Pulp Necrosis:
Studies on mature teeth with pulp necrosis show mixed results, with some cases experiencing apical lesion healing and vitality restoration. However, many teeth did not respond to vitality tests, highlighting the need for further optimization of regenerative therapies in mature teeth. |
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| Key Goals of Regenerative Endodontics |
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Symptom Resolution and Bone Healing: Most studies show successful symptom resolution and apical periodontitis healing, with radiographic bone recovery as a key success marker. |
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Root Development and Strengthening: Significant root lengthening and thickening, especially in immature teeth, improve strength, although balancing dentin formation and canal obliteration remains challenging. |
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Restoration of Tooth Vitality: Vitality testing shows varied results, indicating pulp-like tissue formation, but consistency remains an issue, with advanced testing methods like laser Doppler flowmetry potentially improving outcomes. |
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| Conclusion |
| Regenerative endodontics shows great promise, especially for immature teeth, with benefits like root development and symptom resolution. Larger studies and longer follow-ups are needed to validate these therapies for broader clinical use. |
