Regenerative endodontic procedures are procedures that replace damaged dental structures with vital biological materials that foster the natural growth of new dental structures. While a traditional root canal procedure cleans out the tooth’s pulp chamber and replaces damaged or dead pulp with biologically inert material, regenerative endodontic procedures replace the damaged or dead pulp with biologically active systems that encourage the regeneration of live tooth pulp. The goal of regenerative endodontic procedures is to restore the normal function of the dentin-pulp complex, which is the vital interior of the tooth that lies under the enamel. These procedures are also intended to encourage immature permanent teeth to develop effective root growth and pulp production. It takes permanent teeth 3 years after they erupt for their root formation to be complete; if a tooth undergoes trauma during root development, regenerative endodontic procedures can foster the completion of the tooth’s development.
The live tissue of the dentin-pulp complex can be replaced by stimulating the body’s existing cells to regrow native tissue, or by placing bioactive substances, such as therapeutic stem cells, growth factors, or tissue scaffolds within the chamber of the tooth. If the dental pulp inside a developing permanent tooth dies, this also stops the formation of the root of the tooth, leaving the root tip open and resulting in a poor prognosis for the tooth. If a small amount of dental pulp is healthy enough to leave in the tooth during root canal, this can support the complete formation of the root; through a process called apexification, remaining cells are stimulated and form a seal at the tooth’s root. If all of the pulp has died, it may be able to be revitalized with fibrin that is rich in platelets, ultimately repairing the root tip and facilitating the completed development of the tooth.
Regenerative endodontics was first hypothesized in the early 1960s, when researchers noted that blood clots within the roots of teeth promoted their healing and encouraged the vitality of the pulp. This hypothesis was proven by encouraging bleeding inside the tooth’s root canal and allowing blood clots to form; patients were then observed over varying lengths of time, and the treated teeth were extracted and examined. Continued root development was observed in all treated teeth; improvements were noted as soon as 17 days. The field of regenerative endodontics has expanded due in part to research concerning dental trauma, which has demonstrated that dental pulp that has been injured through trauma can be revitalized with increased blood flow to the pulp tissue.
Trauma is the most common cause of destruction of the tooth’s pulp adult teeth that have not yet completed development. The death of a tooth’s pulp is called pulpal necrosis. It is estimated that as many as 35 percent of children and adolescents experience dental trauma before the development of the permanent teeth is complete, which can lead to pulpal necrosis. When young people lose immature permanent teeth, this can affect bone development, speech patterns, and self-esteem. Children and adolescents are not excellent candidates for dental restorations like implants, which are not recommended for patients whose bones are still growing. In these patients, regenerative endodontic procedures can allow patients to retain their natural teeth, which is the optimal situation medically, functionally, and aesthetically.