Regenerative Endodontics provides alternative therapy in managing immature permanent teeth with pulpal necrosis with thin dentinal walls that have higher risk of cervical fracture. The protocol used for treatment is called regenerative endodontic procedures (REPs). The aim of the treatment is to achieve complete restoration of pulpal function and subsequent completion of root development by replacing damaged dentin, root structures, and cells of the pulp-dentin complex.
Case studies have shown healing of apical periodontitis, continued root apex development and increased thickness of the root canal wall in immature teeth with pulpal necrosis. Clinical considerations for Regenerative Endodontic procedures include, young patient, necrotic pulp with immature apex. Minimal or no instrumentation of the dentinal walls, placement of an intracanal medicament, creation of a blood clot of protein scaffold in canal, effective coronal seal. Regenerative endodontics involves a two- or multi-step procedure. First appointment focuses on disinfection of the pulp space.
With absence of clinical signs and symptoms, the second appointment is centred on removing the medicament, release of growth factors by stimulating a blood clot, then sealing the tooth by placing a pulp space barrier such as MTA (mineral trioxide aggregate) and permanent coronal restoration. Following completion of the regenerative endodontic procedure, close follow up appointments are important to ensure success of treatment.
Guidelines for follow-up are 6-12 month evaluation for resolution of periapical radiolucency and increase in dentinal wall thickness. 12-24 month follow-up to monitor increased dentinal wall thickness and increased root length. During this follow up period if any pain, soft- tissue swelling or increase in size of radiolucency occurs, it indicates failure of the procedure and conventional root canal will be elected.