REGENERATIVE ENDODONTICS: ADVANCEMENTS IN PULP REVITALIZATION TECHNIQUES: A SYSTEMATIC REVIEW

Abstract

Background: Regenerative endodontics represents a paradigm shift in the treatment of necrotic immature permanent teeth by promoting continued root development and biological repair. Traditional apexification has limitations in reinforcing root structure, whereas regenerative endodontic procedures (REPs) provide the potential for root maturation and pulp revitalization.

Objectives: This systematic review aimed to synthesize current evidence on advancements in pulp revitalization techniques, with emphasis on scaffold innovations, long-term outcomes, and clinical success factors.

Methods: A systematic review methodology was adopted in line with PRISMA 2020 guidelines. Databases including PubMed, Scopus, Web of Science, Embase, and Google Scholar were searched for studies published between 2010 and 2025. Eligible studies included randomized clinical trials, cohort studies, case reports, and systematic reviews investigating regenerative protocols for necrotic immature permanent teeth.

Results: Ten eligible studies were included. Evidence indicates that REPs consistently achieve periapical healing (up to 89%), root lengthening (67–80%), and apical narrowing across diverse clinical contexts. Platelet-based scaffolds such as PRF and CGF demonstrated superior or comparable results to blood clot scaffolds, with injectable PRF showing enhanced apical closure. Long-term follow-ups confirmed sustainability of results, although only 61% of treated teeth regained positive pulp sensitivity. Variability in protocols, disinfection methods, and outcome definitions limited comparability.

Conclusions: REPs offer substantial clinical and radiographic benefits in managing necrotic immature teeth, outperforming traditional apexification techniques. However, inconsistent pulp vitality recovery and methodological heterogeneity highlight the need for standardized protocols and histological validation. Emerging bioactive scaffolds and cell-homing strategies hold promise for future translation into clinical practice.