Title Regenerative Endodontics Shows Promise for Treatment of Mature Permanent Teeth With Periapical Pathology
Clinical Question In mature permanent teeth, is regenerative endodontics successful?
Clinical Bottom Line Regenerative endodontics has the potential to resolve pulpal and periapical pathologies and to be used as an alternative to standard root canal therapy in mature permanent teeth. The strongest evidence available regarding this subject matter is a literature review that attempts to summarize the cases series published. There are strong limitations to this evidence due to the small sample size and short follow-up periods. In addition, it is unclear what histologic components comprise the tissue that forms in these canals. Therefore, routine use of regenerative endodontic procedures in mature permanent teeth should be limited until more histologic and clinical evidence is available.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
28844305He/201711 mature necrotic permanent teethLiterature review
Key resultsThe authors provide a review of clinical cases focusing on mature permanent teeth that underwent apical revascularization. Most cases do not regain pulpal vitality; however, all cases showed resolution and/or reduction of clinical and radiographic symptoms at follow-up appointments. In addition, the authors evaluate the current research regarding stem cell transplantation and cell homing as potential sources for pulpal regeneration. Stem cell transplantation from the apical papilla appears to be a viable source for odontoblast-like cells that are able to produce dentin-like tissues, but current evidence is limited in regards to human application. Cell homing is being used successfully in immature apical revascularization cases to recruit cells for dental pulp regeneration.
26525552Saoud/20167 mature necrotic permanent teethCase series
Key resultsThe authors in this case series focus on seven mature permanent teeth—four anterior and three molar teeth. All teeth had closed apices except the distal roots of two mandibular first molars. All teeth were diagnosed with pulpal necrosis and presented with periapical lesions. The teeth were treated in three appointments, and Metapaste was applied between appointments. The largest final file size used was a #40 file. At the third appointment, either a #20 or #25 K-file was passed 3 mm beyond the apex into the periapical tissues to induce bleeding back into the canal. After 15 minutes, the bleeding semi-coagulated and 3 mm of MTA was placed into the coronal portion of the canals. Follow-up appointments ranged from 8 to 26 months, and all teeth exhibited healing of their respective periapical lesions and were asymptomatic at follow-up visits.
26279479Saoud/20152 mature previously treated permanent teethCase series
Key resultsIn this case series the authors study two mature permanent teeth that were previously treated and which presented with apical periodontitis. In both cases, the gutta-percha was removed, canals were debrided, and Metapaste was applied to the canals. At a later appointment, a #25 K-file was passed beyond the apices to induce bleeding back into the canals. After coagulation, MTA was placed in the coronal portion of the canals. At 13 to 14 month follow-up visits, both teeth showed healing of periapical tissues and were asymptomatic. Neither tooth had pulpal responses when tested.
Evidence Search Regenerative endodontics and mature teeth
Comments on
The Evidence
Validity: Although the sample size is small, it appears that regenerative endodontic procedures could offer an alternative approach for patients with mature permanent teeth who are experiencing periapical pathologies. Although initial results are promising, long-term success is uncertain. Perspective: Regenerative endodontics has unlimited potential and could revolutionize how pulpal and periapical pathologies are treated. Revascularizing the canal system and reintroducing a protective immune system could minimize the number of complications that occur with current endodontic procedures. However, further research is needed with larger sample sizes and randomization. In addition, the effectiveness of this procedure in mature permanent teeth with irreversible pulpitis needs to be determined; the tissues that form in the canal space also need to be evaluated histologically.
Applicability If regenerative endodontics in mature permanent teeth continues to prove successful in both short- and long-term follow-ups, then it could change how dentists approach the treatment of pulpal and periapical pathologies. From the evidence available, the evidence suggests that this procedure can be used in teeth with closed apices that have pulpal necrosis or were previously endodontically treated. Although initial results are promising, limited use should be taken until further long-term data is obtained.
Specialty (Endodontics) (General Dentistry)
Keywords Regenerative endodontic procedures; mature permanent teeth
ID# 3286
Date of submission 11/15/2017
E-mail tutwiler@livemail.uthscsa.edu
Author Theodore Young Tutwiler
Co-author(s) e-mail
Faculty mentor
Faculty mentor e-mail
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
by Renee Smith (San Antonio, TX) on 10/20/2022
A PubMed search on Regenerative Endodontic Procedures success in mature permanent teeth was performed in October 2022. A more recent publication was found: Nangia 2022, PubMed: 35558674. This Systematic review and meta-analysis further supports the conclusions of this CAT. It found that Regenerative Endodontic Procedures have a similar success rate (96%) to Non-surgical Endodontic Treatment.