Pulp Injury and Changing Trends in Treatment

In contrast to the high long-term survival rates (>. 93%) of conventional endodontic treatment applied to mature permanent teeth, the treatment of the immature permanent tooth with a necrotic root canal system and apical periodontitis is challenging, due in part to incomplete root development leading to thin dentinal walls and reduced overall length. Conventional apexification procedures treat apical periodontitis in immature teeth, but the cases often have a poor prognosis due to weak root structures. Recent studies have employed a tissue engineering approach designed to regenerate a pulp-like tissue, resulting in continued radiographic root development, healing of apical periodontitis, and improved overall tooth survival. This chapter reviews the biological basis of regenerative endodontics and provides a perspective to interpret ongoing research in this dynamic area.