Regenerative Endodontics

Definition: a series of biologically based procedures designed to restore damaged tooth structures such as dentin (the hard layer of the tooth, found under the enamel), the root, and other cells of the pulp-dentin tissue. This procedure is based on the principles of regenerative medicine and tissue engineering.

RE is a solution for immature permanent teeth with pulpal necrosis that can’t be saved via root canal treatment, considering that implants are usually contraindicated in young patients that still have a growing craniofacial skeleton.
Tissue engineering is based on technologies that develop biological substitutes for cells, tissue, and organs. The main elements in tissue engineering in RE procedures are stem cells, scaffolds and growth factors. 

How does it work?

First, the dentist injects a local anesthetic to numb the area and the tooth. After that, a dental dam (protective sheet made of rubber or vinyl) will be placed over the area of the tooth, to isolate it from the bacteria found in saliva and the rest of the mouth. The dentist will drill a way through the dentin to the pulp and clean it, completing the first procedure by disinfecting the canals, drying them, and placing a double or triple antibiotic paste into the canal system.
At the second visit, the doctor again injects a local anesthetic, only this time it’s one that doesn’t have vasoconstrictor properties, this will ensure a blood clot in the tooth. After drilling through the tooth, and cleaning and drying it, the doctor will use a special instrument to lacerate the tissue around the root to induce bleeding into the canal system. The procedure ends with using a special material to seal the canal system after which, a filling is placed to close the opening of the tooth.
At the third visit (usually after 8-16 months), the doctor performs a radiography of the tooth that will show the increased thickness of the root walls, signs of apical bone healing and apical closure (apexification), which ultimately leads to permanent restoration. 
If restoration does not occur, then the doctor will use another method to treat the tooth. 

What are the risks?

• Discoloration of the tooth;
• Infections;
• The reappearance of the problem in the same tooth after some time;
• Poor root development; 

How to prepare for the procedure?

Abstain from smoking and/or drinking alcohol 24 hours prior to the procedure. 

Ever wondered about the procedure that follows a dental injury? Learn more about it in our article on Endodontic Therapy/Root Canal.

How long does the procedure take?

The first visit may take from 30 to 45 min, while the second one will last for about 1h. If no complications arise, the 3rd visit will last only a few minutes, enough for the radiography and the oral checkup. 

How to recover after the procedure?

• The doctor may prescribe antibiotics for a couple of days after the first visit;
• The first couple of days after the procedure, the tooth will be more sensitive, so avoid chewing with it, eating /drinking cold/hot meals;
• Avoid chewing gum with that tooth for the first 2-3 days, especially if you have a temporary filling;
• Provide good hygiene for your teeth;
• Pain can be managed with medication.

Want to understand how endodontics interact with other restorative procedures? Our article on Ridge Augmentation provides a clear insight.
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