Regenerative endodontic procedures: state of the art and clinical procedures [Procedure endodontiche rigenerative: stato dell’arte e procedure cliniche]

OBJECTIVES Calcium hydroxide apexification and Mineral Trioxide Aggregate (MTA) apexification are classical treatments for necrotic immature permanent teeth, but they still present some drawbacks. With both techniques, the root development is interrupted, compromising long-term prognosis of the tooth. The scope of the present article is to review pertinent literature and to describe the clinical procedures protocol for regenerative endodontic procedures (REP) with its variations and their clinical application. MATERIALS AND METHODS New scientific literature has de-scribed a procedure that allows complete root development of these specific teeth. This regenerative endodontic procedure proposes the use of a combination of antimicrobials and irrigants, no canal walls instrumentation, induced apical bleeding to form a blood clot and a tight seal into the root canal to promote healing. MTA is the most used material to perform this seal, but updated guidelines advise the use of other bioactive endodontic cements that incorporate calcium and silicate in their compositions. They share most of their characteristics with MTA but claim to have fewer drawbacks with regards to manipulation and aesthetics. RESULTS Even if human long-term results don’t exist yet, a variety of studies and systematic reviews describe high survival indexes, high success levels and progression of the root formation. CONCLUSIONS The success of this procedure depends specially of the root-canal disinfection, the application of a matrix (scaffold) inside the canal to allow tissue growth and the bacteria tight seal on the coronal orifice of the canal. CLINICAL SIGNIFICANCE Moving from apexification to the regenerative endodontic procedures is clinically positive for the patient and thanks to the possibility of performing them with materials that are available in most of clinical backgrounds, it becomes easily available for a bigger amount of patients.