The AAE describes regenerative endodontics as a Biologically based procedure designed to physiologically replace damaged tooth structures including dentin and root structures as well as cells of the pulp-dentin complex.
The problems with immature permanent teeth that become infected are they have thin dentinal walls and a lack of innervation and vasculature. The thin walls make them prone to fracture in adulthood and the lack of innervation prevent the tooth from having an immune defense against the infection.
Treatment of necrotic permanent teeth with an immature apex included either apexification or regenerative endodontics. Both these procedures have a high success rate when treating the infection in the tooth. However, when apexification procedures were used the roots were prone to fracture due to thin root walls. Regenerative endodontics allows for the continued thickening and elongation of the root, and therefore protection against fracture in adulthood.
The essentials to regenerative endodontics include disinfection of the root canal system (irrigation and the intracanal medicaments), a scaffold (blood clot), growth factors, and a restoration (MTA, composite).
For a regenerative procedure to be successful the following things need to occur.
- The infection must heal
- Continued development of the root
- Increased thickness of the root
- Regain vascularity and innervation