Regenerative Endodontics versus Apexification: From Practice to Evidence:
The past decade has witnessed major strides in the advancement of modern endodontics.
Technological improvements in the field have been paralleled with an evolution of biologically
based procedures to target tissue regeneration. Endodontics has gone from pulp mumification
to root canal disinfection and sealing, from hand files to motor-driven files, from culturing to one-
visit appointments, from two-dimensional to three-dimensional radiography, and from pulp
removal to pulpal regeneration. Yet still, the clinical and academic controversies are prevalent.
Treatment of immature permanent teeth with pulp necrosis and periapical pathoses remains a
big challenge for endodontists. Until recently, treatment options for the immature necrotic
permanent tooth were limited to apexification procedures whether by the classic calcium
hydroxide approach or the more recently advocated mineral trioxide aggregate apexification
process. Regenerative endodontic procedures have emerged as a continuously developing field
that has revolutionized the concept of modern endodontics even further. This regenerative
approach represents one of the few clinical translations of tissue engineering and regenerative
medicine. Periapical tissues in immature teeth are rich in blood supply and contain stem cells
that have a great potential to regenerate in response to tissue injury. Given the right conditions,
many tissues can be programmed for self-regeneration to restore the lost part. Regenerative
endodontic strategies rely on the cell homing concept to trigger endogenous tissue
regeneration. While apexification has a long history, it is being challenged by its regenerative
adversary by offering the advantage of regenerating healthy vital pulp tissue and perhaps even
restoring tooth vitality. However, while success rates have been widely highlighted with
regenerative procedures, reports of unwanted intracanal calcification and complications with
failed cases have warranted attention. Thus, this presentation will use an evidence-based
approach to confront these two treatment paradigms: apexification versus regenerative
endodontic procedures. At the end, it is the clinician’s ultimate decision to select the best
treatment for his/her patient based on the available evidence and case presentation.
Defining apexification and regenerative endodontic procedures: approved protocols.
Indications and limitations of apexification and regenerative endodontics.
The influence of case selection and treatment planning procedures on the treatment outcome.
Literature and clinical based evidence of the success of both treatment modalities.
Problem solving tips for both treatment strategies.