Vol. 24 No. 1 (2025)
Literature Review

Analysis of the most commonly used clinical protocols in regenerative endodontic treatment

pdf
  • Janaína S. M. da Silva,
  • Wesllayne S. Lima,
  • Marlos B. Ribeiro,
  • Mayara A. Pinheiro,
  • Basílio R. Vieira,
  • Geisa Aiane de M. Sampaio
Janaína S. M. da Silva
Departamento de Odontologia, Faculdade de Odontologia, Universidade de Pernambuco, Arcoverde, PE, Brasil.
Wesllayne S. Lima
Bio
Marlos B. Ribeiro
Bio
Mayara A. Pinheiro
Bio
Basílio R. Vieira
Universidade de Pernambuco
Bio
Geisa Aiane de M. Sampaio
Bio
DOI: https://doi.org/10.12957/bjhbs.2025.93439

Published 2025-08-08

Keywords

  • Clinical protocols,
  • regenerative endodontics,
  • dental trauma,
  • Permanent Dentition

How to Cite

1.
S. M. da Silva J, S. Lima W, B. Ribeiro M, A. Pinheiro M, R. Vieira B, de M. Sampaio GA. Analysis of the most commonly used clinical protocols in regenerative endodontic treatment. BJHBS [Internet]. 2025 Aug. 8 [cited 2025 Oct. 10];24(1). Available from: https://bjhbs.hupe.uerj.br/bjhbs/article/view/211

Copyright (c) 2025 Brazilian Journal of Health and Biomedical Sciences

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Crossref
Scopus
Google Scholar
Europe PMC

Abstract

Introduction: the regenerative endodontic treatment (RET) does not yet have a well-established clinical protocol. Objective: the aim of this study was to carry out a scoping review of RET clinical protocols described in the literature. Methodology and resources: The question used was: "What are the differences between the published RET protocols and which are the most widely used?" The search was carried out in the Lilacs, BVS, PubMed, and Scielo databases. Studies reporting on pulp revascularization protocols published in the last 10 years were included. Results and discussion: Seventy-four studies met the inclusion criteria. Most of the studies used sodium hypochlorite (NaOCl) as an auxiliary substance, either alone or in combination with other substances; however, the concentration of NaOCl used in the protocols varied greatly (between 0.5% and 6%). In more than 90% of the studies, treatment was carried out in 2 or 3 sessions, with intervals between sessions ranging from 24 hours to four weeks. The most used intracanal medication was triple antibiotic paste, followed by calcium hydroxide. The blood clot was the most used type of scaffold, mineral trioxide aggregate (MTA) was the most used material for cervical sealing, and composite resin was used for coronal shielding. Conclusions: Performing the technique over multiple sessions, using triple antibiotic paste as intracanal medication, blood clot as a scaffold, and MTA for cervical sealing are some of the most common characteristics and materials in clinical protocols for RET.

pdf

Metrics

Metrics Loading ...

References

  1. Shivashankar VY, Johns DA, Maroli RK, et al. Comparison of the effect of PRP, PRF and induced bleeding in the revascularization of teeth with necrotic pulp and open apex: a triple blind randomized clinical trial. J Clin Diagn Res. 2017;11(6):zc34-9. doi:10.7860/JCDR/2017/26353.10093
  2. El Ashiry EA, Farsi NM, Abuzeid ST, El Ashiry MM, Hammam, Bahammam. Dental pulp revascularization of necrotic permanent teeth with immature apices. J Clin Pediatr Dent. 2016;40(5):361-6. doi:10.17796/1053-4625-40.5.361
  3. Ince Yusufoglu S, Aydin ZU, Tulumbaci F, Bayrak S. Evaluation of different Apexification treatments of teeth with immature apices and apical periodontitis on the fractal dimensions of trabecular bone. Aust Endod J. 2021;47(2):163-169. doi:10.1111/aej.12510
  4. Kim SG, Malek M, Sigurdsson UM, Lin LM, Kahler B. Regenerative endodontics: a comprehensive review. Int Endod J. 2018;51(12):1367-1388. doi:10.1111/iej.13022
  5. Murray PE. Review of guidance for the selection of regenerative endodontics, apexogenesis, apexification, pulpotomy, and other endodontic treatments for immature permanent teeth. Int Endod J. 2022;56(2):188-199. doi:10.1111/iej.13684
  6. Wikstrom A, Brundin M, Vestman NR, Rakhimova O, Tsilingaridis G. Endodontic pulp revitalization in traumatized necrotic immature permanent incisors: Early failures and long-term outcomes-A longitudinal cohort study. Int Endod J. 2022;55(6):630-645. doi:10.1111/iej.13725
  7. American Association of Endodontists. Clinical considerations for a regenerative procedure. Available at: www.aae.org/specialty/wp-content/uploads/sites/2/2018/06/ConsiderationsForRegEndo_AsOfApril2018.pdf.
  8. Liang Y, Ma R, Chen L, et al. Efficacy of i-PRF in regenerative endodontics therapy for mature permanent teeth with pulp necrosis: study protocol for a multicenter randomized controlled trial. Trials. 2021;22:436. doi:10.1186/s13063-021-05434-3
  9. Lin J, Zeng Q, Wei X, et al. Regenerative endodontics versus apexification in immature permanent teeth with apical periodontitis: a prospective randomized controlled study. JOE. 2017;43:1821-1827. doi:10.1016/j.joen.2017.05.010
  10. El-Kateb NM, El-Backly RN, Amin WM, Abdalla AM. Quantitative Assessment of Intracanal Regenerated Tissues after Regenerative Endodontic Procedures in Mature Teeth Using Magnetic Resonance Imaging: A Randomized Controlled Clinical Trial. JOE. 2020;46:563-574. doi:10.1016/j.joen.2020.01.005
  11. Dori MI, Del Carril MA, Olmos J, Toscano D. Regenerative therapy in an immature permanent maxillary central incisor. Clinical case. Rev Asoc Odontol Argent. 2020;108(1):19-24.
  12. Chaniotis A. Treatment Options for Failing Regenerative Endodontic Procedures: Report of 3 Cases. JOE. 2017;43:1472-1478. doi:10.1016/j.joen.2017.05.002
  13. Pimentel L, Barros K, Pachêco A. Pulp revascularization. RvACBO. 2017;26(2):83-91.
  14. Fabro RMN, Britto MLB, Nabeshima CK. Comparison of different concentrations of sodium hypochlorite and saline used as irrigating solutions. Rev Odonto. 2010;9(4):365-368.
  15. Mafra SC, Girelli CFM, Xavier VFG, Lacerda MFL, Lacerda GP, Coelho RG. The effectiveness of EDTA solution in removing smear layer and its relationship with the time of use: an integrative review. RFO, Passo Fundo. 2017;22(1):120-129.
  16. Yassen GH, Chu TMG, Eckert J, Platt JA. Effect of medicaments used in endodontic regeneration technique on the chemical structure of human immature radicular dentin: an in vitro study. JOE. 2013;39(2):269-273. doi:10.1016/j.joen.2012.10.033
  17. Gatelli G, Bortolini MCT. The use of chlorhexidine as an irrigating solution in endodontics. Uningá Review. 2014;20(1):119-122.
  18. Botero TM, Tang X, Gardner R, Hu JCC, Boynton JR, Holanda GR. Clinical Evidence for Regenerative Endodontic Procedures: Immediate versus Delayed Induction?. J Endod. 2017;43(9):S75-S81. doi:10.1016/j.joen.2017.06.018
  19. Hoshino E, Kurihara-Ando N, Sato I, Uematsu H, Sato M, Kota K, Iwaku M. In-vitro antibacterial susceptibility of bacteria taken from infected root dentine to a mixture of ciprofloxacin, metronidazole and minocycline. Int Endod J. 1996;29(2):125–130.
  20. Ding RY, Cheung GSP, Chen J, Yin XZ, Wang QQ, Zhang CF. Pulp revascularization of immature teeth with apical periodontitis: a clinical study. JOE. 2009;35(5):745-749. doi:10.1016/j.joen.2009.02.013
  21. Mohammadi Z, Jafarzadeh H, Shalavi S, Yaripour S, Sharifi F, Kinoshita JC. A review on triple antibiotic paste as a suitable material used in regenerative endodontics. Iran Endod J. 2018;13(1):1-6.
  22. Ribeiro JS, Munchow EA, Bordini EAF, Rosa WLO, Bottino MC. Antimicrobial therapeutics in regenerative endodontics: A scoping review. JOE. 2020;46(9):S115-S127. doi:10.1016/j.joen.2020.07.022
  23. Báez V, Corcos L, Morgillo F, Imperatrice L, Gualtieri AF. "Meta-analysis of regenerative endodontics outcomes with antibiotics pastes and calcium hydroxide. The apex of the iceberg". J Oral Biol Craniofac Res. 2022;12(1):90-98. doi:10.1016/j.jobcr.2021.12.007
  24. Kahler B, Chugal N, Lin LM. Alkaline materials and regenerative endodontics: A review. Materials. 2017;10(12):1389. doi:10.3390/ma10121389
  25. Staffoli S, Plotino G, Torrijos BGN, et al. Regenerative endodontic procedures using contemporary endodontic materials. Materials. 2019;12(6):908. doi:10.3390/ma12060908
  26. Pedrosa LM, Ribeiro AOP, Câmara JVF, Pierote JJA. Indications and mechanical properties of conventional and bulk-fill composite resins: literature review. J Dent Public Health. 2021;12(1):39-47. doi:10.17267/2675-5012e20210142
  27. Silva DOC, Silva IM, Rocha AO, et al. Glass ionomer cement and its applicability in dentistry: A narrative review with emphasis on its properties. RDS. 2021;10(5):e20110514884.