Regeneration of the dentine-pulp complex with revitalization/revascularization therapy: challenges and hopes

The concept of regenerative endodontics has gained much attention in clinical endodontics in the past decade. One aspect of this discipline is the application of revitalization/revascularization therapies for infected and/or necrotic immature pulps in permanent teeth. Following the publication of a case report (Iwaya et al. 2001), investigators have been rigorously examining the types of tissues formed in the canals as well as exploring strategies to regenerate the pulp-dentine complex in revitalized teeth. This review will provide an update on the types of tissues generated in the canals after revitalization/revascularization therapy in both animal and human studies. The understanding of the role of stem cells and microenvironment in the process of wound healing resulting in either regeneration or repair will be thoroughly discussed. Stem cells and microenvironmental cues introduced into the canal during revitalization/revascularization procedures will be examined. In addition, requirement of a sterile microenvironment in the canal and vital tissue generation in revitalization/revascularization therapy will be emphasized. The challenges that we face and the hopes that we have in revitalization/revascularization therapy for regenerative endodontics will be presented.