Collagen Scaffolds in Regenerative Endodontic Procedures: Current Evidence, Limitations, and Future Perspectives

Area of Science:

• Biomaterials Science
• Regenerative Medicine
• Endodontics

Background:

• Predictable pulp-dentin regeneration is a significant challenge in regenerative endodontic procedures (REPs).
• Collagen-based scaffolds are widely used due to biocompatibility, but their efficacy requires critical evaluation.
• Current regenerative endodontic treatments face limitations in achieving consistent, complete pulp-dentin regeneration.

Purpose of the Study:

• To review recent advancements in collagen scaffold applications for REPs.
• To critically evaluate the clinical and histological outcomes of collagen scaffolds in REPs.
• To propose strategies for improving collagen scaffold design for enhanced pulp-dentin regeneration.

Main Methods:

• Systematic review of clinical studies on collagen scaffolds in REPs.
• Analysis of histological outcomes related to newly formed mineralized tissues.
• Evaluation of physicochemical properties of collagen scaffolds influencing regeneration.

Main Results:

• Clinical studies show high tooth survival rates, vitality recovery, root wall thickening, and apical closure with collagen scaffolds.
• Consistent root lengthening remains a challenge.
• Histological analysis reveals cementum-like or bone-like tissue formation, not true reparative dentin, influenced by scaffold properties like pore size and stiffness.

Conclusions:

• Collagen scaffolds are a promising platform for REPs, offering biocompatibility and positive clinical results.
• Current evidence suggests collagen scaffolds do not consistently achieve true pulp-dentin regeneration.
• Targeted modifications and advanced tissue engineering are proposed to enhance collagen scaffolds for predictable regenerative outcomes.