Regenerative Endodontics in Teeth With Irreversible Pulpitis: A Scoping Review

Regenerative endodontic procedures (REPs) have been widely used to manage a range of pulpal pathologies, particularly in immature permanent teeth. The development of bioactive calcium silicate-based materials has led to a paradigm shift in vital pulp therapy (VPT) and REPs. Conventional clinical and radiographic criteria used to assess the healing ability of teeth diagnosed with irreversible pulpitis (IP) may be inadequate. Emerging evidence suggests that a proportion of pulps diagnosed as 'irreversibly' inflamed retain the capacity to recover normal function following VPT. The aim of this scoping review was to evaluate the current evidence supporting the possible use of REPs to preserve and regenerate vital pulp tissue in teeth diagnosed with IP.

A comprehensive literature search was conducted using MEDLINE (via PubMed), Web of Science, the Cochrane Library, Google Scholar and Scopus to identify studies that met predefined inclusion and exclusion criteria. In addition, manual citation searching was undertaken to ensure comprehensive coverage of the relevant literature.

Four individual case reports describing moderately successful pulp regeneration using REPs in immature permanent teeth diagnosed with IP were identified. In addition, two case series and two case reports reported comparable outcomes following REPs in mature permanent teeth with the same pulpal diagnosis.

Based on the results of this scoping review, the current clinical evidence supporting REPs for pulp regeneration in teeth diagnosed with IP is remarkably limited. However, biological plausibility is conceptually strong, and the potential focus of future investigations to achieve true pulp regeneration. Currently, VPT remains the preferable option for pulp preservation in teeth diagnosed with IP.