Tooth Discoloration After Regenerative Endodontic Therapy in Immature Permanent Teeth: A Systematic Review

Tooth discoloration is a common esthetic complication following regenerative endodontic therapy in immature permanent teeth. This systematic review aimed to summarize the reported occurrence of post-treatment discoloration, identify protocol-related contributors, and synthesize preventive strategies. A comprehensive literature search was conducted, and eligible clinical studies were included after screening and full-text assessment. Due to substantial heterogeneity across study designs, regenerative protocols, discoloration assessment methods, and follow-up schedules, quantitative pooling was not appropriate. Across the included evidence, reported discoloration varied widely, with higher occurrence described in some trauma-focused cohorts and lower occurrence reported in selected material-comparison studies. The evidence indicates that discoloration risk is influenced by modifiable clinical factors, particularly coronal barrier material selection and access cavity or pulp chamber management, and may occur even when clinical and radiographic outcomes are otherwise favorable. Overall, preventive strategies that prioritize lower-staining materials and technique-sensitive chamber decontamination appear most relevant for minimizing esthetic compromise while maintaining the biological objectives of regenerative care.