Human amniotic membrane as an extracellular matrix scaffold in regenerative endodontics: A cell homing perspective

Regenerative endodontics is a biologically driven treatment approach aimed at restoring the structure and function of the pulp-dentin complex. Due to the limitations associated with the commonly used blood clot scaffold, alternative scaffold materials are being explored, including the human amniotic membrane (hAM), which functions as an extracellular matrix scaffold with potential applications in pulpal regeneration. This narrative review aimed to summarize the biological characteristics of hAM and evaluate its role in regenerative endodontics through a comprehensive literature search of in vitro and in vivo studies, with particular emphasis on its use in cell homing-based regenerative strategies. Analysis of the available literature indicates that current clinical evidence is limited and largely based on case reports, reflecting a low level of evidence. Nevertheless, hAM exhibits several favorable biological properties that may contribute to creating a conducive microenvironment for regenerative endodontic procedures, with studies demonstrating encouraging outcomes and potential clinical applicability. Furthermore, histological and immunohistochemical findings suggest that hAM may support cellular recruitment and differentiation. However, despite these promising findings, well-designed clinical trials with larger sample sizes and long-term follow-up are necessary before its widespread clinical application can be recommended.