Regenerative endodontics: current concepts, clinical challenges, and emerging therapies

Regenerative endodontics has transformed the management of immature necrotic teeth by offering the potential to improve root structure rather than merely induce apical closure. Over the past two decades, considerable progress has been made in case selection, disinfection protocols, irrigation strategies, intracanal medicaments, scaffold design, and biologically based tissue engineering approaches. Despite these advances, key challenges remain, including protocol standardization, variability in clinical outcomes, limited high-quality clinical evidence, and the gap between promising laboratory findings and routine clinical implementation. This narrative review summarizes the recent literature on regenerative endodontics, focusing on contemporary clinical protocols and their limitations, prognostic factors, treatment outcomes, and emerging therapeutic strategies. Current evidence supports regenerative procedures that involve careful case selection, appropriate scaffold formation, well-sealed coronal restorations, and effective disinfection that preserves stem cell viability. While these protocols promote infection control, periapical healing, and tooth survival, continued root maturation remains variable, and existing therapies primarily result in tissue repair rather than true regeneration of a functional pulp-dentin complex. Additionally, there are several limitations to the widespread clinical adoption of advanced regenerative therapies, including outcome measures, alongside regulatory, manufacturing, and logistical challenges. Bridging the gap between innovation and clinical practice will require continued advances in tissue engineering, as well as more robust clinical evidence and standardized treatment protocols.