Current and Future Views on Biomaterial Use in Regenerative Endodontics

Abstract

Regeneration of the pulp-dentine complex depends on satisfactory disinfection of the root canal system followed by the wise application of scaffolds, stem cells and growth factors. Hence, the purpose of this chapter is to discuss the latest discoveries on biocompatible strategies of root canal disinfection and the use of scaffolds and tissue engineering strategies in regenerative endodontics. Traditionally, root canal disinfection of necrotic permanent immature teeth has been done using antibiotic pastes, but although effective, these can be extremely toxic to stem cells, preventing reliable regenerative outcomes. Alternatively, nanofibrous constructs have been demonstrated able to function as drug delivery systems for a range of antibiotics, showing comparable antimicrobial effects to antibiotic pastes but using minimal drug concentration. After disinfection, pulp-dentine complex regeneration may be encouraged by cell-free or cell transplantation approaches. While the former approach comprises a cell-free strategy in which no exogenous cells are used, the latter approach induces regenerative outcomes by transplanting cells into the root canal. To conclude, the clinical translation of reliable and predictable regenerative therapeutics to treat teeth with necrotic pulps will involve the use of advanced scaffolds, loaded or not with stem cells, and/or growth factors to predictably foster pulp and dentine regeneration.