Current Clinical Practice and Future Translation in Regenerative Endodontics

Abstract

Interest in vital pulp treatment (VPT) is rapidly developing and progressing within the endodontic community. An improved understanding of pulpal inflammation and repair processes has led to new treatment strategies for the damaged pulp and also improved short- and long-term outcomes for VPT. The current pulpal diagnosis of reversible or irreversible pulpitis should now be replaced by a new classification of pulp inflammation, which reflects the resilience of the injured pulp. These new classifications should direct the practitioner in their management strategy, when selecting pulp capping, pulpotomy or pulpectomy. The choice of capping biomaterials also plays a critical role in determining the long-term prognosis. Materials should be bioactive, provide a good seal and prevent microbial reinfection of the pulpal wound. Reports indicate that pulp regeneration is already possible in vitro using a stem cell-based tissue engineering technique or using a cell-homing strategy. As a rapidly developing area of research, these approaches are expected to improve and evolve, with better pharmacological and biological solutions for in vivo translation. Subsequently, regenerative endodontic approaches in the future should complement current treatment techniques. The aim of this chapter is to describe current and future perspectives in modern endodontics and highlight the need for the basic and clinical sciences to work together to develop improved therapeutic solutions.