Advancements in Regenerative Endodontics: A Systematic Literature Review of Stem Cell-Based Therapies, In Vitro and In Vivo Evidence, Clinical Relevance, and Future Prospects

Objectives: By emphasizing the regeneration of compromised or diseased pulp tissue rather than relying solely on conventional root canal treatments, regenerative endodontics marks a significant advancement in dental care. Primarily relying on stem cell-based treatments, this method aims to restore normal tooth function, repair pulp tissue, and preserve the native tooth structure. With their remarkable capacity to differentiate into multiple cell types, stem cells hold great potential for regenerating pulp and periapical tissues. Stem cell-based regenerative endodontics has excellent potential, but its practical use is hampered in several ways. Methods: The efficacy, challenges, and prospects of stem cell-based therapies in regenerative endodontics were evaluated through a systematic literature review. With an eye toward peer-reviewed preclinical and clinical research from 2013 to 2023, a thorough search was conducted across critical databases including PubMed, Web of Science, and the Cochrane Library. Studies were selected based on their relevance to regenerative endodontic treatments, pulp regeneration, and stem cell-based tissue engineering. Emphasizing stem cell types, techniques, results, and obstacles found, data from qualified studies were gathered, analyzed, and synthesized. Results: Particularly with dental pulp stem cells (DPSCs), stem cells from the apical papilla (SCAP), and induced pluripotent stem cells (iPSCs), stem cell-based therapies for regenerative endodontics have shown promise in regenerating pulp and restoring tooth vitality. Because they can differentiate into odontoblast-like cells and encourage dentin development, DPSCs are known for their particular properties. Particularly in young teeth, SCAPs have shown outstanding regeneration potential; iPSCs offer an alternative but still require further development. Improvements in growth factors and scaffold materials have further enhanced the regenerative capabilities of stem cell treatments. Challenges such as immunological response, stem cell differentiation, and long-term safety still exist, despite favorable preclinical and clinical data. Discussion: Although stem cells from various sources show great promise for regenerative endodontics, their clinical applications are still in their early stages, and further study is required to optimize techniques and enhance results. Effective pulp regeneration depends critically on biomaterial scaffolds, growth factors, and the regulation of stem cell differentiation. Despite significant advancements, the sector still struggles with the long-term viability of regeneration treatments and the standardization of treatment strategies. Conclusion: Mainly stem cell-based treatments, regenerative endodontics has significant promise to transform dental care by repairing damaged pulp tissue and preserving tooth health. Although DPSCs, SCAPs, and iPSCs have made tremendous progress, further study and development are necessary to address clinical issues and enhance the long-term effectiveness of these treatments. The future of regenerative endodontics will be shaped by ongoing research into stem cell technologies and biomaterials, resulting in more biologically oriented and successful therapies for pulp and periapical diseases.