Management of Immature Permanent Necrotic Teeth Treated by Regenerative Endodontic: A Systematic Review

Background: Regenerative endodontics is an evolving field of dentistry that focuses on biological restoration and tissue regeneration rather than traditional apexification techniques. This approach utilizes biological materials, growth factors, and scaffolds to stimulate natural healing, enabling root dentin thickening and lengthening. Regenerative endodontic procedures (REPs) aim to replace damaged structures, relieve symptoms, promote bone healing, and enhance root maturation. The success of REPs relies on three key components: stem cells, signaling molecules, and an appropriate scaffold to support cell growth and differentiation. Methods: This systematic review evaluates the management of immature permanent necrotic teeth treated with regenerative endodontic procedures. A comprehensive literature search was conducted in PubMed and Google Scholar databases for studies published between 2015 and 2024, following PRISMA guidelines. Case series and case reports were included based on predefined eligibility criteria. Data extraction focused on patient demographics, etiology, radiographic findings, treatment protocols, and clinical outcomes. Results: The findings indicate that regenerative endodontic treatment is highly effective, with a success rate of 82.6%, demonstrating significant healing of pre-apical radiolucency and root maturation. The most commonly used irrigation protocol involved NaOCl, saline, and EDTA, while Triple Antibiotic Paste (TAP) was the preferred intracanal medicament. MTA was the most frequently used capping material, and Platelet-Rich Fibrin (PRF) and Blood Clot (BC) were the most commonly utilized scaffolds. Despite the high success rate, a small percentage of cases were only partially successful or failed, emphasizing the need for further research to refine treatment protocols and improve long-term outcomes. Conclusion: This review highlights the importance of regenerative endodontic techniques in promoting root development and periapical healing, offering a biologically driven approach to managing immature necrotic teeth. Further studies are required to optimize treatment strategies and enhance clinical predictability.