Endodontics needs a standardized scaffold evaluation protocol – Why are we still guessing?

One of the most critical yet under-addressed challenges in regenerative endodontics is the lack of a universally accepted protocol for evaluating scaffolds used in pulp-dentin regeneration. Scaffolds are a cornerstone of regenerative strategies, serving as a structural and biological framework to support stem cell homing, differentiation, and tissue organization. However, current literature is plagued by significant variability in the models, methodologies, and outcome measures used to assess these scaffolds. For instance, some studies utilize animal models with open apex teeth, whereas others employ surgically perforated or instrumented mature teeth to mimic regeneration conditions, resulting in inconsistencies in apical closure and healing responses.[1-3] Moreover, the parameters reported across studies vary widely–some focus on histological evidence of tissue formation, whereas others prioritize molecular markers such as vascular endothelial growth factor for vascularization or neurofilament proteins for innervation, with no standardized baseline.[4] Many scaffold studies also fail to consistently assess or report essential physicochemical properties such as porosity, biodegradation rate, compressive strength, and immunogenicity, which are critical for clinical translation and patient safety.[5] This heterogeneity not only hinders reproducibility but also impedes meta-analyses and systematic evaluations that could guide clinicians and researchers in selecting or developing the most effective scaffold platforms. In contrast, the fields of orthopedics and cardiovascular tissue engineering have developed preclinical evaluation standards (e.g., ASTM F2150, ISO 10993), leading to smoother clinical transitions.[6] Regenerative endodontics urgently needs a similar framework or minimal reporting checklist that can serve as a reference standard. Such standardization would not only enhance the quality and comparability of research but also accelerate regulatory approval and clinical adoption. Without it, the field remains fragmented, full of promise, yet unable to consolidate knowledge into widely accepted clinical protocols. Contribution details Conceptualization: Dr. Ruchika Pandey; Methodology: Dr. Ruchika Pandey; Formal analysis and investigation: Dr. Ruchika Pandey; Writing – original draft preparation: Dr. Ruchika Pandey; Writing – review and editing: Dr. Ruchika Pandey; Visualization: Dr. Ruchika Pandey; Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.