Current and Future Views on Cell-Homing-Based Strategies for Regenerative Endodontics

The aim of regenerative endodontics is to replace injured or infected structures, including root and crown dentine as well as cells in the pulp-dentine complex. Two strategies, cell-homing-based and cell-based regenerative strategies, are available for this purpose. In cell-homing-based regenerative strategies, the patient’s endogenous cells undertake tissue repair/regeneration, whereas a cell-based regenerative strategy requires exogenous stem cells to achieve dental pulp regeneration. Clinically, a cell-homing-based regenerative strategy, pulp revascularisation/revitalisation, has been successfully applied in immature permanent teeth with an open apex; however, there is no evidence of new innervation, new dentine deposition or neovascularisation after the procedure. In addition, pulp revascularisation/revitalisation procedures rarely achieve an extension in root length. Although pulp revascularisation treatment cannot be considered as well-controlled tissue regeneration, this procedure has advantages compared with the traditional apexification procedure, which takes more time to establish the dentine/bone tissues at the apex. This chapter describes recent approaches for the cell-homing-based regenerative strategy and identifies the potential improvements possible in pulp revascularisation/revitalisation procedures in the clinic.