Regenerative Endodontics: Regeneration or Repair?

As substitutes to endodontic treatments, since many years biodentistry implicates pulp capping with Ca(OH)2 and/or some molecules of the extracellular matrix (ECM). Pulp cells are committed. They proliferate and differentiate, two successive processes leading to the repair and regeneration of a pulp exposure. Specifically, reactionary and reparative dentins lead to the formation and thickening of dentinal bridges, enhancing the residual dentin thickness to the detriment of the pulp volume. In case of more severe decay of the pulp, repair and regeneration result from the formation of a dense ECM, which will further underwent mineralization after the reduction of the inflammatory process, revascularization, and nerve sprouting. In some conditions, in the coronal part or in the apical part of the pulp, endogenous cells that are still present may proliferate and reconstitute a fibrous but sound conventional tissue. In case of severe infection, the removal of the wounded tissue may be followed by the implantation of a scaffold within the root and/or pulp chamber. Combined with pulp stem cells or not, these approaches may contribute (1) to endodontic soft tissue regeneration and (2) followed by an artificial pulp mineralization, filling all the empty pulp spaces. These biological approaches may pave the way for the future for endodontic treatments.