A Retrospective Case Series in Regenerative Endodontics: Trend Analysis Based on Clinical Evaluation and 2-and 3-dimensional Radiology

Introduction: A regenerative endodontic procedure (REP) is a biologically based treatment to functionally replace the pulp of infected immature permanent teeth. The purpose of this retrospective case series was to assess the outcome of REPs of infected immature permanent teeth in terms of periapical bone healing (PBH), root development (RD), and pulp vitality. Methods: Five patients (1 tooth/patient) who had undergone a REP based on the cell homing concept were recalled 3, 6, 12, 24, and 36 months postoperatively. At each recall session, clinical and periapical radiographic (PR) investigations were performed. Cone beam computed tomographic (CBCT) imaging was taken before and 36 months after REPs. Qualitative and quantitative PR assessments were performed on the teeth that underwent REPs. Quantitative CBCT analyses were performed on the teeth that underwent REP and contralateral teeth. Results: At each recall session, all teeth were asymptomatic but reacted negatively on carbon dioxide snow and electrical pulp testing. All teeth that underwent a REP showed complete PBH and further RD on PR and CBCT assessments when comparing the baseline with the final recall radiographs. CBCT analyses indicated increases in root hard tissue volume and RL for all teeth that underwent a REP, but they were 5 and 3 times less, respectively, than the contralateral teeth. The postoperative CBCT images presented bone ingrowth inside the root canal, calcification, or nonuniform RD. Conclusions: Thirty-six months after the REPs (based on the cell homing concept), this RCS resulted radiographically and clinically in functional and asymptomatic teeth with complete PBH and continued reparative RD. CBCT quantitative measurements and qualitative root development observations are more reliable and accurate than PR analysis.