Regenerative endodontic therapy – What is it?

Regenerative endodontic therapy (RET) is the accessing of a necrotic immature tooth with the goal of allowing it to mature. While success rates are very high, apical closure and root development are inconsistent. Meta-analysis Tong JOE 2017

Regenerative endodontic therapy requirements for the revitalization of a necrotic immature tooth.

• Tooth must be necrotic pulp with immature apex
• Minimal to no dentinal manipulation
• Place intracanal medicament (usually triple antibiotic) DAP better cause no stain of minocycline (metronidazole and ciprofloxacin) Sabrah 2013
• mTAP (modified TAP) ciprofloxacin, metronidazole, cefaclor Thibodea 2007 Jan/Feb Ped Dent. Showed no stain but Akcay 2014 JOE said did.  Akcay said only DAP=no stain
• Seal

The color of teeth after 3 weeks according to the groups: (A) control group, (B) calcium hydroxide, (C) DAP, (D) TAP with minocycline, (E) with doxycycline, (F) with amoxicillin, and (G) with cefaclor.

Step by step for regenerative endodontic therapy with ADA dental codes

May be able to do everything in one step according to Cerqueira-Neto JOE 2021.

Step 1 Code 3351 Debride without dentinal wall manipulation and irrigate with 1.25%-3% NaOCl, place triple antibiotic, and seal.

Interim step if needed 3552 Repeat step 1

Step 2 3354 pulpal regeneration Remove medicine with 1.25%-3% NaOCL, EDTA (CA?) then phosphate buffered saline Aksel JOE 2020, create blood clot, place PRF, seal MTA and filling.  Do not use vasoconstrictor. PRF not shown to be helpful Rahul JOE 2023

Ref 1

Failure of RET

The failure of RET can be treated in multiple ways. Chaniotis JOE 2017

Regenerative endodontic therapy research

10% citric acid could give a better biological response than EDTA according to Ivica 2019 JOE.