Regenerative Endodontic Therapies for Immature Permanent Teeth With Pulp Necrosis: A Review of Biological Foundations, Clinical Outcomes, and Future Frontiers.

Regenerative endodontics is a very promising biological alternative to root canal treatments because it primarily aims to restore the living pulp-dentin complex instead of just disinfecting and sealing the canal. Current evidence in the field points toward support for symptom relief, periapical healing, continued root development, and apical closure, especially in immature and necrotic teeth. Its core strategies include revascularization, biomaterials, and cell-free methods (exosomes and secretomes). Future directions will most likely have to depend on the improvement of biomaterials, more precise and personalized treatment planning, broader access to stem cells, and stronger translation of research. However, the field's progress continues to be hindered by barriers such as protocol variability, technique sensitivity, infection control, cost, and limited long-term evidence. As a result, regenerative endodontic therapy should be understood as clinically promising but not yet fully standardized or completely reliable.