Volume 30, Issue 174, August 2026

Indications and Contraindications for Pulp Revitalization in Mature Permanent Teeth: A Literature Review

Filip Szewczyk^1♦, Amelia Sobanek¹, Erwin Górski¹, Jakub Deptuch¹, Aleksandra Wyciślok¹, Weronika Kubiak¹, Zuzanna Szczerba², Justyna Koziarska³

¹Institute of Dentistry of the Central Clinical Hospital of the Medical University of Łódź, Pomorska 251, 92-213 Łódź, Poland
²Navia Clinic, Dowborczyków 34, 90-019 Łódź, Poland
³Independent Public Healthcare Institution in Tarczyn, Warszawska 42, 05-555 Tarczyn, Poland

^♦Corresponding author
Filip Szewczyk, Institute of Dentistry of the Central Clinical Hospital of the Medical University of Łódź, Pomorska 251, 92-213 Łódź, Poland

ABSTRACT

Evidence suggests that modified disinfection and mechanical enlargement of the apical foramen can facilitate pulp-like tissue ingrowth even in teeth with fully formed roots. In recent years, dentists have used Regenerative Endodontic Procedures (REPs) to restore vitality and neurovascular function of necrotic mature teeth. This study aims to distinguish between clinical conditions that provide predictable outcomes for pulp revitalization/revascularization in mature teeth and those that are deemed unfavourable. By analyzing the current literature, this work seeks to define the practical boundaries of REPs in a clinical setting. Studies found that REPs are indicated for single-rooted teeth, with success rates comparable to those of traditional Root Canal Treatments (RCTs). They are a highly effective alternative in arresting external infection-related resorption (EIRR) and internal infection-related resorption (IIRR). With surgical modifications, it is now possible to achieve revitalization in autotransplanted teeth. In many cases, complex root canal anatomy is a contraindication for regenerative procedures due to the threat of iatrogenic complications during apical preparation. The long-term interaction between revitalized teeth and orthodontic forces is unpredictable. Some evidence suggests a risk of late resorption. Using REPs in mature teeth is a reliable treatment in specific scenarios. It is a predictable treatment for single-rooted teeth and infection-related resorptions. Regenerative endodontics is a rapidly changing field that needs attention from practitioners. Recent advancements show potential, but more studies are required to make this treatment the new standard.

Keywords: pulp revitalization; Regenerative Endodontic Procedures; mature permanent teeth; root resorption; autotransplantation

Medical Science, 2026, 30, e163ms3908

PDF

Published: 25 August 2026