Pulp revascularization — also called Regenerative Endodontic Procedure (REP) — is a biologically based treatment for immature permanent teeth with pulp necrosis. It aims to complete root development and restore pulp-dentine vitality by inducing bleeding from periapical tissues and allowing stem-cell colonization of a biocompatible scaffold.
- Immature permanent tooth (open apex) with pulp necrosis, with or without apical periodontitis.
- Cooperative patient, compliant follow-up, no extensive root resorption.
- Access, copious irrigation with 1.5% NaOCl (not 5.25% — cytotoxic to stem cells).
- Dry canal. Medicate with triple antibiotic paste (ciprofloxacin / metronidazole / minocycline) or calcium hydroxide. Seal temporarily.
- Confirm asymptomatic status. Remove intracanal medicament.
- Induce apical bleeding by over-instrumenting with a pre-curved #40 hand file 2 mm beyond the apex.
- Wait for blood to rise to the CEJ level — this serves as the scaffold.
- Place a collagen plug over the clot.
- Seal with MTA or bioceramic putty (e.g., BioDentine) — 3–4 mm.
- Final restoration with composite or glass ionomer + composite.
Radiographic review at 6, 12, 18, 24 months. Expect root-wall thickening and apical closure over 12–24 months. Histologic analysis in case reports shows the newly formed tissue is often cementum-like rather than true pulp.