Pulp Regeneration in Necrotic Teeth Based on Functionalized Scaffolds: a Review of Clinical and Experimental Strategies

Purpose of Review: This review aims to summarize the literature about the main concepts related to pulp regeneration in necrotic teeth as well as the functions of each of the elements applied, with special consideration on understanding the functionalization of the different biomaterials used in the scaffold design. Recent Findings: Pulp necrosis, caused by trauma, caries, or periodontal disease, interrupts this tissue's formative, nutritive, reparative, and defense functions, making its regeneration challenging to favor the prognosis of the compromised tooth. Although current regenerative endodontic treatments do not fully regenerate the pulp-dentin complex with its vascular and neuronal components, the functionalization of biomaterials could favor the regeneration of functional pulp-like tissue through the strategy called Cell Homing. Summary: The biomaterials used in pulp regeneration when functionalized with protein or pharmacological molecules have a great influence on the migratory, proliferative and differentiation response of undifferentiated mesenchymal cells residing within the dental and periodontal tissues. The structure and physiology of the pulp tissue are considered challenges in regenerative endodontics. However, the development of strategies based on functionalized bio-scaffolds, promoting cell migration and subsequent cell homing is a promising solution to improve the prognosis of tooth with pulp necrosis.