Revascularization is a biologically based option for immature permanent teeth with pulp necrosis, aiming to disinfect the canal and let root development continue. Outcomes are variable and true pulp regeneration is generally not achieved, so case selection and honest expectations matter.
Last updated: July 5, 2026
Revascularization is generally considered for an immature permanent tooth whose pulp has died before the root finished forming. The aim is to disinfect the canal and encourage the tooth's own tissues to continue building the root.
The most established indication is a permanent tooth with a necrotic pulp and an open apex from incomplete root formation, where continued root development would still be valuable.
Evidence
The less mature the root, the more there is to gain from continued development. Staging the root against the Cvek description helps weigh a regenerative approach against a barrier technique.
Evidence
Because outcomes appear over months to years, an agreed follow-up schedule and a patient or family able to attend reviews are part of sensible case selection.
Evidence
A tooth with near-complete or complete root formation may be better served by conventional root canal treatment or an MTA apical barrier, since there is little further root growth to pursue.
Evidence
For an immature necrotic tooth the main options are a regenerative (revascularization) approach, apexification, and an MTA apical barrier. The choice turns on how much root growth remains to be gained, restorability, and the follow-up that is realistic.
Scenario
Often favored
A regenerative approach is often weighed to pursue continued root development.
Evidence note
A systematic review found regenerative treatment and an MTA apical plug had comparable pooled survival and success, with no significant difference.
Scenario
Often favored
Conventional root canal treatment or an MTA apical barrier may be more suitable.
Evidence note
With little further root growth to gain, the added value of a regenerative approach is smaller.
Scenario
Often favored
Apexification with an MTA or bioceramic barrier may be considered.
Evidence note
Apexification does not induce continued root maturation, so the thin root can remain more susceptible to fracture.
Scenario
Often favored
Extraction with a replacement plan may be discussed.
Evidence note
Restorability and the ability to review the tooth strongly shape which option is reasonable.
Revascularization is carried out by a trained clinician, usually across at least two visits. The outline below explains the sequence; it is not an operative protocol, and details vary between published protocols.
An immature permanent tooth with a necrotic pulp is confirmed, and the variable outcomes and the possibility of crown discolouration are discussed with the patient or family.
Under rubber dam, the canal is accessed with minimal or no mechanical instrumentation to preserve the thin dentinal walls, then irrigated gently with lower-concentration sodium hypochlorite followed by saline.
A low-concentration antibiotic paste (double or triple) or calcium hydroxide is placed to disinfect the canal, and the access is sealed for a few weeks.
Once symptoms have settled, the medicament is rinsed out and EDTA is used to help expose dentine-derived growth factors.
Bleeding is evoked from the periapical tissues to fill the canal with a blood clot, or a platelet-rich fibrin or plasma scaffold is used in its place.
A bioceramic or MTA barrier is placed over the scaffold and covered with a well-sealed restoration to protect the healing tissue.
Clinical and radiographic reviews over months to years look for resolution of signs, continued root development, and any return of sensibility.
Access, minimal instrumentation, gentle lower-concentration irrigation, and an intracanal medicament left in place for a few weeks.
Medicament removal, EDTA rinse, induced bleeding or a platelet scaffold, and a bioceramic or MTA coronal seal with a definitive restoration.
Evidence
The scaffold supports the tissue that grows into the canal, and the disinfection materials aim to clean the canal while sparing the cells that make regeneration possible.
Discolouration and consent
Triple antibiotic paste has been associated with crown discolouration: minocycline is the most commonly implicated cause, but in the same laboratory comparison other antibiotic formulations also discoloured the crown, while double antibiotic paste — which omits minocycline — and calcium hydroxide showed no perceptible colour change. Because discolouration and the prospect of extra appointments matter to patients and families, they are usually discussed as part of consent.
Reported outcomes come from case reports, case series, cohort studies and a smaller number of randomized trials, so they describe typical patterns rather than a guarantee for one tooth.
Success is usually judged on three variable outcomes: resolution of signs and symptoms, continued root development in length and dentine-wall thickness, and, less predictably, some return of sensibility.
True regeneration of the pulp-dentine complex is generally not achieved; histological studies show healing that is largely repair derived from periodontal and osseous tissues.
In a systematic review and meta-analysis, regenerative treatment and an MTA apical plug had comparable pooled survival, around 98 and 97 percent, and success, around 91 and 95 percent, with no significant difference and a low overall level of evidence.
Factors that shape the result
Regenerative outcomes develop slowly, so scheduled review is part of the plan.
New swelling, a sinus tract, increasing pain, or radiographic breakdown warrants reassessment and a change of plan rather than continued waiting.
The evidence base for regenerative endodontics has grown quickly, but it still carries limitations that shape how confidently a single result can be predicted.
What is regenerative endodontics?
Short answer
It is a biologically based approach — also called revascularization or revitalization — for immature permanent teeth with a necrotic pulp.
Which teeth are suitable?
Short answer
It is generally considered for immature permanent teeth with pulp necrosis and incomplete root formation.
Does it truly regenerate the pulp?
Short answer
Usually not in the strict sense.
How does it compare with apexification?
Short answer
A systematic review found regenerative treatment and an MTA apical plug had comparable survival and success, with no significant difference and low-certainty evidence.
Can the tooth change colour?
Short answer
It can.
How many appointments are involved?
Short answer
Most protocols use at least two visits — one to disinfect and medicate the canal and another to induce bleeding and place a coronal seal — followed by review over months.
What causes an immature tooth to need this?
Short answer
A common cause is dental trauma, such as luxation or avulsion, which can lead to pulp necrosis before the root has finished forming.
This guide is educational decision-support and cannot replace a clinical examination. Regenerative endodontic procedures are planned and carried out by a trained clinician; the outline here is an overview of an evolving, variable-outcome treatment and is not an operative protocol or a substitute for in-person assessment.
Reviewed by
Dr. Levent Yuksel
DDS · Endodontist
Independently authored and clinically reviewed.