Regenerative Endodontics in Children: Current Evidence, Challenges, and Future Directions

The management of immature permanent teeth with necrotic pulps presents a significant challenge in paediatric endodontics, due to incomplete root formation, thin dentinal walls, and vulnerability to fracture. Traditional methods (e.g., apexification) promote apical closure but do not restore the functional pulp–dentin complex or allow for continued root maturation. Regenerative endodontic procedures (REPs) represent a paradigm-shift, aiming to biologically regenerate pulpal tissue, reestablish the pulp–dentin complex, and promote root development. This review critically examines the current evidence for REPs in children, discusses the biological basis and clinical protocols, highlights specific issues in the paediatric population, identifies current limitations and challenges, and outlines future directions. Although REPs demonstrate promising clinical and radiographic outcomes (resolution of apical periodontitis, increased root length and width), histologic evidence of true pulp– dentin regeneration remains limited. Standardised protocols, outcome definitions, longer-term follow‐up data, and translational research are needed before REPs can be considered as routine therapy in paediatric endodontics.