Clinical, Radiographic, and Histologic Outcome of Regenerative Endodontic Treatment in Human Teeth Using a Novel Collagen-hydroxyapatite Scaffold

J Endod. 2019 Feb;45(2):136-143. doi: 10.1016/j.joen.2018.10.012.


Introduction: Histologic examination of teeth after regenerative endodontic treatment (RET) shows that the type, quality, and quantity of tissues formed in the root canal space are not predictable. The aim of this study was to examine clinically, radiographically, and histologically the outcome of RET in immature noninfected human teeth using SynOss Putty (Collagen Matrix Inc, Oakland, NJ) as a scaffold.

Methods: Three pairs of maxillary/mandibular first premolars in 3 patients scheduled for extraction were included. Sensibility tests confirmed the presence of vital pulps. After informed consent, anesthesia, and rubber dam isolation, the pulps were removed. RET was performed using the following scaffolds: SynOss Putty + blood in both teeth in patient #1, SynOss Putty with or without blood in patient #2, and SynOss Putty + blood or blood only in patient #3. After a follow-up period of 2.5-7.5 months, the teeth were clinically and radiographically evaluated, extracted, and examined histologically.

Results: Patients remained asymptomatic after treatment. Radiographic examination of the teeth showed signs of root development after treatment. In teeth treated with SynOss Putty + blood, histologic examination showed formation of intracanal mineralized tissue around the scaffold particles solidifying with newly formed cementumlike tissue on the dentinal walls. The tooth treated with SynOss Putty without blood showed the formation of a periapical lesion. The tooth treated with a blood clot only showed tissues of periodontal origin growing into the root canal space.

Conclusions: SynOss Putty + blood showed a predictable pattern of tissue formation and mineralization when used as a scaffold for RET in human immature noninfected teeth. The newly formed mineralized tissue solidifies with newly formed cementum on the dentinal walls.

Keywords: Immature tooth; SynOss Putty; regenerative endodontic treatment; revascularization; revitalization; scaffold.

MeSH terms

  • Child
  • Collagen*
  • Dental Pulp Cavity / diagnostic imaging
  • Dental Pulp Cavity / physiology*
  • Dentin / diagnostic imaging
  • Dentin / physiology*
  • Durapatite*
  • Female
  • Guided Tissue Regeneration, Periodontal / methods*
  • Humans
  • Male
  • Radiography, Dental*
  • Regeneration*
  • Regenerative Endodontics / methods*
  • Tissue Scaffolds*
  • Tooth Root / diagnostic imaging
  • Tooth Root / physiology*
  • Tooth, Nonvital / diagnostic imaging*
  • Tooth, Nonvital / pathology*
  • Tooth, Nonvital / physiopathology
  • Treatment Outcome


  • Collagen
  • Durapatite