Regeneration of the pulp-dentin complex in mature teeth using autologous demineralized dentin matrix and dental pulp stem cells: two case reports.

backgroundRegenerating the true pulp-dentin complex in mature teeth with necrotic pulps or apical lesions remains challenging, and consistent clinical evidence of dentin bridge formation is limited. This report describes two adult cases treated with regenerative endodontic therapy (RET) using autologous dental pulp stem cells (DPSCs) and demineralized dentin matrix (DDM). CASE PRESENTATION: In Case 1, a 33-year-old woman developed pulp necrosis with apical periodontitis in a maxillary left central incisor following traumatic subluxation. After canal disinfection, autologous DPSCs isolated from her extracted third molar were transplanted into the canal, and DDM particles were placed at the orifice as a capping scaffold. The contralateral traumatized but still vital incisor was monitored as a control. During 52 weeks of follow-up, the treated tooth regained positive pulp sensibility within 1 week, developed a dentin-like bridge exceeding 3 mm at the orifice, and on 52-week MRI showed high-signal pulp-like tissue comparable to adjacent healthy teeth, whereas the untreated control lost vitality and underwent progressive pulp canal obliteration. In Case 2, a 48-year-old man presented with a maxillary left central incisor that had previously undergone root canal treatment and exhibited severe coronal dentin loss beneath an old crown. Orthodontic extrusion was performed to expose sound supragingival dentin, followed by RET with autologous DPSCs and DDM. Sensibility testing was not feasible due to coronal coverage; however, at 48 weeks CBCT demonstrated a well-defined dentin-like bridge extending from beneath the canal orifice into the coronal pulp chamber. In both cases, quantitative CBCT showed progressive increases in mineral density at the regenerated tissue, reaching approximately 75-80% of adjacent native dentin by the final follow-up. No adverse events were observed, and there were no signs of ankylosis, root resorption, or generalized canal obliteration.

conclusionsThese cases suggest that autologous DPSCs combined with DDM can support dentin-like bridge formation and functional recovery in mature incisors, offering a potential biologically based alternative or adjunct to conventional root canal therapy for preserving structurally compromised teeth.