1Consultant endodontist, General Department of Medical Services in Presidency of State Security, Riyadh, Saudi Arabia. BDS, SSC - endo
2AEGD, McDPH, Ministry of Interior, Riyadh, Saudi Arabia
3Consultant Endodontics, Prince Naif Security Campus, Riyadh, Saudi Arabia. BDS, SBE
4Consultant in Endodontics, Presidency of State Security, Riyadh, Saudi Arabia. BDS, SBE
Regenerative endodontic therapy (RET) is a biologically based treatment modality for immature permanent teeth with necrotic pulp and incomplete root formation, developed to overcome the limitations of apexification, which does not restore pulp vitality or predictably support further root maturation. RET is founded on tissue-engineering principles involving stem cells, scaffolds, growth factors, and a disinfected canal environment. Among these, local drug delivery is a central component, as intracanal irrigants, medicaments, and scaffold-associated bioactive systems directly influence disinfection, stem cell survival, and regenerative outcomes. This review summarizes current concepts in regenerative endodontics with emphasis on intracanal drug delivery and biomimetic scaffold design. It outlines the biologic rationale of RET, recommended clinical protocols, case selection criteria, and treatment outcomes, while highlighting the role of low-concentration sodium hypochlorite, EDTA, calcium hydroxide, and antibiotic pastes in achieving canal disinfection with minimal toxicity to apical stem cells. The review also discusses scaffold-based strategies, including blood clot, platelet-rich derivatives, collagen, hydrogel, and other bioengineered matrices, as well as emerging delivery platforms such as antibiotic-loaded nanofibers and patient-specific three-dimensional constructs. Available evidence indicates that RET achieves favorable rates of symptom resolution and periapical healing, although continued root development, canal wall thickening, and true pulp–dentin complex regeneration remain variable and less predictable. Current limitations include discoloration, intracanal calcification, reinfection, and inconsistent histologic outcomes. Nevertheless, advances in scaffold technology, local therapeutic delivery, stem cell transplantation, and cell-homing approaches continue to expand the regenerative potential of endodontic therapy. RET therefore represents a promising intersection of endodontics, biomaterials, and localized drug-delivery science with growing translational relevance.
Keywords: Regenerative endodontics; Regenerative endodontic therapy; Intracanal drug delivery; Scaffolds; Stem cells; Growth factors; Immature necrotic teeth; Biomimetic materials; Tissue engineering; Root maturation
How to cite this article: Alabdulsalam ZM, Alwazzan RA, Almazrou YM, AlBihlal AS. Local Drug Delivery Approaches in Regenerative Endodontics: Intracanal Medicaments, Biomimetic Scaffolds, and Emerging Clinical Strategies. Int J Drug Deliv Technol. 2026;16(11s): 901-915. DOI: 10.25258/ijddt.16.11s.90
Source of support: Nil.
Conflict of interest: None