Regenerative Root Canal Treatment of Immature Teeth Using Omega-3 Fatty Acids

Immature permanent teeth with pulp necrosis have thin, fragile dentinal walls, making conventional endodontic sealing techniques challenging. Regenerative endodontics (RE) offers a biologically based alternative that enables continued root development, apical closure, and potential restoration of vitality through approaches such as tissue engineering and revascularization. These procedures rely heavily on the survival and differentiation of stem cells from the apical papilla, even in the presence of infection.

Inflammation plays a pivotal role in RE, influencing both healing and regenerative outcomes. Specialized pro-resolving mediators (SPMs), derived from omega-3 and omega-6 fatty acids, actively resolve inflammation and promote tissue regeneration. Among them, Resolvin E1 (RvE1), derived from EPA, has shown potent anti-inflammatory and pro-regenerative effects, including inhibition of leukocyte infiltration and enhancement of dental pulp stem cell recruitment. Experimental studies demonstrated that intracanal RvE1 reduced periapical inflammation and promoted root development more effectively than traditional intracanal medicaments.

Omega-3 polyunsaturated fatty acids (ω-3 PUFAs), particularly EPA and DHA, have been widely studied in dentistry for their anti-inflammatory and regenerative properties. Evidence from animal studies and clinical trials indicates that ω-3 PUFAs reduce inflammatory mediators, suppress bone resorption, enhance new bone formation, and support stem cell proliferation and differentiation, even under inflammatory conditions. Clinically, ω-3 PUFAs have shown benefits in periodontal therapy, oral mucositis, and other inflammatory oral diseases.

Despite these promising findings, clinical evidence supporting the use of ω-3 PUFAs in endodontics remains limited. Further research is needed to evaluate their role in regenerative endodontic procedures, particularly in necrotic immature teeth where mechanical disinfection is restricted and preservation of apical stem cells is critical. The proposed hypothesis is that ω-3 PUFAs may enhance regenerative endodontic outcomes by modulating inflammation and supporting tissue regeneration.

Inclusion criteria

• Patients aged between 6 and 28 years.
• Systemically healthy patients with no history of systemic diseases.
• Patients with necrotic immature permanent teeth due to trauma and/or caries.
• Preoperative radiographic evidence of incomplete root formation.
• Wide apical foramen (apical diameter ≥ 1 mm).
• Thin dentinal walls on preoperative radiographs.

Exclusion criteria

• Patients with known allergy to any of the drugs used in the study.
• Patients with systemic diseases or medically compromised conditions.
• Grossly decayed or fractured teeth requiring post and core restorations.
• Presence of draining sinus tract.
• Presence of periodontal pockets.
• Radiographic evidence of external or internal root resorption.
• Patients with a history of major surgeries (e.g., cardiac surgery, kidney transplantation).
• Patients undergoing hemodialysis.