Determinants of regenerative endodontic therapy use among pediatric and endodontic specialists in 13 countries

Abstract

This study aimed to evaluate the factors influencing the adoption and application of regenerative endodontic therapy (RET) among endodontists and pediatric dentists across multiple countries, focusing on demographic, professional, and geographic variability.A cross-sectional survey was conducted with 1394 participants from 13 countries. The survey included demographic information, motivational and demotivational factors, and seven clinical scenarios to assess RET application. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for RET adoption using univariate logistic regression. Meta-analysis was performed to account for heterogeneity.The findings revealed significant variability in RET practices. Immature teeth with apical periodontitis and necrotic pulp had the highest odds of RET application (OR = 21.25, 95% CI 16.43–27.49), while mature teeth with necrotic pulp showed significantly lower odds (OR = 0.11, 95% CI 0.09–0.14). Barriers to RET included insufficient training (25.8%), patient disapproval (17.1%), and concerns over unconvincing results (15.9%). Endodontists were more likely to perform RET than pediatric dentists (OR = 2.11 vs. OR = 1.33), and younger practitioners demonstrated higher adoption rates. Countries like Turkey and Yemen exhibited the highest RET application rates, whereas Serbia and Poland reported minimal adoption.Despite the well-documented biological advantages of RET, its broader adoption is hindered by gaps in training, knowledge, and systemic support. Addressing these barriers through targeted educational initiatives and policy integration can enhance the global implementation of RET, optimizing patient outcomes and advancing endodontic practice.