A Novel In-Situ Lateral Neuro-Lymphangiogenic Perforation Approach to Overcome Compartment Syndrome in Regenerative Endodontics: A Hypothesized Model of Super-Defensive Pulp

This medical hypothesis introduces a novel bio-intelligent tissue engineering framework in regenerative endodontics: the In-Situ Lateral Neuro-Lymphangiogenic Perforation Approach. Current regenerative procedures are restricted by vertical revascularization via the apical foramen, leaving the pulp vulnerable to compartment syndrome and total ischemic necrosis during severe bacterial infections due to the lack of an efficient lymphatic drainage system within the rigid dentin chamber. We hypothesize that establishing a horizontal microvascular triad network (artery, vein, and lymphatics) through a micro-window 3 mm apical to the cemento-enamel junction can regulate intratissue hydrostatic pressure. Supported by a sustained-release hydrogel containing specific growth factors (VEGF, VEGF-C, bFGF, NGF) and molecular antiresorptive shields, this model creates a super-defensive pulp. Upon aggressive bacterial contamination, this engineered tissue is hypothesized to resist total necrosis by forming a hyper-calcified tertiary dentin barrier, allowing routine restorative dental interventions instead of conventional root canal treatments.