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Alshahhoud A, Rikab MS, Issa N, Manadili A, Alsayed Tolaibah Y. A Comparison Between Three Types of Scaffolds for Pulp Regeneration: A Histological Study on Dogs. Clin Exp Dent Res 2024; 10:e70031. [PMID: 39444253 PMCID: PMC11499569 DOI: 10.1002/cre2.70031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 10/06/2024] [Accepted: 10/08/2024] [Indexed: 10/25/2024] Open
Abstract
OBJECTIVES This study aims to compare the application of three types of normal scaffolds-native chitosan, enzymatically modified chitosan, and blood clot (BC)-on pulp regeneration in the teeth of experimental dogs through histological examination, to determine the quantity and type of new tissues formed within the root canal. MATERIALS AND METHODS The research sample consisted of 32 root canals from 20 premolars of two male local experimental dogs. The sample was randomly divided into a control group, in which no intervention was performed on the teeth, and three experimental groups based on the type of scaffold used: the BC group, the native chitosan combined with BC (NCS + BC) group, and the enzymatically modified chitosan combined with BC (EMCS + BC) group. Mechanical and chemical cleaning of the canals was performed, followed by the application of the studied scaffolds within the root canals. After 3 months, the teeth were extracted and prepared for histological study, where two variables were studied: the percentage of total vital tissue (soft and hard; VT%) and the percentage of soft vital tissue only (ST%). A one-way ANOVA and Bonferroni tests were used to determine significant differences between the groups at a 95% confidence level. RESULTS The VT% values were significantly higher in the EMCS + BC group compared to both the NCS + BC and BC groups. The ST% values were also significantly higher in the EMCS + BC group compared to the BC group. However, no significant differences in ST% values were observed between the NCS + BC group and either the BC or EMCS + BC groups. CONCLUSIONS Within the limitations of this study, we conclude that the application of enzymatically modified chitosan scaffolds combined with BC yields superior results in pulp regeneration, which contributes to the formation of pulp-like tissue and cells resembling odontoblasts, as well as apex closure with tissue resembling bone tissue.
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Affiliation(s)
- Aliaa Alshahhoud
- Department of Endodontics and Operative Dentistry, Faculty of DentistryDamascus UniversityDamascusSyria
| | - Mhd. Salem Rikab
- Department of Endodontics and Operative Dentistry, Faculty of DentistryDamascus UniversityDamascusSyria
| | - Nizar Issa
- Department of Biology, Faculty of ScienceDamascus UniversityDamascusSyria
| | - Ahmad Manadili
- Department of Pathology, Faculty of DentistryDamascus UniversityDamascusSyria
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Kaur K, Varghese E, Eswara U, Goh Pei En J. Histologic and radiological observations of a human immature premolar with pulp necrosis treated with regenerative endodontic procedure - A case report of a four-year follow-up. Saudi Dent J 2023; 35:869-875. [PMID: 38025601 PMCID: PMC10658369 DOI: 10.1016/j.sdentj.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 12/01/2023] Open
Abstract
Background Reports are found on long-term radiographic follow-up of teeth treated with regenerative endodontic techniques, but scarce literature is observed regarding the tissue formed in the root canal. A four-year radiographic follow-up with histologic findings in an immature mandibular premolar with dens evaginatus that underwent a regenerative endodontic procedure (REP) is presented here. After four years following REP, the tooth was extracted for orthodontic purposes thereby presenting an opportunity to report the histologic findings. Summary The radiographic changes included a slight root lengthening and thickening and apex closure. Histologic evaluation revealed a fibrous connective tissue with an inflammatory infiltrate in the canal space. In the apical region, cementum-like irregular mineralization developed toward the center, giving the appearance of a closed apex. Root thickening, increase in length, and radiographic closure of the apex occurred due to cemental hyperplasia. Conclusion After 4 years following REP in an immature mandibular premolar with apical periodontitis, granulation tissue had formed in the root canal, indicating repair and not regeneration.
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Affiliation(s)
- Kanwardeep Kaur
- Faculty of Dentistry, Manipal University College Malaysia, Jalan Batu Hampar, Bukit Baru, Melaka 75150, Malaysia
| | - Eby Varghese
- Department of Pediatric Dentistry, Faculty of Dentistry, Manipal University College Malaysia, Jalan Batu Hampar, Bukit Baru, Melaka 75150, Malaysia
| | - Uma Eswara
- Department of Pediatric Dentistry, Faculty of Dentistry, Manipal University College Malaysia, Jalan Batu Hampar, Bukit Baru, Melaka 75150, Malaysia
| | - Joanne Goh Pei En
- Department of Oral and Maxillofacial Clinical Science, Faculty of Dentistry, University of Malaya, Malaysia
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Kwon SK, Kyeong M, Adasooriya D, Cho SW, Jung IY. Histologic and Electron Microscopic Characterization of a Human Immature Permanent Premolar with Chronic Apical Abscess 16 years after Regenerative Endodontic Procedures. J Endod 2023:S0099-2399(23)00289-3. [PMID: 37268290 DOI: 10.1016/j.joen.2023.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/24/2023] [Accepted: 05/24/2023] [Indexed: 06/04/2023]
Abstract
Previous studies have reported successful clinical outcomes after regenerative endodontic procedures (REPs) for immature permanent teeth with pulpal infection. However, it remains unclear whether the procedures promote true regeneration or repair. This case report describes the histologic and electron microscopic characteristics of a human immature permanent premolar with a chronic apical abscess that was treated with an REP. Tooth #20 of a 9-year-old girl underwent an REP. At the 6-year follow-up, the patient was asymptomatic, and closure of the apex and thickening of the dentinal walls were observed. However, 16 years after the procedure, apical periodontitis recurred, necessitating apical surgery. The resected root fragments were obtained during the surgery and analyzed using micro-computed tomography, light microscopy, and scanning electron microscopy. Distinct dentinal tubules and interglobular dentin were observed in the regenerated hard tissue. Cementum-like tissue and a root canal were also observed in the apical fragment. The regenerated root tissue in this case exhibited a structure similar to the native root structure. Therefore, we believe that cell-free REPs possess regenerative potential for teeth diagnosed with pulp necrosis and chronic apical abscess.
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Affiliation(s)
- Seung-Kyung Kwon
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea
| | - Minjae Kyeong
- Division of Anatomy and Developmental Biology, Department of Oral biology, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, Korea
| | - Dinuka Adasooriya
- Division of Anatomy and Developmental Biology, Department of Oral biology, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, Korea
| | - Sung-Won Cho
- Division of Anatomy and Developmental Biology, Department of Oral biology, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, Korea
| | - Il-Young Jung
- Professor, Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea.
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Chung CS, Wei YF, Lin LS. Submucosal Injection of Activated Platelet-Rich Plasma for Treatment of Periodontal Disease in Dogs. J Vet Dent 2023; 40:19-27. [PMID: 36131537 DOI: 10.1177/08987564221124165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Periodontal disease is the most common oral disease seen in dogs, and its routine treatment usually involves dental scaling. Platelet-rich plasma (PRP) therapy may enhance the effectiveness of treatment of periodontal disease, delay the progression of the disease and decrease the time under anesthesia. However, its application in dogs is rarely discussed. The objective of this study was to evaluate the benefits of activated PRP for treatment of periodontal disease in dogs. 43 mL of whole blood was collected from six adult dogs and PRP extracted using the double centrifugation tube method. Subsequently, the PRP was activated using calcium chloride (A-PRP). Significantly elevated concentrations of PDGF-BB (7000.28 pg/mL), TGF-β (378.98 pg/mL), and VEGF (7.14 pg/mL) were detected in the A-PRP. Additionally, three of the dogs with stage 2-3 periodontal disease were enrolled in the clinical trial. Periodontal pocket depth, stage of periodontal disease, gingival index, horizontal bone loss, and alveolar bone density involving the maxillary third and fourth premolar and first molar teeth (107, 108, 109, 207, 208, and 209) were evaluated. Teeth were treated by dental scaling alone (control group) or by dental scaling followed by submucosal injection of 0.1 mL A-PRP per site. After 56 days, significant improvement in periodontal pocket depth, stage of periodontal disease, gingival index, and horizontal bone loss was observed in dogs injected with A-PRP. The high concentrations of growth factors in A-PRP likely contributed to this effect. The use of submucosal injections of A-PRP to treat canine stage 2-3 periodontal disease appears safe and effective for clinical practice.
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Affiliation(s)
- Cheng-Shu Chung
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung, Taiwan.,Division of Small Anival Surgery, Veterinary Medical Teaching Hospital, National Pingtung University of Science and Technology, Pingtung, Taiwan
| | - Yi-Fang Wei
- Division of Small Anival Surgery, Veterinary Medical Teaching Hospital, National Pingtung University of Science and Technology, Pingtung, Taiwan
| | - Lee-Shuan Lin
- Laboratory of Veterinary Diagnostic Imaging, Department of Veterinary Medicine, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung, Taiwan.,Division of Diagnostic Imaging, Veterinary Medical Teaching Hospital, National Pingtung University of Science and Technology, Pingtung, Taiwan.,School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Imaging and Radiological Sciences, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
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5
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Kumar N, Maher N, Amin F, Ghabbani H, Zafar MS, Rodríguez-Lozano FJ, Oñate-Sánchez RE. Biomimetic Approaches in Clinical Endodontics. Biomimetics (Basel) 2022; 7:biomimetics7040229. [PMID: 36546929 PMCID: PMC9775094 DOI: 10.3390/biomimetics7040229] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/19/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022] Open
Abstract
In the last few decades, biomimetic concepts have been widely adopted in various biomedical fields, including clinical dentistry. Endodontics is an important sub-branch of dentistry which deals with the different conditions of pulp to prevent tooth loss. Traditionally, common procedures, namely pulp capping, root canal treatment, apexification, and apexigonesis, have been considered for the treatment of different pulp conditions using selected materials. However, clinically to regenerate dental pulp, tissue engineering has been advocated as a feasible approach. Currently, new trends are emerging in terms of regenerative endodontics which have led to the replacement of diseased and non-vital teeth into the functional and healthy dentine-pulp complex. Root- canal therapy is the standard management option when dental pulp is damaged irreversibly. This treatment modality involves soft-tissue removal and then filling that gap through the obturation technique with a synthetic material. The formation of tubular dentine and pulp-like tissue formation occurs when stem cells are transplanted into the root canal with an appropriate scaffold material. To sum up tissue engineering approach includes three components: (1) scaffold, (2) differentiation, growth, and factors, and (3) the recruitment of stem cells within the pulp or from the periapical region. The aim of this paper is to thoroughly review and discuss various pulp-regenerative approaches and materials used in regenerative endodontics which may highlight the current trends and future research prospects in this particular area.
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Affiliation(s)
- Naresh Kumar
- Department of Science of Dental Materials, Dr. Ishrat Ul Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi 74200, Pakistan
- Correspondence: ; Tel.: +92-333-2818500
| | - Nazrah Maher
- Department of Science of Dental Materials, Dr. Ishrat Ul Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi 74200, Pakistan
| | - Faiza Amin
- Department of Science of Dental Materials, Dow Dental College, Dow University of Health Sciences, Karachi 74200, Pakistan
| | - Hani Ghabbani
- Department of Restorative Dentistry, College of Dentistry, Taibah University, Al Madinah, Al Munawwarah 41311, Saudi Arabia
| | - Muhammad Sohail Zafar
- Department of Restorative Dentistry, College of Dentistry, Taibah University, Al Madinah, Al Munawwarah 41311, Saudi Arabia
- Department of Dental Materials, Islamic International Dental College, Riphah International University, Islamabad 44000, Pakistan
| | | | - Ricardo E. Oñate-Sánchez
- Department of Special Care in Dentistry, Hospital Morales Meseguer, IMIB-Arrixaca, University of Murcia, 30008 Murcia, Spain
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6
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Tirez E, Pedano MS. Regeneration of the Pulp Tissue: Cell Homing versus Cell Transplantation Approach: A Systematic Review. MATERIALS (BASEL, SWITZERLAND) 2022; 15:8603. [PMID: 36500098 PMCID: PMC9736993 DOI: 10.3390/ma15238603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/19/2022] [Accepted: 11/23/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The main objective of this systematic review was to compare the apical healing, root maturation and histological characteristics of teeth treated with cell-based versus cell-free techniques. METHODS The methodology of this review was based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A literature search strategy was carried out on PubMed, EMBASE and the Web of Science databases. The last search was done on 1 August 2021. Articles written in languages other than English were excluded. Two researchers independently selected the studies and extracted the data. As no randomized clinical trials were available, animal studies were included. RESULTS In total, 26 studies were included in the systematic review: 22 articles only researched the cell-free technique, 3 articles compared the cell-based to the cell-free technique, and 1 article compared the cell-based technique to apexification. In terms of apical healing, qualitative analysis of the data suggested that there seems to be no significant difference between cell-free and cell-based techniques. The results regarding tooth maturation are contradictory. The main difference between the cell-free and the cell-based techniques seems to be the histology of the treated tooth. The cell-free technique seems to result in cementum-like, bone-like or periodontal ligament-like tissue. One study, on the other hand, found that the cell-based technique resulted in regeneration of the whole pulp with an odontoblast layer, connective tissue, blood vessels and neuronal tissue. CONCLUSIONS Currently, the number of randomized clinical trials on this topic are very scarce. This is probably due to the limited infrastructure and lack of resources to apply the cell-based technique. Even though both techniques seem to be promising for clinical application, long-term data need to be provided regarding the healing and reparative patterns.
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Vidán-Estévez J, Escalante-Barrigón F, Sánchez-Herráez S, Seco-Calvo J. Platelet-derived growth factors from a single donor by apheresis and one freeze-thaw cycle for treating medication-related osteonecrosis of the jaw. Regen Med 2022; 17:915-929. [PMID: 36169261 DOI: 10.2217/rme-2022-0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Aim: To assess whether the use of allogeneic platelet-derived growth factors could serve as a feasible, effective and safe biological therapy for the treatment of medication-related osteonecrosis of the jaw (MRONJ). Materials & methods: Patients with multiple myeloma and MRONJ were included and treated with allogeneic platelet-rich plasma, continued for between 6 and 18 weeks (mean: 9). Results: We observed a treatment success rate of 87.5% (p < 0.05). Assessing the association between healing and treatment duration, we observed a statistically significant relationship (χ2 = 8.00; p = 0.018; Cramer's V = 1), confirming that healing was very closely related to the duration of the treatment. Conclusion: Allogeneic platelet-rich plasma could be a recommended treatment for MRONJ. Future research with a large sample to validate our findings is required.
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Affiliation(s)
- Julia Vidán-Estévez
- Transfusion, Hematology & Hemotherapy Unit, Complejo Asistencial Universitario de León (CAULE), León, 24071, Spain
| | - Fernando Escalante-Barrigón
- Transfusion, Hematology & Hemotherapy Unit, Complejo Asistencial Universitario de León (CAULE), León, 24071, Spain
| | - Sergio Sánchez-Herráez
- Department of Traumatology & Orthopedic Surgery, Complejo Asistencial Universitario de León (CAULE), León, 24071, Spain
| | - Jesús Seco-Calvo
- Department of Physical Therapy, Institute of Biomedicine (IBIOMED), University of León, León, 24071, Spain.,Visiting Professor & Researcher of Department of Physiology, University of the Basque Country, Leioa, 48940, Spain
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8
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Noohi P, Abdekhodaie MJ, Nekoofar MH, Galler KM, Dummer PMH. Advances in Scaffolds Used for Pulp-Dentine Complex Tissue Engineering - A Narrative Review. Int Endod J 2022; 55:1277-1316. [PMID: 36039729 DOI: 10.1111/iej.13826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/28/2022] [Accepted: 08/10/2022] [Indexed: 11/27/2022]
Abstract
Pulp necrosis in immature teeth disrupts root development and predisposes roots to fracture as a consequence of their thin walls and open apices. Regenerative endodontics is a developing treatment modality whereby necrotic pulps are replaced with newly formed healthy tissue inside the root canal. Many clinical studies have demonstrated the potential of this strategy to stimulate root maturation and apical root-end closure. However, clinical outcomes are patient-dependent and unpredictable. The development of predictable clinical protocols is achieved through the interplay of the three classical elements of tissue engineering, namely, stem cells, signaling molecules, and scaffolds. Scaffolds provide structural support for cells to adhere and proliferate and also regulate cell differentiation and metabolism. Hence, designing and fabricating an appropriate scaffold is a crucial step in tissue engineering. In this review, four main classes of scaffolds used to engineer pulp-dentine complexes, including bioceramic-based scaffolds, synthetic polymer-based scaffolds, natural polymer-based scaffolds, and composite scaffolds, are covered. Additionally, recent advances in the design, fabrication, and application of such scaffolds are analysed along with their advantages and limitations. Finally, the importance of vascular network establishment in the success of pulp-dentine complex regeneration and strategies used to create scaffolds to address this challenge are discussed.
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Affiliation(s)
- Parisa Noohi
- Department of Chemical and Petroleum Engineering, Sharif University of Technology, Tehran, Iran
| | - Mohammad J Abdekhodaie
- Department of Chemical and Petroleum Engineering, Sharif University of Technology, Tehran, Iran
| | - Mohammad H Nekoofar
- Department of Endodontics, School of Dentistry, Tehran University of Medical Sciences Tehran University of Medical Sciences, Tehran, Iran.,Department of Tissue Engineering, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Department of Endodontic, Bahçeşehir University School of Dentistry, Istanbul, Turkey
| | - Kerstin M Galler
- Department of Conservative Dentistry and Periodontology, University Hospital Erlangen-Nürnberg, Erlangen, Germany
| | - Paul M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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Kim M, Hayashi M, Yu B, Lee TK, Kim RH, Jo DW. Effects of Fucoidan Powder Combined with Mineral Trioxide Aggregate as a Direct Pulp-Capping Material. Polymers (Basel) 2022; 14:polym14122315. [PMID: 35745892 PMCID: PMC9228542 DOI: 10.3390/polym14122315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022] Open
Abstract
The development of direct pulp-capping materials with favorable biological and structural properties is an important goal in restorative dentistry. Fucoidan is a sulfated, fucose-containing polysaccharide obtained from brown seaweed, with a wide range of applications; however, its use as a direct pulp-capping material has not been examined. This study aimed to evaluate the mechanical, physical, and biological effects of fucoidan combined with conventional mineral trioxide aggregate (MTA) for direct pulp capping. The capping materials were created using Portland cement (80 wt%) and zirconium oxide (20 wt%) as base components, compared with base components plus 5 wt% fucoidan (PZF5) and base components plus 10 wt% fucoidan (PZF10). The initial and final setting time, compressive strength, chemical components, cell viability, adhesion, migration, osteogenesis, and gene expression were analyzed. Fucoidan significantly reduced the initial and final setting time, regardless of quantity. However, the compressive strength was lower for PZF5. Sulfur levels increased with fucoidan. The biological activity improved, especially in the PZF5 group. Cell migration, Alizarin Red S staining, and alkaline phosphatase activity were upregulated in the PZF5 group. Fucoidan is a useful regenerative additive for conventional pulp-capping materials because it reduces the setting time and improves cell migration and osteogenic ability.
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Affiliation(s)
- Mijoo Kim
- UCLA School of Dentistry Restorative Materials and Applied Dental Research Laboratory, Los Angeles, CA 90095, USA; (M.K.); (M.H.); (B.Y.); (T.K.L.); (R.H.K.)
- Section of Restorative Dentistry, UCLA School of Dentistry, Los Angeles, CA 90095, USA
| | - Marc Hayashi
- UCLA School of Dentistry Restorative Materials and Applied Dental Research Laboratory, Los Angeles, CA 90095, USA; (M.K.); (M.H.); (B.Y.); (T.K.L.); (R.H.K.)
- Section of Restorative Dentistry, UCLA School of Dentistry, Los Angeles, CA 90095, USA
| | - Bo Yu
- UCLA School of Dentistry Restorative Materials and Applied Dental Research Laboratory, Los Angeles, CA 90095, USA; (M.K.); (M.H.); (B.Y.); (T.K.L.); (R.H.K.)
- Section of Restorative Dentistry, UCLA School of Dentistry, Los Angeles, CA 90095, USA
| | - Thomas K. Lee
- UCLA School of Dentistry Restorative Materials and Applied Dental Research Laboratory, Los Angeles, CA 90095, USA; (M.K.); (M.H.); (B.Y.); (T.K.L.); (R.H.K.)
- Section of Restorative Dentistry, UCLA School of Dentistry, Los Angeles, CA 90095, USA
| | - Reuben H. Kim
- UCLA School of Dentistry Restorative Materials and Applied Dental Research Laboratory, Los Angeles, CA 90095, USA; (M.K.); (M.H.); (B.Y.); (T.K.L.); (R.H.K.)
- Section of Restorative Dentistry, UCLA School of Dentistry, Los Angeles, CA 90095, USA
| | - Deuk-Won Jo
- Section of Dentistry, Department of Prosthodontics, Seoul National University Bundang Hospital, Seongnam 13620, Korea
- Correspondence: ; Tel.: +82-31-787-7548
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10
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Liu H, Lu J, Jiang Q, Haapasalo M, Qian J, Tay FR, Shen Y. Biomaterial scaffolds for clinical procedures in endodontic regeneration. Bioact Mater 2022; 12:257-277. [PMID: 35310382 PMCID: PMC8897058 DOI: 10.1016/j.bioactmat.2021.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/04/2021] [Accepted: 10/04/2021] [Indexed: 12/14/2022] Open
Abstract
Regenerative endodontic procedures have been rapidly evolving over the past two decades and are employed extensively in clinical endodontics. These procedures have been perceived as valuable adjuvants to conventional strategies in the treatment of necrotic immature permanent teeth that were deemed to have poor prognosis. As a component biological triad of tissue engineering (i.e., stem cells, growth factors and scaffolds), biomaterial scaffolds have demonstrated clinical potential as an armamentarium in regenerative endodontic procedures and achieved remarkable advancements. The aim of the present review is to provide a broad overview of biomaterials employed for scaffolding in regenerative endodontics. The favorable properties and limitations of biomaterials organized in naturally derived, host-derived and synthetic material categories were discussed. Preclinical and clinical studies published over the past five years on the performance of biomaterial scaffolds, as well as current challenges and future perspectives for the application of biomaterials for scaffolding and clinical evaluation of biomaterial scaffolds in regenerative endodontic procedures were addressed in depth.
Overview of biomaterials for scaffolding in regenerative endodontics are presented. Findings of preclinical and clinical studies on the performance of biomaterial scaffolds are summarized. Challenges and future prospects in biomaterial scaffolds are discussed.
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Bucchi C, Ohlsson E, de Anta JM, Woelflick M, Galler K, Manzanares-Cespedes MC, Widbiller M. Human Amnion Epithelial Cells: A Potential Cell Source for Pulp Regeneration? Int J Mol Sci 2022; 23:ijms23052830. [PMID: 35269973 PMCID: PMC8911206 DOI: 10.3390/ijms23052830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to analyze the suitability of pluripotent stem cells derived from the amnion (hAECs) as a potential cell source for revitalization in vitro. hAECs were isolated from human placentas, and dental pulp stem cells (hDPSCs) and dentin matrix proteins (eDMPs) were obtained from human teeth. Both hAECs and hDPSCs were cultured with 10% FBS, eDMPs and an osteogenic differentiation medium (StemPro). Viability was assessed by MTT and cell adherence to dentin was evaluated by scanning electron microscopy. Furthermore, the expression of mineralization-, odontogenic differentiation- and epithelial–mesenchymal transition-associated genes was analyzed by quantitative real-time PCR, and mineralization was evaluated through Alizarin Red staining. The viability of hAECs was significantly lower compared with hDPSCs in all groups and at all time points. Both hAECs and hDPSCs adhered to dentin and were homogeneously distributed. The regulation of odontoblast differentiation- and mineralization-associated genes showed the lack of transition of hAECs into an odontoblastic phenotype; however, genes associated with epithelial–mesenchymal transition were significantly upregulated in hAECs. hAECs showed small amounts of calcium deposition after osteogenic differentiation with StemPro. Pluripotent hAECs adhere on dentin and possess the capacity to mineralize. However, they presented an unfavorable proliferation behavior and failed to undergo odontoblastic transition.
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Affiliation(s)
- Cristina Bucchi
- Research Centre for Dental Sciences (CICO), Department of Integral Adult Dentistry, Faculty of Dentistry, Universidad de La Frontera, Temuco 4811230, Chile
- Correspondence:
| | - Ella Ohlsson
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, 93053 Regensburg, Germany; (E.O.); (M.W.); (M.W.)
| | - Josep Maria de Anta
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences, Campus de Bellvitge, Universitat de Barcelona, 08907 L’Hospitalet de Llobregat, Spain; (J.M.d.A.); (M.C.M.-C.)
| | - Melanie Woelflick
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, 93053 Regensburg, Germany; (E.O.); (M.W.); (M.W.)
| | - Kerstin Galler
- Department of Conservative Dentistry and Periodontology, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany;
| | - María Cristina Manzanares-Cespedes
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences, Campus de Bellvitge, Universitat de Barcelona, 08907 L’Hospitalet de Llobregat, Spain; (J.M.d.A.); (M.C.M.-C.)
| | - Matthias Widbiller
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, 93053 Regensburg, Germany; (E.O.); (M.W.); (M.W.)
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Farhad A, Saatchi M, Bagherieh S. Effect of citric acid versus ethylenediaminetetraacetic acid on radiographic root development in regenerative endodontic treatment: An animal study. J Endod 2022; 48:535-541. [PMID: 35026229 DOI: 10.1016/j.joen.2022.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/26/2021] [Accepted: 01/03/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Regenerative endodontic treatment was introduced aiming to reinforce the root and enable further root development. In the process of dentin mineralization, bioactive molecules are entrapped in the dentin matrix, which can be later released by rinsing the dentin with chelating agents. This study aimed to compare the effects of citric acid and ethylenediaminetetraacetic acid (EDTA) on radiographic root development in regenerative endodontic treatment in an animal model. METHODS Premolars of three beagle dogs were used in this study. The teeth at one side of the jaw were irrigated with EDTA according to the regeneration protocol of the American Association of Endodontists (AAE). The teeth in the other quadrant were irrigated with citric acid in the second treatment session. Follow-up radiographs were obtained at six months, and the primary and final data were analyzed in SPSS using the Analysis of covariance (ANCOVA). RESULTS There was no significant difference between the two irrigating solutions regarding the increase in root length (P=0.668); however, EDTA showed significantly superior efficacy in increasing the root dentin thickness compared with citric acid (P=0.022). CONCLUSIONS Within the limitations of this study, the use of citric acid versus EDTA was not superior on radiographic root development in regenerative endodontic treatment.
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Affiliation(s)
- Alireza Farhad
- Department of Endodontics, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoud Saatchi
- Department of Endodontics, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shervin Bagherieh
- Department of Endodontics, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran.
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13
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Nosrat A, Bolhari B, Saber Tahan S, Dianat O, Dummer PMH. Revitalizing previously treated teeth with open apices: A case report and a literature review. Int Endod J 2021; 54:1782-1793. [PMID: 34003516 DOI: 10.1111/iej.13570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 12/14/2022]
Abstract
Revitalizing the root canals of previously treated teeth with open apices is appealing to clinicians and patients. However, there are fundamental differences in the microbiome and the microenvironment between a canal with a primary endodontic infection and a canal with a persistent endodontic infection. The aims of this report are to report a case where a previously treated tooth with an open apex and a large apical radiolucency was treated successfully using regenerative endodontic treatment (RET) and to review and critically appraise the literature on procedures and outcomes of RET that result in revitalization of canal(s) in previously treated teeth with open apices. A maxillary central incisor with poor-quality root filling, a large apical radiolucency and an open apex was retreated using RET using platelet-rich fibrin as the scaffold. After 24 months, there was complete healing of the periapical lesion and obvious radiographic signs of apical root closure. Electronic searches were performed in MEDLINE, Scopus and Embase, and the baseline, procedural and outcome data of qualified articles were collected. An assessment tool was developed to rate the quality of evidence reported in these case report/series. Nine articles, three case series and six case reports, with a total of 17 teeth of all types, were included in the reports identified. The age of patients ranged from 7 to 48 years (mean: 19.4 years). The recall period ranged from 12 to 72 months (mean: 29 months). All 17 teeth survived and were functional with healing/healed outcomes. "Apical closure" was the most common radiographic finding regarding root development. The quality of evidence using the new assessment tool was rated "Excellent" in three case reports but only "Fair" in the other six articles. The present case report, as well as the review of the literature, suggests that revitalizing the root canal system of teeth with open apices and post-treatment disease using RET is a potentially valid treatment option. However, more clinical studies with higher levels of evidence and higher quality of evidence are required to confirm the viability of this treatment approach.
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Affiliation(s)
- Ali Nosrat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, Maryland, USA.,Private Practice, Centreville Endodontics, Centreville, Virginia, USA
| | - Behnam Bolhari
- Department of Endodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Shima Saber Tahan
- Department of Endodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Omid Dianat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, Maryland, USA
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14
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Sharma S, Nangia D, Saini A, Kumar V, Chawla A, Perumal V, Logani A. Treatment outcome of regenerative endodontic procedures in mature permanent teeth compared to nonsurgical endodontic treatment: A systematic review and meta-analysis. J Conserv Dent 2021; 24:530-538. [PMID: 35558674 PMCID: PMC9089762 DOI: 10.4103/jcd.jcd_535_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/18/2021] [Accepted: 12/21/2021] [Indexed: 11/04/2022] Open
Abstract
Background: Regenerative endodontic procedures (REP) have the advantage of restoring root canal's native defense ability by re-establishing vital pulp-like tissue. This review aims to determine the overall clinical and/or radiographic success rate (O) of REP (I) in mature permanent teeth (P) and to compare it (C) with nonsurgical endodontic treatment (NSET). Materials and Methods: Sources: PubMed, Web of Science, Embase, EBSCO, Cochrane Central Register of Controlled trials, ClinicalTrials.gov, Clinical Trials Registry-India and OpenGrey. Inclusion: Randomized clinical trials and single-arm prospective studies evaluating the treatment outcomes of REP in mature permanent teeth. Exclusion: Incomplete trials/studies, in vitro studies, animal studies, case reports/series, conference proceedings. Cochrane ROB2.0 and ROBINS-I tools were used to assess the risk of bias. Risk difference (R.D.) between NSET and REP was determined by meta-analysis of the randomized clinical trials. The overall success rate of REP was calculated using data from both randomized clinical trials and single-arm prospective studies. Sensitivity analysis and subgroup analysis were performed. Results: Ten studies (n = 552) were included. R.D between REP and NSET was 0.032 (95% C.I: 0.023–0.087; P = 0.258). Overall success rate of REP was 96.0% (95% confidence interval: 94%–98%). No significant difference was found in sensitivity analysis (P = 0.551), or any of the subgroup analysis (P > 0.05). Discussion: A limited number of randomized clinical trials were available, and only two of them had a low risk of bias. Consistent results were obtained in both types of included studies. Conclusion: Based on a limited number of comparative studies, REP has a similar success rate to NSET in mature permanent teeth. Other: Funding: Nil. Registration: PROSPERO (CRD42020204882).
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15
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Regenerating the Pulp-Dentine Complex Using Autologous Platelet Concentrates: A Critical Appraisal of the Current Histological Evidence. Tissue Eng Regen Med 2020; 18:37-48. [PMID: 33150561 PMCID: PMC7862478 DOI: 10.1007/s13770-020-00291-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/06/2020] [Accepted: 07/27/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Autologous platelet concentrates such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) have gained overwhelming popularity in regenerative endodontics. Clinical evidence reveals the lack of a particular advantage of using PRP or PRF over an evoked blood clot in promoting canal wall thickening and/or continued root development in immature necrotic teeth. Moreover, despite stimulating tissue repair and repopulating the root canals of immature and mature permanent teeth, the new vital tissue may not possess the functional activity of the native pulp tissue. Methods: To better understand the origin, nature, and long-term fate of the tissue types found within the pulp space, we critically examine all available histo-/morphological evidence for pulp–dentine complex regeneration using PRP and/or PRF, alone or together with an evoked blood clot, specialised or unspecialised primary cells, and other biomaterials. Results: Histological data from clinical studies is scant. Reportedly, the inner dentinal surface supports cementum-like tissue formation, but this interface likely deviates in structure and function from the native cementodentinal junction. Presence of bone-like tissue within the pulp space is intriguing since de novo osteogenesis requires closely coordinated recruitment and differentiation of osteoprogenitor cells. Compared to untreated necrotic teeth, an evoked blood clot (with/without PRF) improves fracture resistance. Tooth regeneration using PRF and dental bud cells is unreliable and the constituent neoformed tissues are poorly organised. Conclusion: PRP/PRF fail to demonstrate a significant advantage over an induced blood clot, alone. The true nature of neoformed tissues remains poorly characterised while their response to subsequent insult/injury is unexplored.
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16
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Qi Y, Zou T, Dissanayaka WL, Wong HM, Bertassoni LE, Zhang C. Fabrication of Tapered Fluidic Microchannels Conducive to Angiogenic Sprouting within Gelatin Methacryloyl Hydrogels. J Endod 2020; 47:52-61. [PMID: 33045266 DOI: 10.1016/j.joen.2020.08.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/10/2020] [Accepted: 08/13/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The transplantation of stem cells/tissue constructs into root canal space is a promising strategy for regenerating lost pulp tissue. However, the root canal system, which is cone shaped with a taper from the larger coronal end to the smaller apical end, limits the vascular supply and, therefore, the regenerative capacity. The current study aimed to fabricate built-in microchannels with different tapers to explore various approaches to endothelialize these microchannels. METHODS The fluidic microchannels with varying tapers (parallel, 0.04, and 0.06) were fabricated within gelatin methacryloyl (GelMA) hydrogel (with or without stem cell from the apical papilla [SCAP] encapsulation) of different concentrations (5%, 7.5%, and 10% [w/v]). Green fluorescent protein-expressing human umbilical vein endothelial cells (HUVECs-GFP) were seeded alone or with SCAPs in coculture into these microchannels. Angiogenic sprouting was assessed by fluorescence and a confocal microscope and ImageJ software (National Institutes of Health, Bethesda, MD). Immunostaining was conducted to illustrate monolayer formation. Data were statistically analyzed by 1-way/2-way analysis of variance. RESULTS HUVEC-only inoculation formed an endothelial monolayer inside the microchannel without angiogenic sprouting. HUVECs-GFP/SCAPs cocultured at a 1:1 ratio produced the longest sprouting compared with the other 3 ratios. The average length of the sprouting in the 0.04 taper microchannel was significantly longer compared with that in the parallel and 0.06 taper microchannels. Significant differences in HUVEC-GFP sprouting were observed in 5% GelMA hydrogel. Encapsulation of SCAPs within hydrogel further stimulated the sprouting of HUVECs. CONCLUSIONS The coculture of SCAPs and HUVECs-GFP at a ratio of 1:1 in 0.04 taper fluidic microchannels fabricated with 5% (w/v) GelMA hydrogel with SCAPs encapsulated was found to be the optimal condition to enhance angiogenesis inside tapered microchannels.
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Affiliation(s)
- Yubingqing Qi
- Department of Endodontology, Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Ting Zou
- Department of Endodontology, Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Waruna Lakmal Dissanayaka
- Department of Endodontology, Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Hai Ming Wong
- Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Luiz E Bertassoni
- Department of Biomaterials and Biomechanics, School of Dentistry Center for Regenerative Medicine, Oregon Health and Science University, Portland, Oregon
| | - Chengfei Zhang
- Department of Endodontology, Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Pokfulam, Hong Kong, China.
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17
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Regenerative Endodontic Therapy in the Management of Immature Necrotic Permanent Dentition: A Systematic Review. ScientificWorldJournal 2020; 2020:7954357. [PMID: 32765197 PMCID: PMC7374232 DOI: 10.1155/2020/7954357] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/22/2020] [Accepted: 06/27/2020] [Indexed: 12/25/2022] Open
Abstract
Materials and Methods The electronic databases PubMed and Google Scholar were used to search the literature for relevant studies after applying specific inclusion and exclusion criteria. Studies that fulfilled both the inclusion and exclusion criteria were included in this systematic review. The search was conducted by two independent reviewers following the PRISMA guidelines. Results Only 46 studies that fulfilled both the inclusion and exclusion criteria, which were conducted within the last 10 years, were included in this systematic review. These studies investigated different aspects of regenerative endodontic therapy including different types of scaffolds, intracanal medications, pulpal space/barriers, root maturation stage, follow-up duration, and updated studies on their use in the management of immature necrotic permanent teeth. Conclusions This review concluded the compiled data observed that endodontic regenerative therapy was more efficient in treating immature necrotic permanent teeth and offered a greater advantage that should lead to wider acceptance among endodontists for effective results compared to different treatment options. However, more clinical trials with a standardized protocol and defined clinical, radiographic, and histopathological outcomes with longer follow-up periods are warranted.
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18
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Xu J, Gou L, Zhang P, Li H, Qiu S. Platelet-rich plasma and regenerative dentistry. Aust Dent J 2020; 65:131-142. [PMID: 32145082 PMCID: PMC7384010 DOI: 10.1111/adj.12754] [Citation(s) in RCA: 171] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2020] [Indexed: 11/30/2022]
Abstract
Regenerative dentistry is an emerging field of medicine involving stem cell technology, tissue engineering and dental science. It exploits biological mechanisms to regenerate damaged oral tissues and restore their functions. Platelet‐rich plasma (PRP) is a biological product that is defined as the portion of plasma fraction of autologous blood with a platelet concentration above that of the original whole blood. A super‐mixture of key cytokines and growth factors is present in platelet granules. Thus, the application of PRP has gained unprecedented attention in regenerative medicine. The rationale underlies the utilization of PRP is that it acts as a biomaterial to deliver critical growth factors and cytokines from platelet granules to the targeted area, thus promoting regeneration in a variety of tissues. Based on enhanced understanding of cell signalling and growth factor biology, researchers have begun to use PRP treatment as a novel method to regenerate damaged tissues, including liver, bone, cartilage, tendon and dental pulp. To enable better understanding of the regenerative effects of PRP in dentistry, this review describes different methods of preparation and application of this biological product, and provides detailed explanations of the controversies and future prospects related to the use of PRP in dental regenerative medicine.
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Affiliation(s)
- J Xu
- Shenzhen Longgang Institute of Stomatology, Shenzhen, Guangdong, China.,Department of Otolaryngology, Longgang E.N.T. Hospital & Shenzhen Key Laboratory of E.N.T., Institute of E.N.T, Shenzhen, Guangdong, China
| | - L Gou
- Center for Genetic Medicine, Xuzhou Maternity and Child Health Care Hospital, Xuzhou, Jiangsu, China
| | - P Zhang
- Shenzhen Longgang Institute of Stomatology, Shenzhen, Guangdong, China.,Department of Otolaryngology, Longgang E.N.T. Hospital & Shenzhen Key Laboratory of E.N.T., Institute of E.N.T, Shenzhen, Guangdong, China
| | - H Li
- Shenzhen Longgang Institute of Stomatology, Shenzhen, Guangdong, China.,Department of Otolaryngology, Longgang E.N.T. Hospital & Shenzhen Key Laboratory of E.N.T., Institute of E.N.T, Shenzhen, Guangdong, China
| | - S Qiu
- Department of Otolaryngology, Longgang E.N.T. Hospital & Shenzhen Key Laboratory of E.N.T., Institute of E.N.T, Shenzhen, Guangdong, China
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19
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Digka A, Sakka D, Lyroudia K. Histological assessment of human regenerative endodontic procedures (
REP
) of immature permanent teeth with necrotic pulp/apical periodontitis: A systematic review. AUST ENDOD J 2019; 46:140-153. [DOI: 10.1111/aej.12371] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Anna Digka
- Department of Endodontology School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece
| | - Dimitra Sakka
- Department of Endodontology School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece
| | - Kleoniki Lyroudia
- Department of Endodontology School of Dentistry Aristotle University of Thessaloniki Thessaloniki Greece
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20
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El-Tayeb MM, Abu-Seida AM, El Ashry SH, El-Hady SA. Evaluation of antibacterial activity of propolis on regenerative potential of necrotic immature permanent teeth in dogs. BMC Oral Health 2019; 19:174. [PMID: 31387578 PMCID: PMC6685241 DOI: 10.1186/s12903-019-0835-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 06/27/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND This study evaluated the antibacterial efficiency and ability of propolis to promote regeneration of immature permanent non-vital dogs' teeth. METHODS Ninety six immature permanent premolars teeth in 6 mongrel dogs were divided randomly into: experimental teeth (N = 72) and control teeth (N = 24). Periapical pathosis was induced in all experimental and positive control teeth. Experimental teeth were classified according to the used intra-canal medication into: group I (N = 36), propolis paste was used and group II (N = 36), triple antibiotic paste (TAP) was used. Bacteriologic samplings were collected before and after exposure to intra-canal medicaments. After the disinfection period (3 weeks), revascularization was induced in all experimental teeth. Each group was subdivided according to the root canal orifice plug into: subgroup A (N = 18), propolis paste was used and subgroup B (N = 18), mineral trioxide aggregates (MTA) was used. Each subgroup was further subdivided according to the evaluation period into 3 subdivisions (6 teeth each): subdivision 1; after 2 weeks, subdivision 2; after one month and subdivision 3; after 2 months. Positive control group had 12 teeth with induced untreated periapical pathosis. Negative control group had 12 untouched sound teeth. All teeth were evaluated with radiography and histology. The bacteriologic and radiographic data were analyzed using repeated measures ANOVA and post-hoc Tukey tests. The histologic data were analyzed using Kruskal-Wallis test, Mann-Whitney U test with Bonferroni's adjustment and Chi-square test. The significance level was set at P ≤ .05. RESULTS There was no significant difference in the antibacterial effectiveness between TAP and propolis groups (P > .05). In all subdivisions, there was no significant difference between the experimental groups in terms of increase in root length and dentin thickness, decrease in apical closure, new hard tissue formation, vital tissue formation inside the pulp canal and apical closure scores (P > .05). CONCLUSION Propolis can be comparable with TAP as a disinfection treatment option in regenerative endodontic. As a root canal orifice plug after revascularization of necrotic immature permanent teeth in dogs, propolis induces a progressive increase in root length and dentin thickness and a decrease in apical diameter similar to those of MTA.
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Affiliation(s)
- M. M. El-Tayeb
- Department of Endodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - A. M. Abu-Seida
- Department of Surgery, Anesthesiology & Radiology, Faculty of Veterinary Medicine, Cairo University, Giza Square, Giza, PO: 12211 Egypt
| | - S. H. El Ashry
- Department of Endodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - S. A. El-Hady
- Department of Microbiology & Immunology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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21
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Nosrat A, Kolahdouzan A, Khatibi AH, Verma P, Jamshidi D, Nevins AJ, Torabinejad M. Clinical, Radiographic, and Histologic Outcome of Regenerative Endodontic Treatment in Human Teeth Using a Novel Collagen-hydroxyapatite Scaffold. J Endod 2019; 45:136-143. [PMID: 30711168 DOI: 10.1016/j.joen.2018.10.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 10/20/2018] [Accepted: 10/24/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Histologic examination of teeth after regenerative endodontic treatment (RET) shows that the type, quality, and quantity of tissues formed in the root canal space are not predictable. The aim of this study was to examine clinically, radiographically, and histologically the outcome of RET in immature noninfected human teeth using SynOss Putty (Collagen Matrix Inc, Oakland, NJ) as a scaffold. METHODS Three pairs of maxillary/mandibular first premolars in 3 patients scheduled for extraction were included. Sensibility tests confirmed the presence of vital pulps. After informed consent, anesthesia, and rubber dam isolation, the pulps were removed. RET was performed using the following scaffolds: SynOss Putty + blood in both teeth in patient #1, SynOss Putty with or without blood in patient #2, and SynOss Putty + blood or blood only in patient #3. After a follow-up period of 2.5-7.5 months, the teeth were clinically and radiographically evaluated, extracted, and examined histologically. RESULTS Patients remained asymptomatic after treatment. Radiographic examination of the teeth showed signs of root development after treatment. In teeth treated with SynOss Putty + blood, histologic examination showed formation of intracanal mineralized tissue around the scaffold particles solidifying with newly formed cementumlike tissue on the dentinal walls. The tooth treated with SynOss Putty without blood showed the formation of a periapical lesion. The tooth treated with a blood clot only showed tissues of periodontal origin growing into the root canal space. CONCLUSIONS SynOss Putty + blood showed a predictable pattern of tissue formation and mineralization when used as a scaffold for RET in human immature noninfected teeth. The newly formed mineralized tissue solidifies with newly formed cementum on the dentinal walls.
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Affiliation(s)
- Ali Nosrat
- Iranian Center for Endodontic Research, Dental Research Center, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, Maryland.
| | - Alireza Kolahdouzan
- Department of Endodontics, School of Dentistry, Ghazvin University of Medical Sciences, Ghazvin, Iran; Department of Endodontics, School of Dentistry, Shahed University of Medical Sciences, Tehran, Iran
| | | | - Prashant Verma
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, Maryland
| | - Davoud Jamshidi
- Department of Endodontics, School of Dentistry, Ghazvin University of Medical Sciences, Ghazvin, Iran
| | | | - Mahmoud Torabinejad
- Torabinejad Institute of Surgical Education and Research Venues, Irvine, California
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22
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Sağlam BC, HAZAR E, Koçak S, Koçak MM. Efficacy of XP-Endo Finisher and Passive Ultrasonic Irrigation on Modified Triple Antibiotic Paste Removal. CUMHURIYET DENTAL JOURNAL 2019. [DOI: 10.7126/cumudj.490589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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23
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Siddiqui YD, Omori K, Ito T, Yamashiro K, Nakamura S, Okamoto K, Ono M, Yamamoto T, Van Dyke TE, Takashiba S. Resolvin D2 Induces Resolution of Periapical Inflammation and Promotes Healing of Periapical Lesions in Rat Periapical Periodontitis. Front Immunol 2019; 10:307. [PMID: 30863409 PMCID: PMC6399419 DOI: 10.3389/fimmu.2019.00307] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/06/2019] [Indexed: 12/19/2022] Open
Abstract
Periapical periodontitis results from pulpal infection leading to pulpal necrosis and resorption of periapical bone. The current treatment is root canal therapy, which attempts to eliminate infection and necrotic tissue. But, in some cases periapical inflammation doesn't resolve even after treatment. Resolvins belongs to a large family of specialized pro-resolving lipid mediators that actively resolves inflammation signaling via specific receptors. Resolvin D2 (RvD2), a metabolite of docosahexaenoic acid (DHA), was tested as an intracanal medicament in rats in vivo. Mechanism was evaluated in rat primary dental pulp cells (DPCs) in vitro. The results demonstrate that RvD2 reduces inflammatory cell infiltrate, periapical lesion size, and fosters pulp like tissue regeneration and healing of periapical lesion. RvD2 enhanced expression of its receptor, GPR18, dentin matrix acidic phosphoprotein 1 (DMP1) and mineralization in vivo and in vitro. Moreover, RvD2 induces phosphorylation of Stat3 transcription factor in dental pulp cells. We conclude that intracanal treatment with RvD2 resolves inflammation and promoting calcification around root apex and healing of periapical bone lesions. The data suggest that RvD2 induces active resolution of inflammation with pulp-like tissue regeneration after root canal infection and thus maybe suitable for treating periapical lesions.
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Affiliation(s)
- Yasir Dilshad Siddiqui
- Department of Pathophysiology-Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kazuhiro Omori
- Department of Periodontics and Endodontics, Okayama University Hospital, Okayama, Japan
| | - Takashi Ito
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Keisuke Yamashiro
- Department of Pathophysiology-Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shin Nakamura
- Department of Pathophysiology-Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kentaro Okamoto
- Department of Pathophysiology-Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Mitsuaki Ono
- Department of Molecular Biology and Biochemistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Tadashi Yamamoto
- Department of Periodontics and Endodontics, Okayama University Hospital, Okayama, Japan
| | - Thomas E Van Dyke
- Center for Clinical and Translational Research, The Forsyth Institute, Cambridge, MA, United States
| | - Shogo Takashiba
- Department of Pathophysiology-Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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24
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Tissue Engineering of Necrotic Dental Pulp of Immature Teeth with Apical Periodontitis in Dogs: Radiographic and Histological Evaluation. J Clin Pediatr Dent 2018; 42:373-382. [PMID: 29763345 DOI: 10.17796/1053-4625-42.5.9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
AIM To evaluate tissue engineering technology to regenerate pulp-dentin like tissues in pulp canals of immature necrotic permanent teeth with apical periodontitis in dogs. STUDY DESIGN The study was performed on 36 teeth in 12 dogs. The experiment was carried out using split mouth design. In each dog 3 teeth were selected for implementing the study procedure. Apical periodontitis was induced in Group A and B teeth. Group (A): immature upper left 2nd permanent incisors that were transplanted with a construct of autologous dental pulp stem cells with growth factors seeded in a chitosn hydrogel scaffold. Group (B): immature upper right 2nd permanent incisor that received only growth factors with scaffold. A third tooth in each dog was selected randomly for isolation of dental pulp stem cells (DPSCs). Both groups were closed with a double coronal seal of white MTA (Mineral trioxide aggregate) and glass ionomer cement. Both groups were monitored radiographically for 4 months and histologically after sacrificing the animals. RESULTS There was no statistically significant difference in radiographic findings between group (A) and group (B) for healing of radiolucencies, while there was statistically significant difference between group (A) and group (B) regarding radicular thickening, root lengthening and apical closure. Histologically, group (A) teeth showed regeneration of pulp- dentin like tissue while group (B) teeth did not show any tissue regeneration. CONCLUSION Dental pulp stem cells and growth factors incorporated in chitosan hydrogel are able to regenerate pulp- dentine like tissue and help in complete root maturation of non-vital immature permanent teeth with apical periodontitis in dogs.
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Meschi N, EzEldeen M, Torres Garcia AE, Jacobs R, Lambrechts P. A Retrospective Case Series in Regenerative Endodontics: Trend Analysis Based on Clinical Evaluation and 2- and 3-dimensional Radiology. J Endod 2018; 44:1517-1525. [DOI: 10.1016/j.joen.2018.06.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 06/09/2018] [Accepted: 06/15/2018] [Indexed: 12/17/2022]
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26
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Lv H, Chen Y, Cai Z, Lei L, Zhang M, Zhou R, Huang X. The efficacy of platelet-rich fibrin as a scaffold in regenerative endodontic treatment: a retrospective controlled cohort study. BMC Oral Health 2018; 18:139. [PMID: 30103724 PMCID: PMC6090610 DOI: 10.1186/s12903-018-0598-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 07/30/2018] [Indexed: 12/20/2022] Open
Abstract
Background Blood Clot (BC) or platelet concentrates have been used as scaffold in regenerative endodontic treatment (RET). The aim of this retrospective study was to compare the performance of platelet-rich fibrin (PRF) with BC in inducing root development and periapical lesion healing after tooth revascularization. Methods Five patients receiving RET using PRF as a scaffold were matched 1:1 to a previous cohort of 5 patients who underwent tooth revascularization by provoking periapical bleeding. Clinical signs and symptoms were examined at follow-ups. Periapical lesion healing and root development were monitored radiographically. The resolution of clinical signs and symptoms as well as periapical radiolucency was observed in all patients (100%). Results Root elongation, dentinal wall thickening and apex closure were found in most cases (80% in both groups). There was no significant difference between the groups in terms of clinical sign resolution, root development and periapical healing. Conclusions Within the limits of this study, PRF achieved comparable outcomes to BC in terms of clinical sign and symptom resolution, periapical lesion healing and continued root development in RET.
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Affiliation(s)
- Hongbing Lv
- School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350002, China
| | - Yuemin Chen
- School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350002, China
| | - Zhiyu Cai
- Department of Stomatology, Fujian Medical University Union Hospital, Fuzhou, 350001, China.
| | - Lishan Lei
- School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350002, China
| | - Ming Zhang
- School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350002, China
| | - Ronghui Zhou
- School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350002, China
| | - Xiaojing Huang
- School and Hospital of Stomatology, Fujian Medical University, Fuzhou, 350002, China.
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Kulakov AA, Goldshtein DV, Krechina EK, Bukharova TB, Volkov AV, Gadzhiev AK. [Regeneration of dental pulp tissue using pulpal autologous mesenchymal stem cells and platelet-rich plasma]. STOMATOLOGII︠A︡ 2018; 96:12-16. [PMID: 29260758 DOI: 10.17116/stomat201796612-16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Regeneration of pulp and dentin could be important in operative dentistry as a method to save teeth. Currently cell population from dental pulp of deciduous and permanent teeth of humans and laboratory animals are isolated and characterized. The paper presents a study on pulp regeneration using autologous mesenchymal stromal cells from pulp of molars in combination with fibrin clot, transplanted in pulp chamber of miniature pigs after pulp removal. The results proved that transplantation of autologous multipotent stromal cells of dental pulp in combination with autologous platelet-rich plasma in pulp chamber of miniature pigs after pulp removal leads to pulp restoration and reparative dentinogenesis with dentinal bridge formation on the 30th day. However, the completion of regeneration also results in a decrease in the pulp chamber volume due to the neodentin bedding. Tissue regeneration of dental pulp by direct pulp capping in the absence of inflammatory processes is a promising direction of the use of cellular technologies.
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Affiliation(s)
- A A Kulakov
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | | | - E K Krechina
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - T B Bukharova
- Research Centre for Medical Genetics, Moscow, Russia
| | - A V Volkov
- N.N. Priorov National Medical Research Centre of Traumatology and Orthopedics, Moscow, Russia
| | - A K Gadzhiev
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
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He L, Kim SG, Gong Q, Zhong J, Wang S, Zhou X, Ye L, Ling J, Mao JJ. Regenerative Endodontics for Adult Patients. J Endod 2018; 43:S57-S64. [PMID: 28844305 DOI: 10.1016/j.joen.2017.06.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The goal of endodontics is to save teeth. Since inception, endodontic treatments are performed to obturate disinfected root canals with inert materials such as gutta-percha. Although teeth can be saved after successful endodontic treatments, they are devitalized and therefore susceptible to reinfections and fractures. The American Association of Endodontists (AAE) has made a tremendous effort to revitalize disinfected immature permanent teeth in children and adolescents with diagnoses including pulp necrosis or apical periodontitis. The American Dental Association (ADA) in 2011 issued several clinical codes for regenerative endodontic procedures or apical revascularization in necrotic immature permanent teeth in children and adolescents. These AAE and ADA initiatives have stimulated robust interest in devising a multitude of tissue engineering approaches for dental pulp and dentin regeneration. Can the concept of regenerative endodontics be extended to revitalize mature permanent teeth with diagnoses including irreversible pulpitis and/or pulp necrosis in adults? The present article was written not only to summarize emerging findings to revitalize mature permanent teeth in adult patients but also to identify challenges and strategies that focus on realizing the goal of regenerative endodontics in adults. We further present clinical cases and describe the biological basis of potential regenerative endodontic procedures in adults. This article explores the frequently asked question if regenerative endodontic therapies should be developed for dental pulp and/or dentin regeneration in adults, who consist of the great majority of endodontic patients.
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Affiliation(s)
- Ling He
- Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China; Columbia University Medical Center, Center for Craniofacial Regeneration, New York, NY
| | - Sahng G Kim
- Division of Endodontics, College of Dental Medicine, Columbia University, New York, New York
| | - Qimei Gong
- Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China; Columbia University Medical Center, Center for Craniofacial Regeneration, New York, NY
| | - Juan Zhong
- Columbia University Medical Center, Center for Craniofacial Regeneration, New York, NY; State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Sainan Wang
- Columbia University Medical Center, Center for Craniofacial Regeneration, New York, NY; Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Ling Ye
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Junqi Ling
- Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China.
| | - Jeremy J Mao
- Columbia University Medical Center, Center for Craniofacial Regeneration, New York, NY.
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Zhu X, Liu J, Yu Z, Chen CA, Aksel H, Azim AA, Huang GTJ. A Miniature Swine Model for Stem Cell-Based De Novo Regeneration of Dental Pulp and Dentin-Like Tissue. Tissue Eng Part C Methods 2018; 24:108-120. [PMID: 29298406 DOI: 10.1089/ten.tec.2017.0342] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The goal of this study was to establish mini-swine as a large animal model for stem cell-based pulp regeneration studies. Swine dental pulp stem cells (sDPSCs) were isolated from mini-swine and characterized in vitro. For in vivo studies, we first employed both ectopic and semi-orthotopic study models using severe combined immunodeficiency mice. One is hydroxyapatite-tricalcium phosphate (HA/TCP) model for pulp-dentin complex formation, and the other is tooth fragment model for complete pulp regeneration with new dentin depositing along the canal walls. We found that sDPSCs are similar to their human counterparts exhibiting mesenchymal stem cell characteristics with ability to form colony forming unit-fibroblastic and odontogenic differentiation potential. sDPSCs formed pulp-dentin complex in the HA/TCP model and showed pulp regeneration capacity in the tooth fragment model. We then tested orthotopic pulp regeneration on mini-swine including the use of multi-rooted teeth. Using autologous sDPSCs carried by hydrogel and transplanted into the mini-swine root canal space, we observed regeneration of vascularized pulp-like tissue with a layer of newly deposited dentin-like (rD) tissue or osteodentin along the canal walls. In some cases, dentin bridge-like structure was observed. Immunohistochemical analysis detected the expression of nestin, dentin sialophosphoprotein, dentin matrix protein 1, and bone sialoprotein in odontoblast-like cells lining against the produced rD. We also tested the use of allogeneic sDPSCs for the same procedures. Similar findings were observed in allogeneic transplantation. This study is the first to show an establishment of mini-swine as a suitable large animal model utilizing multi-rooted teeth for further cell-based pulp regeneration studies.
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Affiliation(s)
- Xiaofei Zhu
- 1 Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center , Memphis, Tennessee.,2 VIP Dental Service and Geriatric Dentistry, School and Hospital of Stomatology, Peking University , Beijing, China
| | - Jie Liu
- 1 Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center , Memphis, Tennessee
| | - Zongdong Yu
- 1 Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center , Memphis, Tennessee
| | - Chao-An Chen
- 1 Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center , Memphis, Tennessee.,3 Department of Endodontics, Chi Mei Medical Center , Liouying, Tainan, Taiwan
| | - Hacer Aksel
- 1 Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center , Memphis, Tennessee.,4 Department of Endodontics, School of Dentistry, Hacettepe University , Ankara, Turkey
| | - Adham A Azim
- 1 Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center , Memphis, Tennessee
| | - George T-J Huang
- 1 Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center , Memphis, Tennessee
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Decellularized Swine Dental Pulp as a Bioscaffold for Pulp Regeneration. BIOMED RESEARCH INTERNATIONAL 2017; 2017:9342714. [PMID: 29387727 PMCID: PMC5745671 DOI: 10.1155/2017/9342714] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/30/2017] [Accepted: 11/15/2017] [Indexed: 01/09/2023]
Abstract
Endodontic regeneration shows promise in treating dental pulp diseases; however, no suitable scaffolds exist for pulp regeneration. Acellular natural extracellular matrix (ECM) is a favorable scaffold for tissue regeneration since the anatomical structure and ECM of the natural tissues or organs are well-preserved. Xenogeneic ECM is superior to autologous or allogeneic ECM in tissue engineering for its unlimited resources. This study investigated the characteristics of decellularized dental pulp ECM from swine and evaluated whether it could mediate pulp regeneration. Dental pulps were acquired from the mandible anterior teeth of swine 12 months of age and decellularized with 10% sodium dodecyl sulfate (SDS) combined with Triton X-100. Pulp regeneration was conducted by seeding human dental pulp stem cells into decellularized pulp and transplanted subcutaneously into nude mice for 8 weeks. The decellularized pulp demonstrated preserved natural shape and structure without any cellular components. Histological analysis showed excellent ECM preservation and pulp-like tissue, and newly formed mineralized tissues were regenerated after being transplanted in vivo. In conclusion, decellularized swine dental pulp maintains ECM components favoring stem cell proliferation and differentiation, thus representing a suitable scaffold for improving clinical outcomes and functions of teeth with dental pulp diseases.
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Radiographic, Histologic, and Biomechanical Evaluation of Combined Application of Platelet-rich Fibrin with Blood Clot in Regenerative Endodontics. J Endod 2017; 43:2034-2040. [DOI: 10.1016/j.joen.2017.07.021] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 07/27/2017] [Accepted: 07/28/2017] [Indexed: 11/19/2022]
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Abstract
Currently regeneration of tooth and periodontal damage still remains great challenge. Stem cell-based tissue engineering raised novel therapeutic strategies for tooth and periodontal repair. Stem cells for tooth and periodontal regeneration include dental pulp stem cells (DPSCs), periodontal ligament stem cells (PDLSCs), stem cells from the dental apical papilla (SCAPs), and stem cells from human exfoliated deciduous teeth (SHEDs), dental follicle stem cells (DFSCs), dental epithelial stem cells (DESCs), bone marrow mesenchymal stem cells (BMMSCs), adipose-derived stem cells (ADSCs), embryonic stem cells (ESCs) and induced pluripotent stem cells (iPSCs). To date, substantial advances have been made in stem cell-based tooth and periodontal regeneration, including dentin-pulp, whole tooth, bioroot and periodontal regeneration. Translational investigations have been performed such as dental stem cell banking and clinical trials. In this review, we present strategies for stem cell-based tissue engineering for tooth and periodontal repair, and the translational studies.
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Affiliation(s)
- L Hu
- Molecular Laboratory for Gene Therapy and Tooth Regeneration, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing, China
| | - Y Liu
- Laboratory of Tissue Regeneration and Immunology and Department of Periodontics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, School of Stomatology, Capital Medical University, Beijing, China
| | - S Wang
- Molecular Laboratory for Gene Therapy and Tooth Regeneration, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing, China.,Department of Biochemistry and Molecular Biology, Capital Medical University School of Basic Medical Sciences, Beijing, China
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33
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Sueyama Y, Kaneko T, Ito T, Kaneko R, Okiji T. Implantation of Endothelial Cells with Mesenchymal Stem Cells Accelerates Dental Pulp Tissue Regeneration/Healing in Pulpotomized Rat Molars. J Endod 2017; 43:943-948. [DOI: 10.1016/j.joen.2017.01.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 01/10/2017] [Accepted: 01/25/2017] [Indexed: 12/17/2022]
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34
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Peng C, Zhao Y, Wang W, Yang Y, Qin M, Ge L. Histologic Findings of a Human Immature Revascularized/Regenerated Tooth with Symptomatic Irreversible Pulpitis. J Endod 2017; 43:905-909. [DOI: 10.1016/j.joen.2017.01.031] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 01/10/2017] [Accepted: 01/25/2017] [Indexed: 10/19/2022]
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35
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Effect of Bacterial Biofilm on the Osteogenic Differentiation of Stem Cells of Apical Papilla. J Endod 2017; 43:916-922. [DOI: 10.1016/j.joen.2017.01.023] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/23/2016] [Accepted: 01/13/2017] [Indexed: 11/30/2022]
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Nakayama H, Iohara K, Hayashi Y, Okuwa Y, Kurita K, Nakashima M. Enhanced regeneration potential of mobilized dental pulp stem cells from immature teeth. Oral Dis 2017; 23:620-628. [PMID: 27973697 DOI: 10.1111/odi.12619] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 11/24/2016] [Accepted: 12/01/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVES We have previously demonstrated that dental pulp stem cells (DPSCs) isolated from mature teeth by granulocyte colony-stimulating factor (G-CSF)-induced mobilization method can enhance angiogenesis/vasculogenesis and improve pulp regeneration when compared with colony-derived DPSCs. However, the efficacy of this method in immature teeth with root-formative stage has never been investigated. Therefore, the aim of this study was to examine the stemness, biological characteristics, and regeneration potential in mobilized DPSCs compared with colony-derived DPSCs from immature teeth. MATERIALS AND METHODS Mobilized DPSCs isolated from immature teeth were compared to colony-derived DPSCs using methods including flow cytometry, migration assays, mRNA expression of angiogenic/neurotrophic factor, and induced differentiation assays. They were also compared in trophic effects of the secretome. Regeneration potential was further compared in an ectopic tooth transplantation model. RESULTS Mobilized DPSCs had higher migration ability and expressed more angiogenic/neurotrophic factors than DPSCs. The mobilized DPSC secretome produced a higher stimulatory effect on migration, immunomodulation, anti-apoptosis, endothelial differentiation, and neurite extension. In addition, vascularization and pulp regeneration potential were higher in mobilized DPSCs than in DPSCs. CONCLUSIONS G-CSF-induced mobilization method enhances regeneration potential of colony-derived DPSCs from immature teeth.
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Affiliation(s)
- H Nakayama
- Department of Stem Cell Biology and Regenerative Medicine, National Center for Geriatrics and Gerontology, Research Institute, Obu, Japan.,Department of Oral Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - K Iohara
- Department of Stem Cell Biology and Regenerative Medicine, National Center for Geriatrics and Gerontology, Research Institute, Obu, Japan
| | - Y Hayashi
- Department of Stem Cell Biology and Regenerative Medicine, National Center for Geriatrics and Gerontology, Research Institute, Obu, Japan.,Department of Pediatric Dentistry, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Y Okuwa
- Department of Stem Cell Biology and Regenerative Medicine, National Center for Geriatrics and Gerontology, Research Institute, Obu, Japan.,Department of Oral Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - K Kurita
- Department of Oral Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - M Nakashima
- Department of Stem Cell Biology and Regenerative Medicine, National Center for Geriatrics and Gerontology, Research Institute, Obu, Japan
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Alagl A, Bedi S, Hassan K, AlHumaid J. Use of platelet-rich plasma for regeneration in non-vital immature permanent teeth: Clinical and cone-beam computed tomography evaluation. J Int Med Res 2017; 45:583-593. [PMID: 28415948 PMCID: PMC5536665 DOI: 10.1177/0300060517692935] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective This study was performed to assess the clinical and radiological outcomes of a revascularization procedure in immature teeth with apical periodontitis using platelet-rich plasma (PRP). The PRP protocol and conventional revascularization protocol, which used a blood clot as the scaffold, were compared. Methods Thirty non-vital immature permanent teeth were randomly categorized into two groups. After disinfecting the root canal space with triple antibiotic paste (1:1:1 ciprofloxacin, metronidazole, and cefaclor), a tissue scaffold was created using either PRP or a blood clot (control) and covered with white mineral trioxide aggregate. All cases were followed up clinically and radiographically for 12 months. Differences in bone density, root length, and lesion size were calculated using preoperative and postoperative computed tomography images. The means of the differences in individual parameters in the blood clot and PRP groups were compared using the Mann–Whitney U test. Results After 5 months, sensitivity tests (cold and electric pulp tests) elicited a delayed positive response in 23 sites. At 12 months, cone-beam computed tomography revealed resolution or a decrease in lesion size and an increase in bone density in all 30 (100%) teeth. Additionally, continued root development was observed in 22 (73%) teeth and early root growth was observed in the test group (mineral trioxide aggregate with PRP). Conclusions The results of this study suggest that PRP can serve as a successful scaffold for regenerative endodontic treatment. With the exception of a significant increase in root length, the results of treatment with PRP were not significantly different from those of the conventional protocol using a blood clot as the scaffold.
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Affiliation(s)
- Adel Alagl
- 1 Division of Periodontics, Department of Preventive Dental Sciences, College of Dentistry, University of Dammam, Dammam, Saudi Arabia
| | - Sumit Bedi
- 2 Division of Paediatric Dentistry, Department of Preventive Dental Sciences, College of Dentistry, University of Dammam, Dammam, Saudi Arabia
| | - Khalid Hassan
- 1 Division of Periodontics, Department of Preventive Dental Sciences, College of Dentistry, University of Dammam, Dammam, Saudi Arabia
| | - Jehan AlHumaid
- 2 Division of Paediatric Dentistry, Department of Preventive Dental Sciences, College of Dentistry, University of Dammam, Dammam, Saudi Arabia
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Abstract
Apical revascularization (AR) and platelet-rich plasma have been used to restore dental pulp vitality in infected immature permanent teeth. Two regenerative therapies are cell transplantation and cell homing. This article updates and benchmarks these therapies with cell homing. A case report concluded that AR increased root length; however, quantitative and statistical assessments disproved this. Regenerative endodontic therapies require prospective clinical trials demonstrating safety and efficacy. These therapies are intrinsically susceptible to procedural and patient variations. Cell homing uses novel molecules that drive therapeutic efficacy, and may be less sensitive to procedural and patient variations.
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Affiliation(s)
- Ling He
- Division of Endodontics, Center for Craniofacial Regeneration, Columbia University Medical Center, Columbia University, 630 West 168 Street, New York, NY 10032, USA; Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Hospital of Stomatology, Guangdong Province Key Laboratory of Stomatology, Sun Yat-sen University, 56 Lingyuan West Road, Guangzhou, Guangdong, 510055, China
| | - Juan Zhong
- Division of Endodontics, Center for Craniofacial Regeneration, Columbia University Medical Center, Columbia University, 630 West 168 Street, New York, NY 10032, USA
| | - Qimei Gong
- Division of Endodontics, Center for Craniofacial Regeneration, Columbia University Medical Center, Columbia University, 630 West 168 Street, New York, NY 10032, USA; Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Hospital of Stomatology, Guangdong Province Key Laboratory of Stomatology, Sun Yat-sen University, 56 Lingyuan West Road, Guangzhou, Guangdong, 510055, China
| | - Bin Cheng
- Department of Biostatistics, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 631, New York, NY 10032, USA.
| | - Sahng G Kim
- Division of Endodontics, Center for Craniofacial Regeneration, Columbia University Medical Center, College of Dental Medicine, Columbia University, 630 West 168 Street - PH7Stem #128, New York, NY 10032, USA.
| | - Junqi Ling
- Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Hospital of Stomatology, Guangdong Province Key Laboratory of Stomatology, Sun Yat-sen University, 56 Lingyuan West Road, Guangzhou, Guangdong, 510055, China.
| | - Jeremy J Mao
- Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Hospital of Stomatology, Guangdong Province Key Laboratory of Stomatology, Sun Yat-sen University, 56 Lingyuan West Road, Guangzhou, Guangdong, 510055, China; Division of Endodontics, Center for Craniofacial Regeneration, Columbia University Medical Center, Columbia University, 630 West 168 Street - PH7E, New York, NY 10032, USA.
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Mapar MA, Shahriari S, Haghighizadeh MH. Efficacy of platelet-rich plasma in the treatment of androgenetic (male-patterned) alopecia: A pilot randomized controlled trial. J COSMET LASER THER 2016; 18:452-455. [DOI: 10.1080/14764172.2016.1225963] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Mohammad Ali Mapar
- Ahvaz Jundishapur University of Medical Sciences, Ahvaz, The Islamic Republic of Iran
| | - Sadegh Shahriari
- Ahvaz Jundishapur University of Medical Sciences, Ahvaz, The Islamic Republic of Iran
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Verma P, Nosrat A, Kim J, Price J, Wang P, Bair E, Xu H, Fouad A. Effect of Residual Bacteria on the Outcome of Pulp Regeneration In Vivo. J Dent Res 2016; 96:100-106. [DOI: 10.1177/0022034516671499] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- P. Verma
- Department of Endodontics, Periodontics, and Prosthodontics, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA
| | - A. Nosrat
- Department of Endodontics, Periodontics, and Prosthodontics, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA
| | - J.R. Kim
- Department of Endodontics, Temple University, Philadelphia, PA, USA
| | - J.B. Price
- Department of Oncology and Diagnostic Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA
| | - P. Wang
- Department of Endodontics, Periodontics, and Prosthodontics, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA
| | - E. Bair
- Department of Endodontics, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - H.H. Xu
- Department of Endodontics, Periodontics, and Prosthodontics, School of Dentistry, University of Maryland Baltimore, Baltimore, MD, USA
| | - A.F. Fouad
- Department of Endodontics, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Lolato A, Bucchi C, Taschieri S, Kabbaney AE, Fabbro MD. Platelet concentrates for revitalization of immature necrotic teeth: a systematic review of the clinical studies. Platelets 2016; 27:383-92. [DOI: 10.3109/09537104.2015.1131255] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Alessandra Lolato
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milano, Italia
- IRCCS Istituto Ortopedico Galeazzi, Università degli Studi di Milano, Milano, Italia
| | - Cristina Bucchi
- Facultad de Odontología, CICO Research Center, Universidad de La Frontera, Temuco, Chile
| | - Silvio Taschieri
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milano, Italia
- IRCCS Istituto Ortopedico Galeazzi, Università degli Studi di Milano, Milano, Italia
| | - Ahmed El Kabbaney
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milano, Italia
- Conservative Dentistry and Endodontic Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Massimo Del Fabbro
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milano, Italia
- IRCCS Istituto Ortopedico Galeazzi, Università degli Studi di Milano, Milano, Italia
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Xu W, Jiang S, Chen Q, Ye Y, Chen J, Heng BC, Jiang Q, Wu B, Ding Z, Zhang C. Systemically Transplanted Bone Marrow–derived Cells Contribute to Dental Pulp Regeneration in a Chimeric Mouse Model. J Endod 2016; 42:263-8. [DOI: 10.1016/j.joen.2015.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/05/2015] [Accepted: 10/12/2015] [Indexed: 12/20/2022]
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Devillard R, Rémy M, Kalisky J, Bourget JM, Kérourédan O, Siadous R, Bareille R, Amédée-Vilamitjana J, Chassande O, Fricain JC. In vitroassessment of a collagen/alginate composite scaffold for regenerative endodontics. Int Endod J 2016; 50:48-57. [DOI: 10.1111/iej.12591] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 11/30/2015] [Indexed: 01/08/2023]
Affiliation(s)
- R. Devillard
- Bioingénierie Tissulaire; University Bordeaux; Bordeaux France
- Bioingénierie Tissulaire; INSERM; Bordeaux France
- Service d'Odontologie et de Santé Buccale; CHU de Bordeaux; Bordeaux France
| | - M. Rémy
- Bioingénierie Tissulaire; University Bordeaux; Bordeaux France
- Bioingénierie Tissulaire; INSERM; Bordeaux France
| | - J. Kalisky
- Bioingénierie Tissulaire; University Bordeaux; Bordeaux France
- Bioingénierie Tissulaire; INSERM; Bordeaux France
| | | | - O. Kérourédan
- Bioingénierie Tissulaire; University Bordeaux; Bordeaux France
- Bioingénierie Tissulaire; INSERM; Bordeaux France
- Service d'Odontologie et de Santé Buccale; CHU de Bordeaux; Bordeaux France
| | - R. Siadous
- Bioingénierie Tissulaire; INSERM; Bordeaux France
| | - R. Bareille
- Bioingénierie Tissulaire; INSERM; Bordeaux France
| | | | - O. Chassande
- Bioingénierie Tissulaire; University Bordeaux; Bordeaux France
- Bioingénierie Tissulaire; INSERM; Bordeaux France
| | - J.-C. Fricain
- Bioingénierie Tissulaire; University Bordeaux; Bordeaux France
- Bioingénierie Tissulaire; INSERM; Bordeaux France
- Service d'Odontologie et de Santé Buccale; CHU de Bordeaux; Bordeaux France
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Homayounfar N, Verma P, Nosrat A, El Ayachi I, Yu Z, Romberg E, Huang GTJ, Fouad AF. Isolation, Characterization, and Differentiation of Dental Pulp Stem Cells in Ferrets. J Endod 2016; 42:418-24. [PMID: 26794343 DOI: 10.1016/j.joen.2015.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/05/2015] [Accepted: 12/01/2015] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The ferret canine tooth has been introduced as a suitable model for studying dental pulp regeneration. The aim of this study was to isolate and characterize ferret dental pulp stem cells (fDPSCs) and their differentiation potential. METHODS Dental pulp stem cells were isolated from freshly extracted ferret canine teeth. The cells were examined for the expression of stem cell markers STRO-1, CD90, CD105, and CD146. The osteo/odontogenic and adipogenic differentiation potential of fDPSCs was evaluated. Osteogenic and odontogenic marker genes were evaluated using quantitative real-time polymerase chain reaction (qRT-PCR) on days 1, 4, and 8 after osteo/odontogenic induction of fDPSCs including dentin sialophosphoprotein (DSPP), dentin matrix protein-1, osteopontin, and alkaline phosphatase. Human dental pulp cells were used as the control. The results were analyzed using 3-way analysis of variance. RESULTS fDPSCs were positive for STRO1, CD90, and CD105 and negative for CD146 markers with immunohistochemistry. fDPSCs showed strong osteogenic and weak adipogenic potential. The overall expression of DSPP was not significantly different between fDPSCs and human dental pulp cells. The expression of DSPP in osteo/odontogenic media was significantly higher in fDPSCs on day 4 (P < .01). The overall expression of dentin matrix protein-1, osteopontin, and alkaline phosphatase was significantly higher in fDPSCs (P = .0005). CONCLUSIONS fDPSCs were positive for several markers of dental pulp stem cells resembling human DPSCs and appeared to show a stronger potential to differentiate to osteoblastic rather than odontoblastic lineage.
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Affiliation(s)
- Negar Homayounfar
- Department of Endodontics, Periodontics and Prosthodontics, School of Dentistry, University of Maryland, Baltimore, Maryland
| | - Prashant Verma
- Department of Endodontics, Periodontics and Prosthodontics, School of Dentistry, University of Maryland, Baltimore, Maryland
| | - Ali Nosrat
- Department of Endodontics, Periodontics and Prosthodontics, School of Dentistry, University of Maryland, Baltimore, Maryland
| | - Ikbale El Ayachi
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Zongdong Yu
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Elaine Romberg
- Department of Endodontics, Periodontics and Prosthodontics, School of Dentistry, University of Maryland, Baltimore, Maryland
| | - George T-J Huang
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Ashraf F Fouad
- Department of Endodontics, University of North Carolina, Chapel Hill, North Carolina.
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Del Fabbro M, Lolato A, Bucchi C, Taschieri S, Weinstein RL. Autologous Platelet Concentrates for Pulp and Dentin Regeneration: A Literature Review of Animal Studies. J Endod 2015; 42:250-7. [PMID: 26631301 DOI: 10.1016/j.joen.2015.10.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 10/15/2015] [Accepted: 10/20/2015] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The purpose of this study was to evaluate the effectiveness of autologous platelet concentrates (APCs) in promoting pulp and dentin regeneration in animal models. METHODS An electronic search was performed on MEDLINE, Embase, Scopus, SciELO, LILACS, and CENTRAL. Animal studies using APC as a root filling material after pulpectomy in mature or immature teeth were included. Articles underwent risk of bias assessment. Histologic evaluation of intracanal neoformed tissue was the primary outcome; root development, root wall thickening, apical closure, and periapical healing in apical periodontitis were the secondary outcomes. RESULTS Seven articles were included. Platelet-rich plasma (PRP) was used as root filling material during regenerative procedures in the experimental group in either mature or immature teeth. After revascularization with PRP alone or in conjunction with stem cells of a different source, the histologic analyses revealed that, in addition to an odontoblastic cell layer or dentinlike structure, the neoformed intracanal tissues were mainly cementumlike, bonelike, and connective tissues. CONCLUSIONS True regeneration of necrotic pulp may not be achieved with current techniques using PRP, all of which stimulated tissue repair. Benefits of PRP adjunct for pulp tissue regeneration in preclinical studies remain unclear. Further studies with standardized protocols are necessary to assess the actual contribution of PRP in endodontic regenerative therapies.
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Affiliation(s)
- Massimo Del Fabbro
- Università degli Studi di Milano, Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
| | - Alessandra Lolato
- Università degli Studi di Milano, Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Cristina Bucchi
- Research Centre in Dental Sciences (CICO), Dental School, Universidad de La Frontera, Temuco, Chile
| | - Silvio Taschieri
- Università degli Studi di Milano, Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Roberto L Weinstein
- Università degli Studi di Milano, Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Ok E, Altunsoy M, Nur BG, Kalkan A. Effectiveness of different irrigation solutions on triple antibiotic paste removal from simulated immature root canal. SCANNING 2015; 37:409-413. [PMID: 26061777 DOI: 10.1002/sca.21229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/21/2015] [Indexed: 06/04/2023]
Abstract
To evaluate the effectiveness of different irrigation solutions and ultrasonic activation of irrigation solutions on removal of triple antibiotic paste (TAP) from root canals of the simulated immature teeth. Fifty single-rooted teeth were used. TAP was placed into each root canal, and specimens were stored in distilled water for 4 weeks at 37°C. After 4 weeks, the temporary coronal seal was removed and the samples were randomly divided into five groups as follows: (i) saline; (ii) ultrasonic activation of saline; (iii) NaOCl; (iv) ultrasonic activation of NaOCl; (v) chlorhexidine digluconate (CHX). The amount of remaining TAP on the canal walls was measured under stereomicroscope with 30× magnification. The data were analyzed using a one-way ANOVA and post-hoc Tukey test at a significance level of 0.05. There were statistically differences among CHX and ultrasonic activation of NaOCl and other groups (p < 0.05). There were no significant differences among the ultrasonic activation of saline, NaOCl, and saline groups (p > 0.05). Irrigation solutions and ultrasonic activation of the irrigation solutions could not completely remove the triple antibiotic paste from simulated immature root canals. Ultrasonic activation of the NaOCl gave the best and CHX was the worst results.
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Affiliation(s)
- Evren Ok
- Department of Endodontics, Faculty of Dentistry, Şifa University, Izmir, Turkey
| | - Mustafa Altunsoy
- Department of Pedodontics, Faculty of Dentistry, Şifa University, Izmir, Turkey
| | - Bilge Gülsüm Nur
- Department of Pedodontics, Faculty of Dentistry, Şifa University, Izmir, Turkey
| | - Abdussamed Kalkan
- Department of Endodontics, Faculty of Dentistry, Şifa University, Izmir, Turkey
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Cao Y, Song M, Kim E, Shon W, Chugal N, Bogen G, Lin L, Kim RH, Park NH, Kang MK. Pulp-dentin Regeneration: Current State and Future Prospects. J Dent Res 2015; 94:1544-1551. [PMID: 26310721 DOI: 10.1177/0022034515601658] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2025] Open
Abstract
The goal of regenerative endodontics is to reinstate normal pulp function in necrotic and infected teeth that would result in reestablishment of protective functions, including innate pulp immunity, pulp repair through mineralization, and pulp sensibility. In the unique microenvironment of the dental pulp, the triad of tissue engineering would require infection control, biomaterials, and stem cells. Although revascularization is successful in resolving apical periodontitis, multiple studies suggest that it alone does not support pulp-dentin regeneration. More recently, cell-based approaches in endodontic regeneration based on pulpal mesenchymal stem cells (MSCs) have demonstrated promising results in terms of pulp-dentin regeneration in vivo through autologous transplantation. Although pulpal regeneration requires the cell-based approach, several challenges in clinical translation must be overcome-including aging-associated phenotypic changes in pulpal MSCs, availability of tissue sources, and safety and regulation involved with expansion of MSCs in laboratories. Allotransplantation of MSCs may alleviate some of these obstacles, although the long-term stability of MSCs and efficacy in pulp-dentin regeneration demand further investigation. For an alternative source of MSCs, our laboratory developed induced MSCs (iMSCs) from primary human keratinocytes through epithelial-mesenchymal transition by modulating the epithelial plasticity genes. Initially, we showed that overexpression of ΔNp63α, a major isoform of the p63 gene, led to epithelial-mesenchymal transition and acquisition of stem characteristics. More recently, iMSCs were generated by transient knockdown of all p63 isoforms through siRNA, further simplifying the protocol and resolving the potential safety issues of viral vectors. These cells may be useful for patients who lack tissue sources for endogenous MSCs. Further research will elucidate the level of potency of these iMSCs and assess their transdifferentiation capacities into functional odontoblasts when transplanted into the root canal microenvironment.
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Affiliation(s)
- Y Cao
- School of Dentistry, UCLA, Los Angeles, CA, USA
| | - M Song
- School of Dentistry, UCLA, Los Angeles, CA, USA
| | - E Kim
- School of Dentistry, Yonsei University, Seoul, Korea
| | - W Shon
- School of Dentistry, UCLA, Los Angeles, CA, USA
| | - N Chugal
- School of Dentistry, UCLA, Los Angeles, CA, USA
| | - G Bogen
- School of Dentistry, UCLA, Los Angeles, CA, USA
| | - L Lin
- New York University College of Dentistry, New York, NY, USA
| | - R H Kim
- School of Dentistry, UCLA, Los Angeles, CA, USA Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA
| | - N-H Park
- School of Dentistry, UCLA, Los Angeles, CA, USA Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - M K Kang
- School of Dentistry, UCLA, Los Angeles, CA, USA Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA
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Nosrat A, Kolahdouzan A, Hosseini F, Mehrizi EA, Verma P, Torabinejad M. Histologic Outcomes of Uninfected Human Immature Teeth Treated with Regenerative Endodontics: 2 Case Reports. J Endod 2015; 41:1725-9. [DOI: 10.1016/j.joen.2015.05.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/05/2015] [Accepted: 05/05/2015] [Indexed: 01/09/2023]
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Chaniotis A. The use of a single-step regenerative approach for the treatment of a replanted mandibular central incisor with severe resorption. Int Endod J 2015. [DOI: 10.1111/iej.12515] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Meschi N, Hilkens P, Lambrichts I, Van den Eynde K, Mavridou A, Strijbos O, De Ketelaere M, Van Gorp G, Lambrechts P. Regenerative endodontic procedure of an infected immature permanent human tooth: an immunohistological study. Clin Oral Investig 2015; 20:807-14. [DOI: 10.1007/s00784-015-1555-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 07/28/2015] [Indexed: 11/27/2022]
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