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Journal of Endodontics Aug 2022Dental pulp fibroblasts (DPFs) are the most abundant cell type in the dental pulp. They play pivotal roles; however, they are often mistaken to be involved only in the... (Review)
Review
INTRODUCTION
Dental pulp fibroblasts (DPFs) are the most abundant cell type in the dental pulp. They play pivotal roles; however, they are often mistaken to be involved only in the repair and maintenance of this connective tissue.
METHODS
We used the search terms "pulp fibroblast," "complement system proteins," "pulp inflammation," "angiogenesis," and "dentin pulp regeneration" to identify articles from the PubMed and Scopus databases.
RESULTS
These sentinel cells produce all complement system proteins participating in defense processes, control of inflammation, and dentin-pulp regeneration; produce several proinflammatory cytokines and chemokines and express pattern-recognition receptors, demonstrating their involvement in immunoregulatory mechanisms; express neuropeptides and their receptors, playing an important role in neurogenic inflammation and dental pulp wound healing; secrete angiogenic growth factors as well as neurotrophic proteins, essential for dentin-pulp regeneration; regulate neuronal plasticity processes; and can sense the external environment.
CONCLUSIONS
This review highlights that DPFs are more than mere passive cells in pulp biology and presents an integrative analysis of their roles and functions.
Topics: Complement System Proteins; Dental Pulp; Dentin; Fibroblasts; Humans; Inflammation; Regeneration
PubMed: 35577145
DOI: 10.1016/j.joen.2022.05.004 -
British Dental Journal Mar 2022Thermal and electric pulp sensibility tests are commonly used by the majority of clinicians when diagnosing endodontic disease. These tests indirectly determine the... (Review)
Review
Thermal and electric pulp sensibility tests are commonly used by the majority of clinicians when diagnosing endodontic disease. These tests indirectly determine the state of pulpal health by assessing the response of the Aδ nerve fibres within the pulp-dentine complex. A positive response to sensibility testing indicates that the nerve fibres are functioning but does not give any quantitative information on nerve function, pulpal blood flow or histological status of the dental pulp. These tests have inherent limitations, including a reliance on a patient's subjective response to the test and the dentist's interpretation of the patient's response. This two-part series aims to help clinicians to reach an accurate endodontic diagnosis by providing an overview of how to undertake common pulpal sensibility tests correctly, how to interpret their results and understand their limitations. This section provides an overview of pulp testing, definitions of terminology relevant to pulp testing, the diagnostic uses of pulp testing and a summary of the diagnostic accuracy of different pulp tests.
Topics: Data Collection; Dental Pulp; Dental Pulp Diseases; Humans
PubMed: 35277620
DOI: 10.1038/s41415-022-3988-1 -
Journal of Biomedical Materials... May 2016Trauma to the dental pulp, physical or microbiologic, can lead to inflammation of the pulp followed by necrosis. The current treatment modality for such cases is... (Review)
Review
Trauma to the dental pulp, physical or microbiologic, can lead to inflammation of the pulp followed by necrosis. The current treatment modality for such cases is non-surgical root canal treatment. The damaged tissue is extirpated and the root canal system prepared. It is then obturated with an inert material such a gutta percha. In spite of advances in techniques and materials, 10%-15% of the cases may end in failure of treatment. Regenerative endodontics combines principles of endodontics, cell biology, and tissue engineering to provide an ideal treatment for inflamed and necrotic pulp. It utilizes mesenchymal stem cells, growth factors, and organ tissue culture to provide treatment. Potential treatment modalities include induction of blood clot for pulp revascularization, scaffold aided regeneration, and pulp implantation. Although in its infancy, successful treatment of damaged pulp tissue has been performed using principles of regenerative endodontics. This field is dynamic and exciting with the ability to shape the future of endodontics. This article highlights the fundamental concepts, protocol for treatment, and possible avenues for research in regenerative endodontics.
Topics: Animals; Dental Pulp; Dental Pulp Diseases; Endodontics; Humans; Regenerative Medicine; Tissue Engineering
PubMed: 26699211
DOI: 10.1002/jbm.b.33587 -
Advances in Experimental Medicine and... 2018Recent advances in regenerative medicine and cell-based therapy are bringing promising perspectives for the use of stem cells in clinical trials. Stem cells are... (Review)
Review
Recent advances in regenerative medicine and cell-based therapy are bringing promising perspectives for the use of stem cells in clinical trials. Stem cells are undifferentiated cells capable of multilineage differentiation and available in numerous sources in the human body. Dental pulp constitutes an attractive source of these cells since collecting mesenchymal stem cells from this site is a noninvasive procedure which can be done following a common surgical extraction of supernumerary or wisdom teeth. Thus tissue sacrifice is very low and several cytotypes can be obtained owing to these cells' multipotency, in addition to the fact that they can be cryopreserved and stored for long periods. Mesenchymal stem cells have high proliferation rates making them favorable for clinical application. These multipotent cells present in a biological waste constitute an appropriate support in the management of many neurological disorders. After a brief overview on the different types of dental stem cells, this chapter will focus on the characteristics of dental pulp stem cells, their handling and applications in neural tissue engineering, as well as neural induction protocols leading to their potential therapeutic use in the management of neurological diseases.
Topics: Cell Differentiation; Cell Proliferation; Dental Pulp; Humans; Mesenchymal Stem Cells; Neurogenesis; Tissue Engineering
PubMed: 28687960
DOI: 10.1007/5584_2017_71 -
Primary Dental Journal Dec 2023Traumatic dental injuries pose a variety of complex ongoing issues to the dental practitioner. As dental injuries are commonly experienced at a young age, the treatment... (Review)
Review
Traumatic dental injuries pose a variety of complex ongoing issues to the dental practitioner. As dental injuries are commonly experienced at a young age, the treatment often takes place during adolescence or early in adulthood years at crucial development stages and very early in the life of the permanent successor. Therefore, the ability to correctly diagnose the injury, and follow an appropriate management plan should increase practitioners' ability to improve both the outcomes of dental trauma and long-term prognosis of the tooth.The consequences of dental trauma can be explored by taking into consideration the type of injury, which enables an assessment of the degree of insult to the pulpal tissues, neurovascular bundle, periodontal ligament and cemental cells. This has a direct influence on post-trauma complications. Early intervention, where indicated, and appropriate follow-up utilising international guidelines is imperative to identify changing diagnoses and act accordingly. This review paper will discuss the classification of traumatic injuries and their associated outcomes with management strategies for emerging disease including potential endodontic and restorative complexities and when to refer to secondary care.
Topics: Adolescent; Humans; Tooth Injuries; Dentists; Professional Role; Tooth; Dental Pulp
PubMed: 38018673
DOI: 10.1177/20501684231213908 -
Journal of Dental Research Dec 2023Vital pulp therapy and root canal therapy (RCT) are the dominant treatment for irreversible pulpitis. While the success rate of these procedures is favorable, they have...
Vital pulp therapy and root canal therapy (RCT) are the dominant treatment for irreversible pulpitis. While the success rate of these procedures is favorable, they have some limitations. For instance, RCT leads to removing significant dentin in the coronal third of the tooth that increases root-fracture risk, which forces tooth removal. The ideal therapeutic goal is dental pulp regeneration, which is not achievable with RCT. Specialized proresolving mediators (SPMs) are well known for inflammatory resolution. The resolution of inflammation and tissue restoration or regeneration is a dynamic and continuous process. SPMs not only have potent immune-modulating functions but also effectively promote tissue homeostasis and regeneration. Resolvins have been shown to promote dental pulp regeneration. The purpose of this study was to explore further the cellular target of Resolvin E1 (RvE1) therapy in dental pulp regeneration and the impact of RvE1 in infected pulps. We investigated the actions of RvE1 on experimentally exposed pulps with or without microbial infection in an ; genetically defined mouse model. Our results showed RvE1 promoted Axin2-tdTomato cell expansion and odontoblastic differentiation after direct pulp capping in the mouse, which we used to mimic reversible pulpitis cases in the clinic. In cultured mouse dental pulp stem cells (mDPSCs), RvE1 facilitated Axin2-tdTomato cell proliferation and odontoblastic differentiation and also rescued impaired functions after lipopolysaccharide stimulation. In infected pulps exposed to the oral environment for 24 h, RvE1 suppressed inflammatory infiltration, reduced bacterial invasion in root canals, and prevented the development of apical periodontitis, while its proregenerative impact was limited. Collectively, topical treatment with RvE1 facilitated dental pulp regenerative properties by promoting Axin2-expressing cell proliferation and differentiation. It also modulated the resolution of inflammation, reduced infection severity, and prevented apical periodontitis, presenting RvE1 as a novel therapeutic for treating endodontic diseases.
Topics: Mice; Animals; Pulpitis; Dental Pulp; Periapical Periodontitis; Inflammation; Bacteria; Regeneration; Axin Protein
PubMed: 37837227
DOI: 10.1177/00220345231197156 -
Dental Materials : Official Publication... Apr 2023The current standard for treating irreversibly damaged dental pulp is root canal therapy, which involves complete removal and debridement of the pulp space and filling... (Review)
Review
OBJECTIVES
The current standard for treating irreversibly damaged dental pulp is root canal therapy, which involves complete removal and debridement of the pulp space and filling with an inert biomaterial. A regenerative approach to treating diseased dental pulp may allow for complete healing of the native tooth structure and enhance the long-term outcome of once-necrotic teeth. The aim of this paper is, therefore, to highlight the current state of dental pulp tissue engineering and immunomodulatory biomaterials properties, identifying exciting opportunities for their synergy in developing next-generation biomaterials-driven technologies.
METHODS
An overview of the inflammatory process focusing on immune responses of the dental pulp, followed by periapical and periodontal tissue inflammation are elaborated. Then, the most recent advances in treating infection-induced inflammatory oral diseases, focusing on biocompatible materials with immunomodulatory properties are discussed. Of note, we highlight some of the most used modifications in biomaterials' surface, or content/drug incorporation focused on immunomodulation based on an extensive literature search over the last decade.
RESULTS
We provide the readers with a critical summary of recent advances in immunomodulation related to pulpal, periapical, and periodontal diseases while bringing light to tissue engineering strategies focusing on healing and regenerating multiple tissue types.
SIGNIFICANCE
Significant advances have been made in developing biomaterials that take advantage of the host's immune system to guide a specific regenerative outcome. Biomaterials that efficiently and predictably modulate cells in the dental pulp complex hold significant clinical promise for improving standards of care compared to endodontic root canal therapy.
Topics: Biocompatible Materials; Dental Pulp; Tissue Engineering; Root Canal Therapy; Regeneration
PubMed: 36894414
DOI: 10.1016/j.dental.2023.03.013 -
Archives of Oral Biology Jan 2020Description of the odontoblast lifecycle, an overview of the known complex molecular interactions that occur when the health of the dental pulp is challenged and the... (Review)
Review
OBJECTIVE
Description of the odontoblast lifecycle, an overview of the known complex molecular interactions that occur when the health of the dental pulp is challenged and the current and future management strategies on vital and non-vital teeth.
METHODS
A literature search of the electronic databases included MEDLINE (1966-April 2019), CINAHL (1982-April 2019), EMBASE and EMBASE Classic (1947-April 2019), and hand searches of references retrieved were undertaken using the following MESH terms 'odontoblast*', 'inflammation', 'dental pulp*', 'wound healing' and 'regenerative medicine'.
RESULTS
Odontoblasts have a sensory and mechano-transduction role so as to detect external stimuli that challenge the dental pulp. On detection, odontoblasts stimulate the innate immunity by activating defence mechanisms key in the healing and repair mechanisms of the tooth. A better understanding of the role of odontoblasts within the dental pulp complex will allow an opportunity for biological management to remove the cause of the insult to the dental pulp, modulate the inflammatory process, and promote the healing and repair capabilities of the tooth. Current strategies include use of conventional dental pulp medicaments while newer methods include bioactive molecules, epigenetic modifications and tissue engineering.
CONCLUSION
Regenerative medicine methods are in their infancy and experimental stages at best. This review highlights the future direction of dental caries management and consequently research.
Topics: Dental Caries; Dental Pulp; Dental Pulp Exposure; Humans; Immunity, Innate; Odontoblasts; Regeneration
PubMed: 31710968
DOI: 10.1016/j.archoralbio.2019.104591 -
British Dental Journal Mar 2022To reach an accurate endodontic diagnosis, it is important for clinicians to understand how to undertake pulpal sensibility tests correctly, how to interpret their...
To reach an accurate endodontic diagnosis, it is important for clinicians to understand how to undertake pulpal sensibility tests correctly, how to interpret their results and how to understand their limitations. Part one of this series defined different terms relevant to pulp testing and detailed the diagnostic uses and diagnostic accuracy of pulp testing methods. This section describes clinical techniques for commonly used pulp tests and highlights their limitations and correct interpretation of their results. Applying these principles and techniques will enable accurate endodontic diagnosis in different clinical scenarios.
Topics: Dental Care; Dental Pulp; Dental Pulp Diseases; Dental Pulp Test; Humans
PubMed: 35338287
DOI: 10.1038/s41415-022-4039-7 -
The Journal of Clinical Pediatric... 2015Biomarkers are functional elements at the cellular or molecular level, playing important roles in health and disease. The dentin-pulp complex of the tooth houses several... (Review)
Review
Biomarkers are functional elements at the cellular or molecular level, playing important roles in health and disease. The dentin-pulp complex of the tooth houses several biomarkers at different stages of development, and a lack of these biomarkers results in developmental disorders. Furthermore, biomarkers play a very important role in the pathogenesis of dental caries, pulpal and periapical pathoses in two ways - they are essential elements in the pathological process and their detection helps in accurate diagnosis of the pathological condition. The aim of this paper is to review the literature regarding the important biomarkers involved in the development of the dentin-pulp complex and in the pathological conditions involving the dentin-pulp complex.
Topics: Biomarkers; Dental Caries; Dental Pulp; Dentin; Dentinogenesis; Humans; Matrix Metalloproteinases; Odontogenesis; Oral Health; Periapical Diseases; Pulpitis; Tooth Diseases
PubMed: 25951306
DOI: 10.17796/jcpd.39.2.r32617516412p710