-
Australian Dental Journal Mar 2007The dental pulp is a unique tissue and its importance in the long-term prognosis of the tooth is often ignored by clinicians. It is unique in that it resides in a rigid...
The dental pulp is a unique tissue and its importance in the long-term prognosis of the tooth is often ignored by clinicians. It is unique in that it resides in a rigid chamber which provides strong mechanical support and protection from the microbial rich oral environment. If this rigid shell loses its structural integrity, the pulp is under the threat of the adverse stimuli from the mouth, such as caries, cracks, fractures and open restoration margins, all of which provide pathways for micro-organisms and their toxins to enter the pulp. The pulp initially responds to irritation by becoming inflamed and, if left untreated, this will progress to pulp necrosis and infection. The inflammation will also spread to the surrounding alveolar bone and cause periapical pathosis. The magnitude of pulp-related problems should not be underestimated since their most serious consequence is oral sepsis, which can be life threatening, and hence correct diagnosis and management are essential. Clinicians must have a thorough understanding of the physiological and pathological features of the dental pulp as well as the biological consequences of treatment interventions.
Topics: Dental Pulp; Dental Pulp Diseases; Disease Progression; Humans; Microcirculation; Odontoblasts; Pulpitis; Regional Blood Flow
PubMed: 17546858
DOI: 10.1111/j.1834-7819.2007.tb00525.x -
Dental Clinics of North America Jan 2013Vital pulp therapy is performed to preserve the health status of the tooth and its ultimate position in the arch. These procedures are performed routinely in primary and... (Review)
Review
Vital pulp therapy is performed to preserve the health status of the tooth and its ultimate position in the arch. These procedures are performed routinely in primary and permanent teeth. This review is divided into 2 parts: the first aims to illustrate the basic biology of the pulp and the effects on the pulp due to various procedures; the second focuses on the clinical aspects of treatment and the use of various dental materials during different vital pulp therapy procedures performed in the primary and permanent teeth.
Topics: Apexification; Child; Child, Preschool; Dental Pulp; Dental Pulp Capping; Humans; Pulpotomy; Regeneration
PubMed: 23174610
DOI: 10.1016/j.cden.2012.09.004 -
Journal of Endodontics Jul 2017Similar to other tissues, the dental pulp mounts an inflammatory reaction as a way to eliminate pathogens and stimulate repair. Pulp inflammation is prerequisite for... (Review)
Review
INTRODUCTION
Similar to other tissues, the dental pulp mounts an inflammatory reaction as a way to eliminate pathogens and stimulate repair. Pulp inflammation is prerequisite for dentin pulp complex repair and regeneration; otherwise, chronic disease or pulp necrosis occurs. Evaluation of pulp inflammation severity is necessary to predict the clinical success of maintaining pulp vitality. Clinical limitations to evaluating in situ inflammatory status are well-described. A molecular approach that aids clinical distinction between reversible and irreversible pulpitis could improve the success rate of vital pulp therapy. The aim of this article is to review inflammatory mediator expression in the context of clinical diagnosis.
METHODS
We searched PubMed and Cochrane databases for articles published between 1970 and December 2016. Only published studies of inflammatory mediator expression related to clinical diagnosis were eligible for inclusion and analysis.
RESULTS
Thirty-two articles were analyzed. Two molecular approaches were described by study methods, protein expression analysis and gene expression analysis. Our review indicates that interleukin-8, matrix metalloproteinase 9, tumor necrosis factor-α, and receptor for advanced glycation end products expression increase at both the gene and protein levels during inflammation.
CONCLUSIONS
Clinical irreversible pulpitis is related to specific levels of inflammatory mediator expression. The difference in expression between reversible and irreversible disease is both quantitative and qualitative. On the basis of our analysis, in situ quantification of inflammatory mediators may aid in the clinical distinction between reversible and irreversible pulpitis.
Topics: Biomarkers; Dental Pulp; Humans; Pulpitis
PubMed: 28527838
DOI: 10.1016/j.joen.2017.02.009 -
Journal of Endodontics Mar 2022Orthodontic force triggers a sequence of biological responses that can affect dental pulp. The aim of this study was to systematically evaluate the clinical and... (Review)
Review
INTRODUCTION
Orthodontic force triggers a sequence of biological responses that can affect dental pulp. The aim of this study was to systematically evaluate the clinical and radiographic findings of orthodontic force application on dental pulp.
METHODS
Two reviewers comprehensively and systematically searched 6 electronic databases (Latin American and Caribbean Health Sciences [LILACS], Embase, Cochrane Library, MEDLINE/PubMed, Scopus, and Web of Science) and the gray literature (Google Scholar, OpenGrey, and ProQuest) until April 2021. According to the PICOS criteria, randomized clinical trials and observational studies that evaluated clinical or radiographic findings compatible with dental pulp changes due to orthodontic force were included. Studies in open apex or traumatized teeth, case series or reports, and laboratory-based or animal studies were excluded. The Newcastle-Ottawa Scale and Cochrane Risk of Bias 2.0 tool were used to determine the risk of bias assessment. The overall certainty level was evaluated with the Grading of Recommendations, Assessment, Development and Evaluations tool.
RESULTS
Twenty-six studies were included. Among the clinical findings, orthodontic force promoted an increased pulp sensibility response and decreased pulp blood flow. Changes in pulp cavity volume and increased incidence of pulp stones were the radiographic findings observed. The studies presented a moderate risk of bias for most of the domains. The certainty of the evidence was considered very low.
CONCLUSIONS
Orthodontic force promoted changes in the dental pulp, generating clinical and radiographic findings. It is crucial to know these changes so that orthodontic mechanics can be safely performed. The clinician has effective noninvasive methods to assess the health and possible pulp changes during orthodontic treatment.
Topics: Dental Pulp; Dental Pulp Calcification; Humans
PubMed: 34890594
DOI: 10.1016/j.joen.2021.11.018 -
Journal of Endodontics Sep 2017Dental pulp regeneration after pulp necrosis in immature teeth represents a major departure from traditional endodontic therapy of these conditions. Preliminary clinical... (Review)
Review
Dental pulp regeneration after pulp necrosis in immature teeth represents a major departure from traditional endodontic therapy of these conditions. Preliminary clinical attempts have shown the feasibility of developing mineralized repair tissue, which may provide a clinically acceptable outcome. However, this outcome may not provide sufficient host response and root strength to ensure the longevity of the involved teeth. It is not clear if these preliminary suboptimal results are caused by the inability to fully disinfect the pulp space or the absence of a suitable progenitor cell/scaffold template together with adequate vascularity. Moreover, it is not known to what degree the root canal system needs to be disinfected in order for clinical success to be evident. This article describes the current clinical strategies and protocols for the optimal disinfection and preparation of the pulp space environment to promote periapical healing as well as soft and hard tissue development after an infectious process. Current and future strategies for disinfecting the pulp space with minimal disruption of the necessary biological factors from dentin, the progenitor cells in periapical vital tissues, and the vascularity are discussed. The potential for success of pulp regeneration after necrosis and infection would transform the practice of endodontics, even for mature teeth. This is a goal worth pursuing because it would achieve the restoration of normal host responses in the pulp space and the regeneration of destroyed dental tissues.
Topics: Anti-Bacterial Agents; Bacteria; Dental Pulp; Disinfection; Humans; Regeneration; Stem Cells
PubMed: 28778502
DOI: 10.1016/j.joen.2017.06.010 -
International Journal of Paediatric... Jan 2009It is now accepted that progenitor/stem cells reside within the post-natal dental pulp. Studies have identified several niches of multipotent mesenchymal progenitor... (Review)
Review
INTRODUCTION
It is now accepted that progenitor/stem cells reside within the post-natal dental pulp. Studies have identified several niches of multipotent mesenchymal progenitor cells, known as dental pulp stem cells, which have a high proliferative potential for self-renewal. These progenitor stem cells are now recognized as being vital to the dentine regeneration process following injury. Understanding the nature of these progenitor/stem cell populations in the pulp is important in determining their potentialities and development of isolation or recruitment strategies for use in regeneration and tissue engineering. Characterization of these cells, and determination of their potentialities in terms of specificity of regenerative response, may help direct new clinical treatment modalities. Such novel treatments may involve controlled direct recruitment of the cells in situ and possible seeding of stem cells at sites of injury for regeneration or use of the stem cells with appropriate scaffolds for tissue engineering solutions. Such approaches may provide an innovative and novel biologically based new generation of clinical materials and/or treatments for dental disease.
AIM
This study aimed to review the body of knowledge relating to stem cells and to consider the possibility of these cell populations, and related technology, in future clinical applications.
Topics: Dental Pulp; Guided Tissue Regeneration; Humans; Mesenchymal Stem Cells; Multipotent Stem Cells; Stem Cells; Tissue Engineering; Tissue Scaffolds
PubMed: 19120509
DOI: 10.1111/j.1365-263X.2008.00964.x -
Journal of Endodontics Sep 2017Creating an optimal microenvironment that supports angiogenesis, cell-cell cross talk, cell migration, and differentiation is crucial for pulp/dentin regeneration. It... (Review)
Review
Creating an optimal microenvironment that supports angiogenesis, cell-cell cross talk, cell migration, and differentiation is crucial for pulp/dentin regeneration. It was shown that dental stem cells being seeded onto a scaffold and transplanted in vivo could give rise to a new tissue similar to that of the native pulp. However, the unique structure of the tooth with a pulp space encased within hard dentin allows only a single blood supply from a small apical opening located at the apex of the root canals. Therefore, a further strategy that can address this limitation such as the incorporation of endothelial/endothelial progenitor cells or cells with high angiogenic potential into the transplant is required so that the added cells can contribute to the vascularization within the implant. However, the placement of 2 or more different cell types inside 3-dimensional porous scaffolds is technologically challenging. In contrast to the conventional scaffolding approach, self-assembly of monodispersed cells into 3-dimensional tissue mimics permits true physiological interactions between and among different types of cells without any influence from a secondary material. In this review, we discuss potential strategies that can be used in vasculature engineering in dental pulp regeneration with a specific emphasis on combining prevascularization and scaffold-based or scaffold-free approaches.
Topics: Animals; Dental Pulp; Guided Tissue Regeneration; Humans; Neovascularization, Physiologic; Tissue Engineering; Tissue Scaffolds
PubMed: 28962902
DOI: 10.1016/j.joen.2017.09.003 -
Stem Cell Research & Therapy Dec 2018Adult stem cells are excellent cell resource for cell therapy and regenerative medicine. Dental pulp stem cells (DPSCs) have been discovered and well known in various... (Review)
Review
Adult stem cells are excellent cell resource for cell therapy and regenerative medicine. Dental pulp stem cells (DPSCs) have been discovered and well known in various application. Here, we reviewed the history of dental pulp stem cell study and the detail experimental method including isolation, culture, cryopreservation, and the differentiation strategy to different cell lineage. Moreover, we discussed the future potential application of the combination of tissue engineering and of DPSC differentiation. This review will help the new learner to quickly get into the DPSC filed.
Topics: Cells, Cultured; Dental Pulp; Humans; Stem Cells; Tissue Engineering
PubMed: 30545418
DOI: 10.1186/s13287-018-1094-8 -
Pediatric Dentistry 2008The regenerative potential of dental pulp, particularly in mature teeth, has been considered extremely limited. However, our improved understanding of pulpal... (Review)
Review
The regenerative potential of dental pulp, particularly in mature teeth, has been considered extremely limited. However, our improved understanding of pulpal inflammation and repair and improved dental materials and technologies make vital pulp therapy a viable alternative to root canal treatment. This article explores our knowledge in this regard and the future potential of saving or even regenerating the pulp as a routine dental procedure.
Topics: Animals; Dental Pulp; Dental Pulp Exposure; Dental Pulp Necrosis; Humans; Neovascularization, Physiologic; Pulpitis; Pulpotomy; Regeneration
PubMed: 18615985
DOI: No ID Found -
Journal of Endodontics Jul 2008The regenerative potential of dental pulp, particularly in mature teeth, has been considered extremely limited. However, our improved understanding of pulpal... (Review)
Review
The regenerative potential of dental pulp, particularly in mature teeth, has been considered extremely limited. However, our improved understanding of pulpal inflammation and repair and improved dental materials and technologies make vital pulp therapy a viable alternative to root canal treatment. This article explores our knowledge in this regard and the future potential of saving or even regenerating the pulp as a routine dental procedure.
Topics: Animals; Dental Pulp; Dental Pulp Exposure; Dental Pulp Necrosis; Humans; Neovascularization, Physiologic; Pulpitis; Pulpotomy; Regeneration
PubMed: 18565365
DOI: 10.1016/j.joen.2008.04.001