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International Journal of Molecular... Aug 2021Pulpal and periapical diseases account for a large proportion of dental visits, the current treatments for which are root canal therapy (RCT) and pulp revascularisation.... (Review)
Review
Pulpal and periapical diseases account for a large proportion of dental visits, the current treatments for which are root canal therapy (RCT) and pulp revascularisation. Despite the clinical signs of full recovery and histological reconstruction, true regeneration of pulp tissues is still far from being achieved. The goal of regenerative endodontics is to promote normal pulp function recovery in inflamed or necrotic teeth that would result in true regeneration of the pulpodentinal complex. Recently, rapid progress has been made related to tissue engineering-mediated pulp regeneration, which combines stem cells, biomaterials, and growth factors. Since the successful isolation and characterisation of dental pulp stem cells (DPSCs) and other applicable dental mesenchymal stem cells, basic research and preclinical exploration of stem cell-mediated functional pulp regeneration via cell transplantation and cell homing have received considerably more attention. Some of this effort has translated into clinical therapeutic applications, bringing a ground-breaking revolution and a new perspective to the endodontic field. In this article, we retrospectively examined the current treatment status and clinical goals of pulpal and periapical diseases and scrutinized biological studies of functional pulp regeneration with a focus on DPSCs, biomaterials, and growth factors. Then, we reviewed preclinical experiments based on various animal models and research strategies. Finally, we summarised the current challenges encountered in preclinical or clinical regenerative applications and suggested promising solutions to address these challenges to guide tissue engineering-mediated clinical translation in the future.
Topics: Animals; Dental Pulp; Guided Tissue Regeneration, Periodontal; Humans; Mesenchymal Stem Cells; Regeneration; Retrospective Studies; Root Canal Therapy; Stem Cells; Tissue Engineering
PubMed: 34445703
DOI: 10.3390/ijms22168991 -
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 -
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 -
Journal of Tissue Engineering and... Jan 2019More than two thirds of the global population suffers from tooth decay, which results in cavities with various levels of lesion severity. Clinical interventions to treat... (Review)
Review
More than two thirds of the global population suffers from tooth decay, which results in cavities with various levels of lesion severity. Clinical interventions to treat tooth decay range from simple coronal fillings to invasive root canal treatment. Pulp capping is the only available clinical option to maintain the pulp vitality in deep lesions, but irreversible pulp inflammation and reinfection are frequent outcomes for this treatment. When affected pulp involvement is beyond repair, the dentist has to perform endodontic therapy leaving the tooth non-vital and brittle. On-going research strategies have failed to overcome the limitations of existing pulp capping materials so that healthy and progressive regeneration of the injured tissues is attained. Preserving pulp vitality is crucial for tooth homeostasis and durability, and thus, there is a critical need for clinical interventions that enable regeneration of the dentin-pulp complex to rescue millions of teeth annually. The identification and development of appropriate biomaterials for dentin-pulp scaffolds are necessary to optimize clinical approaches to regenerate these hybrid dental tissues. Likewise, a deep understanding of the interactions between the micro-environment, growth factors, and progenitor cells will provide design basis for the most fitting scaffolds for this purpose. In this review, we first introduce the long-lasting clinical dental problem of rescuing diseased tooth vitality, the limitations of current clinical therapies and interventions to restore the damaged tissues, and the need for new strategies to fully revitalize the tooth. Then, we comprehensively report on the characteristics of the main materials of naturally-derived and synthetically-engineered polymers, ceramics, and composite scaffolds as well as their use in dentin-pulp complex regeneration strategies. Finally, we present a series of innovative smart polymeric biomaterials with potential to overcome dentin-pulp complex regeneration challenges.
Topics: Animals; Dental Pulp; Dentin; Humans; Regeneration; Stem Cells; Tissue Engineering; Tissue Scaffolds
PubMed: 30376696
DOI: 10.1002/term.2769 -
International Journal of Molecular... Nov 2021The therapeutic potential of the dental pulp stem (DSC) cell-derived secretome, consisting of various biomolecules, is undergoing intense research. Despite promising in... (Review)
Review
The therapeutic potential of the dental pulp stem (DSC) cell-derived secretome, consisting of various biomolecules, is undergoing intense research. Despite promising in vitro and in vivo studies, most DSC secretome-based therapies have not been implemented in human medicine because the paracrine effect of the bioactive factors secreted by human dental pulp stem cells (hDPSCs) and human exfoliated deciduous teeth (SHEDs) is not completely understood. In this review, we outline the current data on the hDPSC- and SHED-derived secretome as a potential candidate in the regeneration of bone, cartilage, and nerve tissue. Published reports demonstrate that the dental MSC-derived secretome/conditional medium may be effective in treating neurodegenerative diseases, neural injuries, cartilage defects, and repairing bone by regulating neuroprotective, anti-inflammatory, antiapoptotic, and angiogenic processes through secretome paracrine mechanisms. Dental MSC-secretomes, similarly to the bone marrow MSC-secretome activate molecular and cellular mechanisms, which determine the effectiveness of cell-free therapy. Many reports emphasize that dental MSC-derived secretomes have potential application in tissue-regenerating therapy due to their multidirectional paracrine effect observed in the therapy of many different injured tissues.
Topics: Dental Pulp; Humans; Mesenchymal Stem Cells; Neurodegenerative Diseases; Regenerative Medicine; Secretome; Stem Cells
PubMed: 34769446
DOI: 10.3390/ijms222112018 -
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 -
Australian Endodontic Journal : the... Dec 2023Tooth decay, which leads to pulpal inflammation due to the pulp's response to bacterial components and byproducts is the most common infectious disease. The main goals... (Review)
Review
Tooth decay, which leads to pulpal inflammation due to the pulp's response to bacterial components and byproducts is the most common infectious disease. The main goals of clinical management are to eliminate sources of infection, to facilitate healing by regulating inflammation indental tissue, and to replace lost tissues. A variety of novel approaches from tissue engineering based on stem cells, bioactive molecules, and extracellular matrix-like scaffold structures to therapeutic applications, or a combination of all these are present in the literature. Shortcomings of existing conventional materials for pulp capping and the novel approches aiming to preserve pulp vitality highligted the need for developing new targeted dental materials. This review looks at the novel approches for vital pulp treatments after briefly addresing the conventional vital pulp treatment as well as the regenerative and self defense capabilities of the pulp. A narrative review focusing on the current and future approaches for pulp preservation was performed after surveying the relevant papers on vital pulp therapies including pulp capping, pulpotomy, and potential approaches for facilitating dentin-pulp complex regeneration in PubMed, Medline, and Scopus databases.
Topics: Humans; Dental Pulp; Wound Healing; Pulpotomy; Tissue Engineering; Dental Pulp Capping; Inflammation
PubMed: 37515353
DOI: 10.1111/aej.12772 -
PloS One 2016Pulpitis is mainly caused by an opportunistic infection of the pulp space with commensal oral microorganisms. Depending on the state of inflammation, different treatment... (Review)
Review
BACKGROUND AND OBJECTIVE
Pulpitis is mainly caused by an opportunistic infection of the pulp space with commensal oral microorganisms. Depending on the state of inflammation, different treatment regimes are currently advocated. Predictable vital pulp therapy depends on accurate determination of the pulpal status that will allow repair to occur. The role of several players of the host response in pulpitis is well documented: cytokines, proteases, inflammatory mediators, growth factors, antimicrobial peptides and others contribute to pulpal defense mechanisms; these factors may serve as biomarkers that indicate the status of the pulp. Therefore, the aim of this systematic review was to evaluate the presence of biomarkers in pulpitis.
METHODS
The electronic databases of MEDLINE, EMBASE, Scopus and other sources were searched for English and non-English articles published through February 2015. Two independent reviewers extracted information regarding study design, tissue or analyte used, outcome measures, results and conclusions for each article. The quality of the included studies was assessed using a modification of the Newcastle-Ottawa-Scale.
RESULTS AND CONCLUSIONS
From the initial 847 publications evaluated, a total of 57 articles were included in this review. In general, irreversible pulpitis was associated with different expression of various biomarkers compared to normal controls. These biomarkers were significantly expressed not only in pulp tissue, but also in gingival crevicular fluid that can be collected non-invasively, and in dentin fluid that can be analyzed without extirpating the entire pulpal tissue. Such data may then be used to accurately differentiate diseased from healthy pulp tissue. The interplay of pulpal biomarkers and their potential use for a more accurate and biologically based diagnostic tool in endodontics is envisaged.
Topics: Antimicrobial Cationic Peptides; Biomarkers; Cytokines; Databases, Factual; Dental Pulp; Enzymes; Humans; Inflammation; Leukocytes; Peptide Hydrolases
PubMed: 27898727
DOI: 10.1371/journal.pone.0167289 -
Journal of Endodontics Jan 2018The success of periodontal and endodontic treatments depends on the total recovery from both conditions regardless of their occurrence as independent or combined... (Comparative Study)
Comparative Study
INTRODUCTION
The success of periodontal and endodontic treatments depends on the total recovery from both conditions regardless of their occurrence as independent or combined lesions. There is strong presumptive evidence that teeth with periodontal disease may cause pulpal inflammation and degeneration. Therefore, the goal of this study was to establish a correlation between periodontitis and pulp volume.
METHODS
Thirty-four dental images from 17 patients obtained by cone-beam computed tomography were analyzed by medical software to create three-dimensional images. Paired t test analysis was used for statistical analysis.
RESULTS
The statistical analysis showed that periodontitis had a significant effect on the volume and surface areas of the dental pulp (P < .05).
CONCLUSIONS
The findings of this study showed that periodontitis causes pulp volume to reduce by approximately 20%. The use of three-dimensional models provides better understanding of the dental anatomy before endodontic treatment and, consequently, improvement of treatment outcomes. Additional studies are needed to investigate the effect of periodontal disease on pulp volume and surface area.
Topics: Cone-Beam Computed Tomography; Dental Pulp; Female; Humans; Male; Organ Size; Periodontitis
PubMed: 29079049
DOI: 10.1016/j.joen.2017.09.005 -
Journal of Biological Regulators and... 2011Pulpitis is a typical inflammatory disease of dental pulp, characterized by the local accumulation of inflammatory mediators, including cytokines and chemokines. In... (Review)
Review
Pulpitis is a typical inflammatory disease of dental pulp, characterized by the local accumulation of inflammatory mediators, including cytokines and chemokines. In addition to serving as intercellular messengers mediating the inflammatory response, cytokines and chemokines induce the expression and stimulate the activity of molecular and cellular agents which participate actively in destructive and reparative processes in the pulp. It is the balance between these processes which eventually determines the extent of pulp inflammation and the viability of the affected tooth. Over the last decade, a number of studies have attempted to correlate cytokine gene expression in the pulp with various stages of inflammation, with possible diagnostic applications in mind. A small survey of relevant information is presented in this paper.
Topics: Animals; Cytokines; Dental Pulp; Gene Expression Regulation; Humans; Inflammation; Pulpitis
PubMed: 22023754
DOI: No ID Found