1
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Sabeti M, Ghobrial D, Zanjir M, da Costa BR, Young Y, Azarpazhooh A. Treatment outcomes of regenerative endodontic therapy in immature permanent teeth with pulpal necrosis: A systematic review and network meta-analysis. Int Endod J 2024; 57:238-255. [PMID: 37966465 DOI: 10.1111/iej.13999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 10/21/2023] [Accepted: 10/25/2023] [Indexed: 11/16/2023]
Abstract
AIM The aim of this study was to assess which treatment modality regarding scaffold selection for immature permanent teeth with pulpal necrosis will be the most successful for regenerative endodontic treatment (RET). METHODOLOGY PubMed, Cochrane, Web of Science and Embase, and additional records until August 2022 were searched providing a total of 3021 articles, and nine of these articles were included for quantitative synthesis. The reviewers selected eligible randomized controlled trials and extracted pertinent data. Network meta-analysis was conducted to estimate treatment effects for primary outcomes (clinical and radiographic healing) and secondary outcomes (apical closure, root length and root wall thickness increase) following RET [mean difference (MD); 95% credible interval (CrI) and surface under the cumulative ranking curve (SUCRA)]. The quality of the included studies was appraised by the revised Cochrane risk of bias tool, and the quality of evidence was assessed using the GRADE approach. RESULTS Six interventions from nine included studies were identified: blood clot scaffold (BC), blood clot scaffold with basic fibroblast growth factor, blood clot scaffold with collagen, platelet pellet, platelet-rich plasma (PRP) and platelet-rich fibrin (PRF). The PRP scaffold showed the greatest increase in root lengthening at 6-12 months (MD = 4.2; 95% CrI, 1.2 to 6.8; SUCRA = 89.0%, very low confidence). PRP or PRF achieved the highest level of success for primary and secondary outcomes at 1-6 and 6-12 months. Blood clot scaffold (with collagen or combined with basic fibroblast growth factor (bFGF)) achieved the highest level of success for secondary outcomes beyond 12 months follow-up. A very low to low quality of evidence suggests that both PRP and PRF exhibit the greatest success evaluating primary and secondary outcomes within 12 months postoperatively compared to the traditional blood clot scaffold protocol. CONCLUSION Limited evidence suggests both PRP and PRF exhibit success in the short-term, not long-term. The value of this information stems in its recommendation for future randomized trials prioritizing both of these materials in their protocol.
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Affiliation(s)
- Mohammad Sabeti
- Department of Preventive and Restorative Dental Science, UCSF School of Dentistry, San Francisco, California, USA
| | - Daniel Ghobrial
- PG Endodontic Resident, UCSF School of Dentistry, San Francisco, California, USA
| | - Maryam Zanjir
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Bruno R da Costa
- Clinical Epidemiology & Health Care Research, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Yating Young
- UCSF School of Dentistry, San Francisco, California, USA
| | - Amir Azarpazhooh
- Head Division of Endodontics and Research, Director, Department of Dentistry, Faculty of Advanced Training Program in Orofacial, Faculty of Dentistry, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
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2
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Astudillo-Ortiz E, Babo PS, Sunde PT, Galler KM, Gomez-Florit M, Gomes ME. Endodontic Tissue Regeneration: A Review for Tissue Engineers and Dentists. TISSUE ENGINEERING. PART B, REVIEWS 2023; 29:491-513. [PMID: 37051704 DOI: 10.1089/ten.teb.2022.0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
The paradigm shift in the endodontic field from replacement toward regenerative therapies has witnessed the ever-growing research in tissue engineering and regenerative medicine targeting pulp-dentin complex in the past few years. Abundant literature on the subject that has been produced, however, is scattered over diverse areas of knowledge. Moreover, the terminology and concepts are not always consensual, reflecting the range of research fields addressing this subject, from endodontics to biology, genetics, and engineering, among others. This fact triggered some misinterpretations, mainly when the denominations of different approaches were used as synonyms. The evaluation of results is not precise, leading to biased conjectures. Therefore, this literature review aims to conceptualize the commonly used terminology, summarize the main research areas on pulp regeneration, identify future trends, and ultimately clarify whether we are really on the edge of a paradigm shift in contemporary endodontics toward pulp regeneration.
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Affiliation(s)
- Esteban Astudillo-Ortiz
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga, Portugal
- Department of Endodontics, School of Dentistry, University of Cuenca, Cuenca, Ecuador
| | - Pedro S Babo
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga, Portugal
| | - Pia T Sunde
- Department of Endodontics, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Kerstin M Galler
- Department of Operative Dentistry and Periodontology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | | | - Manuela E Gomes
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga, Portugal
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3
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Santos LM, Cardoso PES, Diniz EA, Rahhal JG, Sipert CR. Different concentrations of fetal bovine serum affect cytokine modulation in Lipopolysaccharide-activated apical papilla cells in vitro. J Appl Oral Sci 2023; 31:e20230020. [PMID: 37493700 PMCID: PMC10382075 DOI: 10.1590/1678-7757-2023-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/13/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Fetal bovine serum (FBS) is the most used supplement in culture media; however, it may interfere with in vitro assays via effects on cell proliferation and cytokine production. The ideal FBS concentration for assays using apical papilla cells (APCs) remains unknown. Therefore, this study aimed to evaluate the effects of FBS on APC activation, cell viability/proliferation, and cytokine production. METHODOLOGY Human APCs were cultured, plated, and maintained in media containing increasing concentrations of FBS for 24 h, 48 h, 72 h, 7 days, and 14 days in the presence of Lipopolysaccharide (LPS - 1 µg/mL). At each time point, the cells were subjected to the MTT assay. The cytokines transforming growth factor (TGF)-β1, osteoprotegerin (OPG), and interleukin (IL)-6, along with the chemokine CCL2, were quantified using the enzyme-linked immunosorbent assay at the 24-h time-point. Statistical analysis was performed using two-way analysis of variance (ANOVA) followed by Tukey's post-hoc test (p<0.05). RESULTS In general, APCs exhibited increasing metabolic activity in an FBS concentration-dependent fashion, regardless of the presence of LPS. In contrast, FBS interfered with the production of all the cytokines evaluated in this study, affecting the response induced by the presence of LPS. CONCLUSION FBS increased APC metabolism in a concentration-dependent manner and differentially affected the production of TGF-β1, OPG, IL-6, and CCL2 by APCs in vitro.
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Affiliation(s)
- Letícia Martins Santos
- Universidade de São Paulo, Departamento de Dentística, Faculdade de Odontologia, São Paulo, SP, Brasil
| | - Patricia E Silva Cardoso
- Universidade de São Paulo, Departamento de Dentística, Faculdade de Odontologia, São Paulo, SP, Brasil
| | - Elisa Abreu Diniz
- Universidade de São Paulo, Departamento de Dentística, Faculdade de Odontologia, São Paulo, SP, Brasil
| | - Juliana Garuba Rahhal
- Universidade de São Paulo, Departamento de Dentística, Faculdade de Odontologia, São Paulo, SP, Brasil
| | - Carla Renata Sipert
- Universidade de São Paulo, Departamento de Dentística, Faculdade de Odontologia, São Paulo, SP, Brasil
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4
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Namazi SS, Mahmoud AH, Dal-Fabbro R, Han Y, Xu J, Sasaki H, Fenno JC, Bottino MC. Multifunctional and biodegradable methacrylated gelatin/Aloe vera nanofibers for endodontic disinfection and immunomodulation. BIOMATERIALS ADVANCES 2023; 150:213427. [PMID: 37075551 PMCID: PMC11027083 DOI: 10.1016/j.bioadv.2023.213427] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/21/2023] [Accepted: 04/08/2023] [Indexed: 04/21/2023]
Abstract
Currently employed approaches and materials used for vital pulp therapies (VPTs) and regenerative endodontic procedures (REPs) lack the efficacy to predictably achieve successful outcomes due to their inability to achieve adequate disinfection and/or lack of desired immune modulatory effects. Natural polymers and medicinal herbs are biocompatible, biodegradable, and present several therapeutic benefits and immune-modulatory properties; thus, standing out as a clinically viable approach capable of establishing a conducive environment devoid of bacteria and inflammation to support continued root development, dentinal bridge formation, and dental pulp tissue regeneration. However, the low stability and poor mechanical properties of the natural compounds have limited their application as potential biomaterials for endodontic procedures. In this study, Aloe vera (AV), as a natural antimicrobial and anti-inflammatory agent, was incorporated into photocrosslinkable Gelatin methacrylate (GelMA) nanofibers with the purpose of developing a highly biocompatible biomaterial capable of eradicating endodontic infection and modulating inflammation. Stable GelMA/AV nanofibers with optimal properties were obtained at the ratio of (70:30) by electrospinning. In addition to the pronounced antibacterial effect against Enterococcus faecalis, the GelMA/AV (70:30) nanofibers also exhibited a sustained antibacterial activity over 14 days and significant biofilm reduction with minimal cytotoxicity, as well as anti-inflammatory properties and immunomodulatory effects favoring healing. Our results indicate that the novel GelMA/AV (70:30) nanofibers hold great potential as a biomaterial strategy for endodontic infection eradication and enhanced healing.
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Affiliation(s)
- Sharon S Namazi
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Abdel H Mahmoud
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Renan Dal-Fabbro
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Yuanyuan Han
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Jinping Xu
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Hajime Sasaki
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - J Christopher Fenno
- Department of Biologic and Materials Sciences & Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Marco C Bottino
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, MI, USA.
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5
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Shi Y, Wang Y, Shan Z, Gao Z. Decellularized rat submandibular gland as an alternative scaffold for dental pulp regeneration. Front Bioeng Biotechnol 2023; 11:1148532. [PMID: 37152652 PMCID: PMC10160494 DOI: 10.3389/fbioe.2023.1148532] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/11/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction: Decellularized extracellular matrix has been recognized as an optimal scaffold for dental pulp regeneration. However, the limited amount of native dental pulp tissue restricts its clinical applications. The submandibular gland shares some basic extracellular matrix components and characteristics with dental pulp. However, whether decellularized submandibular gland extracellular matrix (DSMG) can be used as an alternative scaffold for dental pulp regenerative medicine is unclear. Methods: Thus, we successfully decellularized the whole rat submandibular gland and human dental pulp, and then conducted in vitro and in vivo studies to compare the properties of these two scaffolds for dental pulp regeneration. Results: Our results showed that extracellular matrix of the submandibular gland had great similarities in structure and composition with that of dental pulp. Furthermore, it was confirmed that the DSMG could support adhesion and proliferation of dental pulp stem cells in vitro. In vivo findings revealed that implanted cell-seeded DSMG formed a vascularized dental pulp-like tissue and expressed markers involved in dentinogenesis and angiogenesis. Discussion: In summary, we introduced a novel accessible biological scaffold and validated its effectiveness as an extracellular matrix-based tissue engineering scaffold for dental pulp regenerative therapy.
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Affiliation(s)
| | | | | | - Zhenhua Gao
- *Correspondence: Zhenhua Gao, ; Zhaochen Shan,
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6
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The Four Pillars for Successful Regenerative Therapy in Endodontics: Stem Cells, Biomaterials, Growth Factors, and Their Synergistic Interactions. Stem Cells Int 2022; 2022:1580842. [PMID: 36193253 PMCID: PMC9526564 DOI: 10.1155/2022/1580842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 08/14/2022] [Accepted: 08/25/2022] [Indexed: 01/08/2023] Open
Abstract
Endodontics has made significant progress in regenerative approaches in recent years, thanks to advances in biologically based procedures or regenerative endodontic therapy (RET). In recent years, our profession has witnessed a clear conceptual shift in this therapy. RET was initially based on a blood clot induced by apical bleeding without harvesting the patient’s cells or cell-free RET. Later, the RET encompassed the three principles of tissue engineering, stromal/stem cells, scaffolds, and growth factors, aiming for the regeneration of a functional dentin pulp complex. The regenerated dental pulp will recover the protective mechanisms including innate immunity, tertiary dentin formation, and pain sensitivity. This comprehensive review covers the basic knowledge and practical information for translational applications of stem cell-based RET and tissue engineering procedures for the regeneration of dental pulp. It will also provide overall information on the emerging technologies in biological and synthetic matrices, biomaterials, and signaling molecules, recent advances in stem cell therapy, and updated experimental results. This review brings useful and timely clinical evidence for practitioners to understand the challenges faced for a successful cell-based RET and the importance of preserving or reestablishing tooth vitality. The clinical translation of these current bioengineering approaches will undoubtedly be beneficial to the future practice of endodontics.
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7
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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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8
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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: 0.5] [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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9
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Characterization of Histopathology and Microbiota in Contemporary Regenerative Endodontic Procedures: Still Coming up Short. J Endod 2021; 47:1285-1293.e1. [DOI: 10.1016/j.joen.2021.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 05/14/2021] [Accepted: 05/15/2021] [Indexed: 12/25/2022]
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10
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Niu JY, Yin IX, Mei ML, Wu WKK, Li QL, Chu CH. The multifaceted roles of antimicrobial peptides in oral diseases. Mol Oral Microbiol 2021; 36:159-171. [PMID: 33721398 DOI: 10.1111/omi.12333] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/13/2021] [Accepted: 02/19/2021] [Indexed: 12/21/2022]
Abstract
Antimicrobial peptides are naturally occurring protein molecules with antibacterial, antiviral and/or antifungal activity. Some antimicrobial peptides kill microorganisms through direct binding with negatively charged microbial surfaces. This action disrupts the cytoplasmic membrane and leads to the leakage of the cytoplasm. In addition, they are involved in the innate immune response. Antimicrobial peptides play an important role in oral health, as natural antimicrobial peptides are the first line of host defence in response to microbial infection. The level of natural antimicrobial peptides increases during severe disease conditions and play a role in promoting the healing of oral tissues. However, they are insufficient for eliminating pathogenic micro-organisms. The variability of the oral environment can markedly reduce the effect of natural antimicrobial peptides. Thus, researchers are developing synthetic antimicrobial peptides with promising stability and biocompatibility. Synthetic antimicrobial peptides are a potential alternative to traditional antimicrobial therapy. Pertinent to oral diseases, the deregulation of antimicrobial peptides is involved in the pathogenesis of dental caries, periodontal disease, mucosal disease and oral cancer, where they can kill pathogenic microorganisms, promote tissue healing, serve as biomarkers and inhibit tumor cells. This narrative review provides an overview of the multifaceted roles of antimicrobial peptides in oral diseases.
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Affiliation(s)
- John Yun Niu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Iris Xiaoxue Yin
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - May Lei Mei
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.,Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - William Ka Kei Wu
- Department of Anaesthesia & Intensive Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Quan-Li Li
- School of Stomatology, Anhui Medical University, Hefei, China
| | - Chun Hung Chu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
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11
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Tanaka S, Toriumi T, Ito T, Okuwa Y, Futenma T, Otake K, Akiyama Y, Kurita K, Nagao T, Honda M. Histological analysis of dental pulp response in immature or mature teeth after extra-oral subcutaneous transplantation into mice dorsum. J Oral Sci 2021; 63:184-190. [PMID: 33731506 DOI: 10.2334/josnusd.20-0611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
PURPOSE The aim of this study was to assess the response of dental pulp associated with donor or host cells in the pulp chamber and root canal after extra-oral transplantation. METHODS Wild type or green fluorescent protein (GFP) transgenic first molars from 3-week, 6-week, and 12-week mice were transplanted into the subcutaneous layer of GFP mice or wild type mice. The teeth were histologically and immunohistochemically examined at 5 weeks after transplantation. RESULTS Blood vessels present in the original coronal pulp had anastomosed with those from the recipient tissue that had invaded the root canal. Two distinct eosin-stained extracellular matrices were observed in the pulp chamber and root canal. Acellular matrix composed of nestin-positive, odontoblast-like cells invaded from the outside and was seen in the root canal of 3-week teeth. Cellular matrix comprising alkaline phosphatase (ALP)-positive fibroblast-like cells appeared in the original coronal pulp. In the root canal of the 6-week and 12-week teeth, cellular extracellular matrix consisting of ALP-positive fibroblast-like cells had invaded the recipient tissue. CONCLUSION Dental pulp from immature teeth might be able to regenerate dentin-like tissue. This model could be useful in the development of an optimized vitalization treatment.
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Affiliation(s)
- Sho Tanaka
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University
| | - Taku Toriumi
- Department of Oral Anatomy, School of Dentistry, Aichi Gakuin University
| | - Tatsuaki Ito
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University
| | - Yuta Okuwa
- Department of Oral Anatomy, School of Dentistry, Aichi Gakuin University
| | - Taku Futenma
- Department of Oral Anatomy, School of Dentistry, Aichi Gakuin University
| | - Keita Otake
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University
| | - Yasunori Akiyama
- Department of Oral Anatomy, School of Dentistry, Aichi Gakuin University
| | - Kenichi Kurita
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University
| | - Toru Nagao
- Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University
| | - Masaki Honda
- Department of Oral Anatomy, School of Dentistry, Aichi Gakuin University
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12
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Arora A, Bhesania D, Kapoor S, Kaur H. A 5 years' follow-up of root anatomy-based maturogenesis achieved in infected immature molars using regenerative techniques - A case series. J Conserv Dent 2021; 23:422-427. [PMID: 33623248 PMCID: PMC7883779 DOI: 10.4103/jcd.jcd_327_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/09/2020] [Accepted: 09/05/2020] [Indexed: 01/03/2023] Open
Abstract
Infected immature molars are commonly encountered but seldom are they treated using principles of regenerative endodontics. The case series describes a feasible technique for attempting maturogenesis based on molar tooth anatomy. A total of 9 infected immature molars in the patients between 6 and 18 years of age were treated as part of this case series. All the canals were disinfected using 3% sodium hypochlorite and 17% ethylenediaminetetraacetic acid following minimal instrumentation. After using triple antibiotic paste for 3 weeks, bleeding was induced in mesial or constricted canals and platelet-rich fibrin was placed in distal or open wide canals till the orifice level. Coronal seal was obtained using mineral trioxide aggregate. Outcome was evaluated clinically and radiographically at the periods of 3, 6, 12, 24, 36, and 60 months. All the teeth showed continued root development and maintained functionality but none responded to vitality testing. Anatomical aspects of individual roots within a tooth can be utilized as a guide to decide the appropriate approach for attempting maturogenesis in a molar. Root changes can be expected even if the pulp vitality is not restored.
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Affiliation(s)
- Ankit Arora
- Department of Conservative Dentistry and Endodontics, Manubhai Patel Dental College, Vadodara, Gujarat, India
| | - Dhvani Bhesania
- Private practitioner, Just Smile Dental Clinic, Rajkot, Gujarat, India
| | - Sonali Kapoor
- Department of Conservative Dentistry and Endodontics, Manubhai Patel Dental College, Vadodara, Gujarat, India
| | - Harleen Kaur
- Department of Paedodontics and Preventive Dentistry, Manubhai Patel Dental College, Vadodara, Gujarat, India
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13
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Arnold M. Reparative Endodontic Treatment of a Perforating Internal Inflammatory Root Resorption: A Case Report. J Endod 2020; 47:146-155. [PMID: 33065177 DOI: 10.1016/j.joen.2020.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 09/30/2020] [Indexed: 10/23/2022]
Abstract
The aim of this case report was to present a reparative treatment approach of an extensive internal inflammatory resorption with a lateral perforation and apical and lateral inflammatory lesions. Only the necrotic coronal part of the pulp was removed, and the vital pulp tissue within the resorption cavity and the apical part of the root canal was left uninstrumented. Bleeding was induced, and the blood clot was covered with mineral trioxide aggregate. Hard tissue repair and healing of the apical lesion could be observed in the 3-year recall.
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Affiliation(s)
- Michael Arnold
- Praxis für Endodontie und Zahnerhaltung, Dresden, Germany.
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14
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Huang GTJ, Liu J, Zhu X, Yu Z, Li D, Chen CA, Azim AA. Pulp/Dentin Regeneration: It Should Be Complicated. J Endod 2020; 46:S128-S134. [PMID: 32950184 DOI: 10.1016/j.joen.2020.06.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Stem cell-mediated regenerative endodontics has reached the human clinical trial phase; however, many issues still exist that prevent such technology to be a widely used clinical practice. These issues are not straightforward and are complicated. They should be because pulp regeneration is dealing with a small dead-end space. In addition, when regeneration is needed, the space is often heavily infected. The true standard of pulp regeneration should be everything except generation of some fibrous connective tissue and amorphous mineral deposit. As of now, we are still far short of reaching the standard of complete vascularized and innervated pulp regeneration with newly formed tubular dentin in all types of teeth. Thus, we need to go back to the bench and use established animal models or create new animal models to tackle those issues. This article will address several key issues including the possibility of pulp regeneration in small canals of molar teeth by enhancing the neovascularization, and whether the organized tubular dentin can be generated on the canal walls. Data from our semi-orthotopic tooth fragment mouse model have shown that complete pulp regeneration using dental pulp stem cells (DPSCs) in small canal has been inconsistent because of limited blood supply. This inconsistency is similar in our orthotopic miniature swine model, although in some cases vascularized pulp-like tissue can be formed throughout the canal space after DPSC transplantation. Furthermore, no tubular dentin was observed in the orthotopic pulp regeneration, despite the fact that DPSCs have the capacity to generate some tubular dentin-like structure in the hydroxyapatite/tricalcium phosphate-mediated ectopic pulp/dentin formation model in mice. Potential strategies to be tested to address these regeneration issues are discussed herein.
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Affiliation(s)
- George T-J Huang
- University of Tennessee Health Science Center, College of Dentistry, Department of Bioscience Research, Memphis, Tennessee.
| | - Jie Liu
- University of Tennessee Health Science Center, College of Dentistry, Department of Bioscience Research, Memphis, Tennessee
| | - Xiaofei Zhu
- University of Tennessee Health Science Center, College of Dentistry, Department of Bioscience Research, Memphis, Tennessee; VIP Dental Service and Geriatric Dentistry, School and Hospital of Stomatology, Peking University, Beijing, China
| | - Zongdong Yu
- University of Tennessee Health Science Center, College of Dentistry, Department of Bioscience Research, Memphis, Tennessee
| | - Dong Li
- University of Tennessee Health Science Center, College of Dentistry, Department of Bioscience Research, Memphis, Tennessee
| | - Chao-An Chen
- University of Tennessee Health Science Center, College of Dentistry, Department of Bioscience Research, Memphis, Tennessee; Chi Mei Medical Center, Department of Endodontics, Liouying, Tainan, Taiwan
| | - Adham A Azim
- University of Tennessee Health Science Center, College of Dentistry, Department of Bioscience Research, Memphis, Tennessee; University at Buffalo, School of Dental Medicine, Division of Endodontics, Buffalo, New York
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15
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Chang MC, Chang HH, Hsieh WC, Huang WL, Lian YC, Jeng PY, Wang YL, Yeung SY, Jeng JH. Effects of transforming growth factor-β1 on plasminogen activation in stem cells from the apical papilla: role of activating receptor-like kinase 5/Smad2 and mitogen-activated protein kinase kinase (MEK)/extracellular signal-regulated kinase (ERK) signalling. Int Endod J 2020; 53:647-659. [PMID: 31955434 DOI: 10.1111/iej.13266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 01/13/2020] [Indexed: 12/16/2022]
Abstract
AIM To study the effects of TGF-β1 on the plasminogen activation (PA) system of stem cells from the apical papilla (SCAP) and its signalling. METHODOLOGY SCAP cells were isolated from the apical papilla of immature permanent teeth extracted for orthodontic reasons. They were exposed to various concentration of TGF-β1 with/without pretreatment and coincubation by SB431542 (ALK/Smad2/3 inhibitor), or U0126 (MEK/ERK inhibitor). MTT assay, Western blotting and enzyme-linked immunosorbent assay (ELISA) were used to detect their effects on cell viability, and the protein expression of plasminogen activator inhibitor-1 (PAI-1), urokinase-type plasminogen activator (uPA), uPA receptor (uPAR) and their secretion. The paired Student's t-test was used for statistical analysis. RESULTS TGF-β1 significantly stimulated PAI-1 and soluble uPAR (suPAR) secretion of SCAP cells (P < 0.05), whereas uPA secretion was inhibited. Accordingly, TGF-β1 induced both PAI-1 and uPAR protein expression of SCAP cells. SB431542 (an ALK5/Smad2/3 inhibitor) pretreatment and coincubation prevented the TGF-β1-induced PAI-1 and uPAR of SCAP. U0126 attenuated the TGF-β1-induced expression/secretion of uPAR, but not PAI-1 in SCAP. SB431542 reversed the TGF-β1-induced decline of uPA. CONCLUSIONS TGF-β1 may affect the repair/regeneration activities of SCAP via differential increase or decrease of PAI-1, uPA and uPAR. These effects induced by TGF-β1 are associated with ALK5/Smad2/3 and MEK/ERK activation. Elucidation the signalling pathways and effects of TGF-β1 is useful for treatment of immature teeth with open apex by revascularization/revitalization procedures and tissue repair/regeneration.
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Affiliation(s)
- M C Chang
- Biomedical Science Team and Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan City, Taiwan.,Department of Dentistry, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - H H Chang
- Laboratory of Dental Pharmacology, Toxicology and Material Biocompatibility, Graduate Institute of Clinical Dentistry, National Taiwan University Medical College, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - W C Hsieh
- Laboratory of Dental Pharmacology, Toxicology and Material Biocompatibility, Graduate Institute of Clinical Dentistry, National Taiwan University Medical College, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - W L Huang
- Department of Dentistry, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Y C Lian
- Department of Dentistry, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - P Y Jeng
- Laboratory of Dental Pharmacology, Toxicology and Material Biocompatibility, Graduate Institute of Clinical Dentistry, National Taiwan University Medical College, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Y L Wang
- Laboratory of Dental Pharmacology, Toxicology and Material Biocompatibility, Graduate Institute of Clinical Dentistry, National Taiwan University Medical College, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - S Y Yeung
- Department of Dentistry, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - J H Jeng
- Laboratory of Dental Pharmacology, Toxicology and Material Biocompatibility, Graduate Institute of Clinical Dentistry, National Taiwan University Medical College, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
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16
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Mandakhbayar N, El-Fiqi A, Lee JH, Kim HW. Evaluation of Strontium-Doped Nanobioactive Glass Cement for Dentin–Pulp Complex Regeneration Therapy. ACS Biomater Sci Eng 2019; 5:6117-6126. [DOI: 10.1021/acsbiomaterials.9b01018] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Nandin Mandakhbayar
- Department of Nanobiomedical Science and BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan 31116, South Korea
| | - Ahmed El-Fiqi
- Department of Nanobiomedical Science and BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan 31116, South Korea
- Glass Research Department, National Research Centre, Cairo 12622, Egypt
| | - Jung-Hwan Lee
- Department of Nanobiomedical Science and BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan 31116, South Korea
- Glass Research Department, National Research Centre, Cairo 12622, Egypt
- Department of Biomaterials Science, School of Dentistry, Dankook University, Cheonan 330-714, South Korea
| | - Hae-Won Kim
- Department of Nanobiomedical Science and BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan 31116, South Korea
- Department of Biomaterials Science, School of Dentistry, Dankook University, Cheonan 330-714, South Korea
- UCL Eastman-Korea Dental Medicine Innovation Centre, Dankook University, Cheonan 31116, Republic of Korea
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17
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Zein N, Harmouch E, Lutz JC, Fernandez De Grado G, Kuchler-Bopp S, Clauss F, Offner D, Hua G, Benkirane-Jessel N, Fioretti F. Polymer-Based Instructive Scaffolds for Endodontic Regeneration. MATERIALS 2019; 12:ma12152347. [PMID: 31344822 PMCID: PMC6695966 DOI: 10.3390/ma12152347] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 07/19/2019] [Accepted: 07/22/2019] [Indexed: 12/22/2022]
Abstract
The challenge of endodontic regeneration is modulated by clinical conditions which determine five kinds of tissue requirements: pulp connective-tissue formation, dentin formation, revascularization, reinnervation and radicular edification. Polymer scaffolds constitute keystone of the different endodontic regenerative strategies. Indeed, scaffolds are crucial for carrying active molecules and competent cells which optimize the regeneration. Hydrogels are very beneficial for controlling viscosity and porosity of endodontic scaffolds. The nanofibrous and microporous scaffolds mimicking extracellular matrix are also of great interest for promoting dentin-pulp formation. Two main types of polymer scaffolds are highlighted: collagen and fibrin. Collagen scaffolds which are similar to native pulp tissue, are adequate for pulp connective tissue formation. Functionnalization by active biomolecules as BMP, SDF-1, G-CSF enhances their properties. Fibrin or PRF scaffolds present the advantage of promoting stem cell differentiation and concomitant revascularisation. The choice of the type of polymers (polypeptide, PCL, chitosan) can depend on its ability to deliver the active biomolecule or to build as suitable hydrogel as possible. Since 2010s, proposals to associate different types of polymers in a same scaffold have emerged for adding advantages or for offsetting a disadvantage of a polymer. Further works would study the synergetic effects of different innovative polymers composition.
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Affiliation(s)
- Naimah Zein
- French National Institute of Health and Medical Research (INSERM), Regenerative Nanomedicine, UMR 1260, FMTS, 67085 Strasbourg, France
| | - Ezeddine Harmouch
- French National Institute of Health and Medical Research (INSERM), Regenerative Nanomedicine, UMR 1260, FMTS, 67085 Strasbourg, France
| | - Jean-Christophe Lutz
- Faculté de Médecine de Strasbourg, Strasbourg, Université de Strasbourg, 67000 Strasbourg, France
- Pôle de Chirurgie Maxillo-Faciale et Stomatologie, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Gabriel Fernandez De Grado
- French National Institute of Health and Medical Research (INSERM), Regenerative Nanomedicine, UMR 1260, FMTS, 67085 Strasbourg, France
- Faculté de Chirurgie Dentaire de Strasbourg, Université de Strasbourg, 67000 Strasbourg, France
- Hôpitaux Universitaires de Strasbourg, Pôle de Médecine et Chirurgie Bucco-Dentaires, 67000 Strasbourg, France
| | - Sabine Kuchler-Bopp
- French National Institute of Health and Medical Research (INSERM), Regenerative Nanomedicine, UMR 1260, FMTS, 67085 Strasbourg, France
| | - François Clauss
- French National Institute of Health and Medical Research (INSERM), Regenerative Nanomedicine, UMR 1260, FMTS, 67085 Strasbourg, France
- Faculté de Chirurgie Dentaire de Strasbourg, Université de Strasbourg, 67000 Strasbourg, France
- Hôpitaux Universitaires de Strasbourg, Pôle de Médecine et Chirurgie Bucco-Dentaires, 67000 Strasbourg, France
| | - Damien Offner
- French National Institute of Health and Medical Research (INSERM), Regenerative Nanomedicine, UMR 1260, FMTS, 67085 Strasbourg, France
- Faculté de Chirurgie Dentaire de Strasbourg, Université de Strasbourg, 67000 Strasbourg, France
- Hôpitaux Universitaires de Strasbourg, Pôle de Médecine et Chirurgie Bucco-Dentaires, 67000 Strasbourg, France
| | - Guoqiang Hua
- French National Institute of Health and Medical Research (INSERM), Regenerative Nanomedicine, UMR 1260, FMTS, 67085 Strasbourg, France
- Faculté de Chirurgie Dentaire de Strasbourg, Université de Strasbourg, 67000 Strasbourg, France
| | - Nadia Benkirane-Jessel
- French National Institute of Health and Medical Research (INSERM), Regenerative Nanomedicine, UMR 1260, FMTS, 67085 Strasbourg, France
- Faculté de Chirurgie Dentaire de Strasbourg, Université de Strasbourg, 67000 Strasbourg, France
| | - Florence Fioretti
- French National Institute of Health and Medical Research (INSERM), Regenerative Nanomedicine, UMR 1260, FMTS, 67085 Strasbourg, France.
- Faculté de Chirurgie Dentaire de Strasbourg, Université de Strasbourg, 67000 Strasbourg, France.
- Hôpitaux Universitaires de Strasbourg, Pôle de Médecine et Chirurgie Bucco-Dentaires, 67000 Strasbourg, France.
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18
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Medina-Fernandez I, Celiz AD. Acellular biomaterial strategies for endodontic regeneration. Biomater Sci 2019; 7:506-519. [PMID: 30569918 DOI: 10.1039/c8bm01296b] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Dental decay is treated by removing infected dental tissues such as dentine and restoring the tooth with a material. However, the vast majority of these materials have been designed to be mechanically robust and bioinert, whereas the potential regenerative properties of a biomaterial have not been considered. In endodontics for example, materials are used to seal the pulp cavity to avoid bacterial colonisation of the tooth and prevent further infection. While these treatments are effective in the short term, many of these materials have not been designed to interface with the pulp tissue in a biocompatible manner and are often cytotoxic. This can lead to less favourable long-term outcomes such as devitalisation of the tooth via root-canal therapy or extraction of the tooth. Clinical outcomes could be improved if regenerative approaches were followed whereby the biology of the tooth is engineered for repair and regeneration often with the support of a biomaterial. Within these, acellular or cell homing approaches are particularly interesting, as some regulatory hurdles associated with cellular therapies could be circumvented which may aid their clinical translation. In this review, we highlight progress in regenerative dentistry and focus on exciting developments using acellular biomaterials for regenerating dental tissues.
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19
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Patil U, Yeli M, Tapashetti S, Naik B, Tilakchand M. Effect of varying durations of intracanal medicament application used in regenerative endodontic treatment on the push-out bond strength of a novel cement: NeoMTA Plus. JOURNAL OF CONSERVATIVE DENTISTRY : JCD 2019; 22:48-53. [PMID: 30820082 PMCID: PMC6385570 DOI: 10.4103/jcd.jcd_80_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: The aim of the present study was to evaluate the effect of varying durations of intracanal medicament application used in regenerative endodontic treatment on the push out the bond strength of a novel cement-NeoMTA Plus. Materials and Methods: A total of 60 extracted single-rooted maxillary anterior teeth were decoronated. Roots were instrumented uniformly until Peeso Reamer size #5 to simulate open apices. A total of 60 roots were then divided into four groups according to intracanal medicaments used (n = 15): Group 1: Triple antibiotic paste (TAP); Group 2: Double antibiotic paste (DAP); Group 3: Calcium hydroxide paste (CH); and Group 4 (control): No medicament. Samples were kept in saline solution for 2, 4, and 12 weeks, after which time five roots were selected randomly from each group, representing the samples of each time point. After removal of the medicaments, NeoMTA Plus was placed into 8 mm of the coronal third of the roots and samples were incubated. Roots were sectioned to obtain 2 discs per root (n = 10). A push-out test was used to measure the sealing efficacy of NeoMTA Plus. Data were analyzed using a one-way ANOVA followed by Tukey's pairwise comparisons. Results: CH, DAP, and TAP application resulted in significantly lower values of the push-out bond strength of NeoMTA Plus after 12 weeks compared to 2 weeks (P < 0.05). No significant differences were found between the time points in the control group (P > 0.05). DAP showed lowest push-out bond strength. Conclusion: CH, DAP, and TAP cause an alteration in dentinal surface properties leading to negative effect on bond strength of NeoMTA Plus. The effect is more evident in DAP and as treatment time is prolonged. The type and duration of medicament application have to be monitored to achieve a maximum therapeutic value as well as to avoid compromise on the coronal seal.
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Affiliation(s)
- Urjita Patil
- Department of Conservative Dentistry and Endodontics, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka, India
| | - Mahantesh Yeli
- Department of Conservative Dentistry and Endodontics, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka, India
| | - Sharmila Tapashetti
- Department of Conservative Dentistry and Endodontics, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka, India
| | - Balaram Naik
- Department of Conservative Dentistry and Endodontics, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka, India
| | - Mahima Tilakchand
- Department of Conservative Dentistry and Endodontics, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka, India
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20
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Jung C, Kim S, Sun T, Cho YB, Song M. Pulp-dentin regeneration: current approaches and challenges. J Tissue Eng 2019; 10:2041731418819263. [PMID: 30728935 PMCID: PMC6351713 DOI: 10.1177/2041731418819263] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 11/21/2018] [Indexed: 01/03/2023] Open
Abstract
Regenerative endodontic procedures for immature permanent teeth with apical periodontitis confer biological advantages such as tooth homeostasis, enhanced immune defense system, and a functional pulp-dentin complex, in addition to clinical advantages such as the facilitation of root development. Currently, this procedure is recognized as a paradigm shift from restoration using materials to regenerate pulp-dentin tissues. Many studies have been conducted with regard to stem/progenitor cells, scaffolds, and biomolecules, associated with pulp tissue engineering. However, preclinical and clinical studies have evidently revealed several drawbacks in the current clinical approach to revascularization that may lead to unfavorable outcomes. Therefore, our review examines the challenges encountered under clinical conditions and summarizes current research findings in an attempt to provide direction for transition from basic research to clinical practice.
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Affiliation(s)
- Chanyong Jung
- Department of Dentistry, Aerospace Medical Center, Cheongju, Korea.,Department of Conservative Dentistry, College of Dentistry, Dankook University, Cheonan, Korea
| | - Sangwan Kim
- Department of Conservative Dentistry, College of Dentistry, Dankook University, Cheonan, Korea
| | - Taeuk Sun
- Department of Conservative Dentistry, College of Dentistry, Dankook University, Cheonan, Korea
| | - Yong-Bum Cho
- Department of Conservative Dentistry, College of Dentistry, Dankook University, Cheonan, Korea
| | - Minju Song
- Department of Conservative Dentistry, College of Dentistry, Dankook University, Cheonan, Korea
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21
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Nakashima M, Iohara K, Bottino MC, Fouad AF, Nör JE, Huang GTJ. Animal Models for Stem Cell-Based Pulp Regeneration: Foundation for Human Clinical Applications. TISSUE ENGINEERING PART B-REVIEWS 2019; 25:100-113. [PMID: 30284967 DOI: 10.1089/ten.teb.2018.0194] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPACT STATEMENT Animal models are essential for tissue regeneration studies. This review summarizes and discusses the small and large animal models, including mouse, ferret, dog, and miniswine that have been utilized to experiment and to demonstrate stem cell-mediated dental pulp tissue regeneration. We describe the models based on the location where the tissue regeneration is tested-either ectopic, semiorthotopic, or orthotopic. Developing and utilizing optimal animal models for both mechanistic and translational studies of pulp regeneration are of critical importance to advance this field.
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Affiliation(s)
- Misako Nakashima
- 1 Department of Stem Cell Biology and Regenerative Medicine, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Koichiro Iohara
- 1 Department of Stem Cell Biology and Regenerative Medicine, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Marco C Bottino
- 2 Department of Cariology, Restorative Sciences, Endodontics, University of Michigan, School of Dentistry, Ann Arbor, Michigan
| | - Ashraf F Fouad
- 3 Department of Endodontics, School of Dentistry, University of North Carolina, Chapel Hill, North Carolina
| | - Jacques E Nör
- 2 Department of Cariology, Restorative Sciences, Endodontics, University of Michigan, School of Dentistry, Ann Arbor, Michigan
| | - George T-J Huang
- 4 Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee
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22
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Orti V, Collart-Dutilleul PY, Piglionico S, Pall O, Cuisinier F, Panayotov I. Pulp Regeneration Concepts for Nonvital Teeth: From Tissue Engineering to Clinical Approaches. TISSUE ENGINEERING. PART B, REVIEWS 2018; 24:419-442. [PMID: 29724156 DOI: 10.1089/ten.teb.2018.0073] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Following the basis of tissue engineering (Cells-Scaffold-Bioactive molecules), regenerative endodontic has emerged as a new concept of dental treatment. Clinical procedures have been proposed by endodontic practitioners willing to promote regenerative therapy. Preserving pulp vitality was a first approach. Later procedures aimed to regenerate a vascularized pulp in necrotic root canals. However, there is still no protocol allowing an effective regeneration of necrotic pulp tissue either in immature or mature teeth. This review explores in vitro and preclinical concepts developed during the last decade, especially the potential use of stem cells, bioactive molecules, and scaffolds, and makes a comparison with the goals achieved so far in clinical practice. Regeneration of pulp-like tissue has been shown in various experimental conditions. However, the appropriate techniques are currently in a developmental stage. The ideal combination of scaffolds and growth factors to obtain a complete regeneration of the pulp-dentin complex is still unknown. The use of stem cells, especially from pulp origin, sounds promising for pulp regeneration therapy, but it has not been applied so far for clinical endodontics, in case of necrotic teeth. The gap observed between the hope raised from in vitro experiments and the reality of endodontic treatments suggests that clinical success may be achieved without external stem cell application. Therefore, procedures using the concept of cell homing, through evoked bleeding that permit to recreate a living tissue that mimics the original pulp has been proposed. Perspectives for pulp tissue engineering in the near future include a better control of clinical parameters and pragmatic approach of the experimental results (autologous stem cells from cell homing, controlled release of growth factors). In the coming years, this therapeutic strategy will probably become a clinical reality, even for mature necrotic teeth.
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Affiliation(s)
- Valérie Orti
- LBN, Université de Montpellier , Montpellier, France
| | | | | | - Orsolya Pall
- LBN, Université de Montpellier , Montpellier, France
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23
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Natera M, Mukherjee PM. Regenerative Endodontic Treatment with Orthodontic Treatment in a Tooth with Dens Evaginatus: A Case Report with a 4-year Follow-up. J Endod 2018; 44:952-955. [PMID: 29631746 DOI: 10.1016/j.joen.2018.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 01/15/2018] [Accepted: 01/20/2018] [Indexed: 02/06/2023]
Abstract
Dens evaginatus is a developmental tooth anomaly in which an extra cusp or tubercle protrudes on the occlusal surface of the tooth along with some pulpal tissue. Because of the fragile nature of the protrusion, these teeth are often at risk of pulpal exposure. When this occurs in an immature tooth, regenerative endodontic treatment may be a good treatment approach to promote root formation. There is limited literature that documents the occurrence of orthodontic treatment in teeth that have undergone regenerative endodontic therapy using triple antibiotic paste. Here we present a case of an immature premolar tooth with dens evaginatus that was diagnosed with pulp necrosis and chronic apical abscess. The tooth was treated with regenerative endodontic treatment; after which, the patient received orthodontic treatment with fixed appliances for 2 years. The tooth responded favorably to the regenerative endodontic treatment and orthodontic tooth movement. Clinically and radiographically, all the follow-up examinations revealed an asymptomatic tooth with evidence of periapical healing with stunted root development. The tooth remained asymptomatic even after 4 years. The regenerative endodontic procedure (REP) was successful in treating an immature permanent premolar with pulp necrosis and apical periodontitis with dens evaginatus. In this case, the tooth treated with an REP responded to orthodontic treatment similar to the nonendodontically treated teeth. Further studies are recommended to clarify the precise effects of orthodontic treatment on teeth treated with an REP.
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Affiliation(s)
- Marianella Natera
- Department of Endodontics, Rutgers School of Dental Medicine, Newark, New Jersey
| | - Padma M Mukherjee
- Department of Orthodontics, Rutgers School of Dental Medicine, Newark, New Jersey.
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24
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Scott MB, Zilinski GS, Kirkpatrick TC, Himel VT, Sabey KA, Lallier TE. The Effects of Irrigants on the Survival of Human Stem Cells of the Apical Papilla, Including Endocyn. J Endod 2018; 44:263-268. [DOI: 10.1016/j.joen.2017.09.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 09/01/2017] [Accepted: 09/01/2017] [Indexed: 12/24/2022]
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25
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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: 56] [Impact Index Per Article: 9.3] [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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Dimethyloxalylglycine-embedded Poly(ε-caprolactone) Fiber Meshes Promote Odontoblastic Differentiation of Human Dental Pulp–derived Cells. J Endod 2018; 44:98-103.e1. [DOI: 10.1016/j.joen.2017.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 08/30/2017] [Accepted: 09/02/2017] [Indexed: 11/18/2022]
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Regenerative Endodontic Treatment or Mineral Trioxide Aggregate Apical Plug in Teeth with Necrotic Pulps and Open Apices: A Systematic Review and Meta-analysis. J Endod 2017; 43:1806-1820. [DOI: 10.1016/j.joen.2017.06.029] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 06/12/2017] [Accepted: 06/16/2017] [Indexed: 12/29/2022]
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Ducret M, Fabre H, Celle A, Mallein-Gerin F, Perrier-Groult E, Alliot-Licht B, Farges JC. Current challenges in human tooth revitalization. Biomed Mater Eng 2017; 28:S159-S168. [PMID: 28372291 DOI: 10.3233/bme-171637] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Tooth vitality and health are related to the presence of a living connective tissue, the dental pulp (DP), in the center of the dental organ. The DP contains the tooth immune defence system that is activated against invading oral cariogenic bacteria during the caries process and the tissue repair/regeneration machinery involved following microorganisms' eradication. However, penetration of oral bacteria into the DP often leads to complete tissue destruction and colonization of the endodontic space by microorganisms. Classical endodontic therapies consist of disinfecting then sealing the endodontic space with a gutta percha-based material. However, re-infections of the endodontic space by oral bacteria can occur, owing to the lack of tightness of the material. Recent findings suggest that regenerating a fully functional pulp tissue may be an ideal therapeutic solution to maintain a tooth defence system that will detect and help manage future injuries. The objective of this paper was to explain the different revascularization and regeneration strategies that have been proposed to reconstitute a living DP tissue and to discuss the main challenges that have to be resolved to improve these therapeutic strategies.
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Affiliation(s)
- Maxime Ducret
- Laboratoire de Biologie Tissulaire et Ingénierie thérapeutique, UMR5305 CNRS/Université Lyon 1, UMS3444 BioSciences Gerland-Lyon Sud, Lyon, France.,Faculté d'Odontologie, Université de Lyon, Université Lyon 1, Lyon, France.,Hospices Civils de Lyon, Service de Consultations et Traitements Dentaires, Lyon, France
| | - Hugo Fabre
- Laboratoire de Biologie Tissulaire et Ingénierie thérapeutique, UMR5305 CNRS/Université Lyon 1, UMS3444 BioSciences Gerland-Lyon Sud, Lyon, France.,Laboratory of Regenerative Technologies, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Alexis Celle
- Laboratoire de Biologie Tissulaire et Ingénierie thérapeutique, UMR5305 CNRS/Université Lyon 1, UMS3444 BioSciences Gerland-Lyon Sud, Lyon, France
| | - Frédéric Mallein-Gerin
- Laboratoire de Biologie Tissulaire et Ingénierie thérapeutique, UMR5305 CNRS/Université Lyon 1, UMS3444 BioSciences Gerland-Lyon Sud, Lyon, France
| | - Emeline Perrier-Groult
- Laboratoire de Biologie Tissulaire et Ingénierie thérapeutique, UMR5305 CNRS/Université Lyon 1, UMS3444 BioSciences Gerland-Lyon Sud, Lyon, France
| | - Brigitte Alliot-Licht
- Centre de Recherche en Transplantation et Immunologie, UMR1064, INSERM, Faculté d'Odontologie, Université de Nantes, Nantes, France
| | - Jean-Christophe Farges
- Laboratoire de Biologie Tissulaire et Ingénierie thérapeutique, UMR5305 CNRS/Université Lyon 1, UMS3444 BioSciences Gerland-Lyon Sud, Lyon, France.,Faculté d'Odontologie, Université de Lyon, Université Lyon 1, Lyon, France.,Hospices Civils de Lyon, Service de Consultations et Traitements Dentaires, Lyon, France
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29
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Kaval ME, Güneri P, Çalışkan MK. Regenerative endodontic treatment of perforated internal root resorption: a case report. Int Endod J 2017; 51:128-137. [DOI: 10.1111/iej.12784] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 04/20/2017] [Indexed: 11/30/2022]
Affiliation(s)
- M. E. Kaval
- Department of Endodontology School of Dentistry Ege University Izmir Turkey
| | - P. Güneri
- Department of Oral and Maxillofacial Radiology School of Dentistry Ege University Izmir Turkey
| | - M. K. Çalışkan
- Department of Endodontology School of Dentistry Ege University Izmir Turkey
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Abstract
INTRODUCTION Revascularization/revitalization therapy is considered an alternative procedure for management of teeth with an immature apex and necrotic pulp, mainly when root development is interrupted in the early phases of formation. However, this clinical treatment protocol should be considered a permanent procedure? METHOD A maxillary central incisor with a previous and successful RR treatment was intentionally filled with a biocompatible material with the periapical tissues due to the patient's lack of adherence to the follow-up protocol. RESULTS The 20-month follow-up showed absence of clinical, radiological and tomographic signs and symptoms of an endodontic re-infection. CONCLUSION This case demonstrates that once the increased thickening of the canal walls, incrementing the root length, apical closure and the total resolution of the apical lesion are observed, the main canal of a previously treated tooth with an RR procedure can be filled.
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An S, Gong Q, Huang Y. Promotive Effect of Zinc Ions on the Vitality, Migration, and Osteogenic Differentiation of Human Dental Pulp Cells. Biol Trace Elem Res 2017; 175:112-121. [PMID: 27260533 DOI: 10.1007/s12011-016-0763-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/24/2016] [Indexed: 01/02/2023]
Abstract
Zinc is an essential trace element for proper cellular function and bone formation. However, its exact role in the osteogenic differentiation of human dental pulp cells (hDPCs) has not been fully clarified before. Here, we speculated that zinc may be effective to regulate their growth and osteogenic differentiation properties. To test this hypothesis, different concentrations (1 × 10-5, 4 × 10-5, and 8 × 10-5 M) of zinc ions (Zn2+) were added to the basic growth culture medium and osteogenic inductive medium. Cell viability and migration were measured by cell counting kit-8 (CCK-8) and transwell migration assay in the basic growth culture medium, respectively. The reverse transcription-quantitative polymerase chain reaction (RT-qPCR) was used to detect the gene expression levels of selective osteogenic differentiation markers and zinc transporters. Alkaline phosphatase (ALP) activity analysis and alizarin red S staining were used to investigate the mineralization of hDPCs. Exposure of hDPCs to Zn2+ stimulated their viability and migration capacity in a dose- and time-dependent manner. RT-qPCR assay revealed elevated expression levels of osteogenic differentiation-related genes and zinc transporters genes in various degrees. ALP activity was also increased with elevated Zn2+ concentrations and extended culture periods, but enhanced matrix nodules formation were observed only in 4 × 10-5 and 8 × 10-5 M Zn2+ groups. These findings suggest that specific concentrations of Zn2+ could potentiate the vitality, migration, and osteogenic differentiation of hDPCs. We may combine optimum zinc element into pulp capping materials to improve their biological performance.
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Affiliation(s)
- Shaofeng An
- Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, No.56 Lingyuan Xi Road, Guangzhou, Guangdong, 510055, People's Republic of China.
- Guangdong Province Key Laboratory of Stomatology, Sun Yat-Sen University, No.74 Zhongshan Er Road, Guangzhou, Guangdong, 510080, People's Republic of China.
| | - Qimei Gong
- Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, No.56 Lingyuan Xi Road, Guangzhou, Guangdong, 510055, People's Republic of China
- Guangdong Province Key Laboratory of Stomatology, Sun Yat-Sen University, No.74 Zhongshan Er Road, Guangzhou, Guangdong, 510080, People's Republic of China
| | - Yihua Huang
- Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, No.56 Lingyuan Xi Road, Guangzhou, Guangdong, 510055, People's Republic of China
- Guangdong Province Key Laboratory of Stomatology, Sun Yat-Sen University, No.74 Zhongshan Er Road, Guangzhou, Guangdong, 510080, People's Republic of China
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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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Su S, Zhu Y, Li S, Liang Y, Zhang J. The transcription factor cyclic adenosine 3',5'-monophosphate response element-binding protein enhances the odonto/osteogenic differentiation of stem cells from the apical papilla. Int Endod J 2016; 50:885-894. [PMID: 27716996 DOI: 10.1111/iej.12709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 10/04/2016] [Indexed: 12/15/2022]
Abstract
AIM To investigate the role of cAMP response element-binding protein (CREB) in the regulation of odonto/osteogenic differentiation of stem cells from the apical papilla (SCAPs). METHODOLOGY Stem cells from the apical papilla were obtained from human impacted third molars (n = 15). Isolated SCAPs were transfected with CREB overexpressing/silenced lentivirus. Transfected cells were stained with alizarin red to investigate mineralized nodule formation. The expression of the mineralization-related genes, alkaline phosphatase (ALP), collagen type I (Col I), runt-related transcription factor 2 (RUNX2), osterix (OSX) and osteocalcin (OCN), was determined by quantitative reverse transcription polymerase chain reaction (qRT-PCR). Protein expression of the odontogenic-related marker dentine sialoprotein (DSP) and the osteogenic-related marker RUNX2 was measured by Western blotting analysis. One-way analysis of variance (anova) and Student's t-test were used for statistical analysis (a = 0.05). RESULTS The overexpression of CREB enhanced mineralized nodule formation and up-regulated (P < 0.05) the mRNA levels of odonto/osteogenic-related markers, including ALP, Col I, RUNX2, OSX and OCN, and also increased (P < 0.05) the protein expression of DSP and RUNX2. In contrast, the silencing of CREB inhibited (P < 0.05) the mineralization capacity of the SCAPs and decreased (P < 0.05) the expression of odonto/osteogenic-related markers. CONCLUSION Up-regulation of CREB expression promoted odonto/osteogenic differentiation of SCAPs and provided a potential method for the regeneration of the dentine-pulp complex.
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Affiliation(s)
- S Su
- Stomatologic Hospital & College, Anhui Medical University, Key Laboratory of Oral Diseases Research of Anhui Province, Hefei, China
| | - Y Zhu
- Stomatologic Hospital & College, Anhui Medical University, Key Laboratory of Oral Diseases Research of Anhui Province, Hefei, China
| | - S Li
- Stomatologic Hospital & College, Anhui Medical University, Key Laboratory of Oral Diseases Research of Anhui Province, Hefei, China
| | - Y Liang
- Stomatologic Hospital & College, Anhui Medical University, Key Laboratory of Oral Diseases Research of Anhui Province, Hefei, China
| | - J Zhang
- Stomatologic Hospital & College, Anhui Medical University, Key Laboratory of Oral Diseases Research of Anhui Province, Hefei, China
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Lucisano MP, Nelson-Filho P, Silva LAB, Silva RAB, de Carvalho FK, de Queiroz AM. Apical Revascularization after Delayed Tooth Replantation: An Unusual Case. Case Rep Dent 2016; 2016:2651643. [PMID: 27882250 PMCID: PMC5110882 DOI: 10.1155/2016/2651643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 09/19/2016] [Accepted: 10/17/2016] [Indexed: 01/09/2023] Open
Abstract
The aim of this paper is to present the clinical and radiological outcome of the treatment involving a delayed tooth replantation after an avulsed immature permanent incisor, with a follow-up of 1 year and 6 months. An 8-year-old boy was referred after dental trauma that occurred on the previous day. The permanent maxillary right central incisor (tooth 11) had been avulsed. The tooth was hand-held during endodontic therapy and an intracanal medication application with calcium hydroxide-based paste was performed. An apical plug with mineral trioxide aggregate (MTA) was introduced into the apical portion of the canal. When the avulsed tooth was replanted with digital pressure, a blood clot had formed within the socket, which moved the MTA apical plug about 2 mm inside of the root canal. These procedures developed apical revascularization, which promoted a successful endodontic outcome, evidenced by apical closure, slight increase in root length, and absence of signs of external root resorption, during a follow-up of 1 year and 6 months.
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Affiliation(s)
- Marília Pacífico Lucisano
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Paulo Nelson-Filho
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Lea Assed Bezerra Silva
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Raquel Assed Bezerra Silva
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Fabricio Kitazono de Carvalho
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Alexandra Mussolino de Queiroz
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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Subash D, Shoba K, Aman S, Bharkavi SKI. Revitalization of an Immature Permanent Mandibular Molar with a Necrotic Pulp Using Platelet-Rich Fibrin: A Case Report. J Clin Diagn Res 2016; 10:ZD21-ZD23. [PMID: 28050518 DOI: 10.7860/jcdr/2016/21793.8902] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 09/05/2016] [Indexed: 11/24/2022]
Abstract
Any insult to the pulp during its development causes cessation of dentin formation and root growth. Pulpal status and degree of root development are the decisive factors in the treatment approach. Various treatment options have been tried like surgery with root-end sealing, calcium hydroxide-apexification, placement of apical plug and regenerative endodontic procedures to induce apexogenesis. An ideal scenario for a necrosed tooth with immature root would be continued root development coupled with regeneration of pulp tissue. We report a case, where revitalization was done using Platelet-Rich Fibrin (PRF) as a scaffold in immature mandibular molar tooth.
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Affiliation(s)
- Dayalan Subash
- Senior Resident, Department of Conservative Dentistry and Endodontics, Government Dental College , Kottayam, Kerala, India
| | - Krishnamma Shoba
- Professor and Head, Department of Conservative Dentistry and Endodontics, Government Dental College , Kottyam, Kerala, India
| | - Shibu Aman
- Assisant Professor, Department of Conservative Dentistry and Endodontics, Government Dental College , Kottyam, Kerala, India
| | - Srinivasan Kumar Indu Bharkavi
- Senior Lecturer, Department of Oral Pathology and Microbiology, Sathyabama University Dental College and Hospital , Chennai, Tamil Nadu, India
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36
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Azim AA, Aksel H, Zhuang T, Mashtare T, Babu JP, Huang GTJ. Efficacy of 4 Irrigation Protocols in Killing Bacteria Colonized in Dentinal Tubules Examined by a Novel Confocal Laser Scanning Microscope Analysis. J Endod 2016; 42:928-34. [PMID: 27130334 DOI: 10.1016/j.joen.2016.03.009] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 03/10/2016] [Accepted: 03/11/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The aim of this study was to determine the efficiency of 4 irrigation systems in eliminating bacteria in root canals, particularly in dentinal tubules. METHODS Roots of human teeth were prepared to 25/04, autoclaved, and inoculated with Enterococcus faecalis for 3 weeks. Canals were then disinfected by (1) standard needle irrigation, (2) sonically agitating with EndoActivator, (3) XP Endo finisher, or (4) erbium:yttrium aluminum garnet laser (PIPS) (15 roots/group). The bacterial reduction in the canal was determined by MTT assays. For measuring live versus dead bacteria in the dentinal tubules (4 teeth/group), teeth were split open and stained with LIVE/DEAD BackLight. Coronal, middle, and apical thirds of the canal dentin were scanned by using a confocal laser scanning microscope (CLSM) to determine the ratio of dead/total bacteria in the dentinal tubules at various depths. RESULTS All 4 irrigation protocols significantly eliminated bacteria in the canal, ranging from 89.6% to 98.2% reduction (P < .001). XP Endo had the greatest bacterial reduction compared with other 3 techniques (P < .05). CLSM analysis showed that XP Endo had the highest level of dead bacteria in the coronal, middle, and apical segments at 50-μm depth. On the other hand, PIPS had the greatest bacterial killing efficiency at the 150-μm depth in all 3 root segments. CONCLUSIONS XP Endo appears to be more efficient than other 3 techniques in disinfecting the main canal space and up to 50 μm deep into the dentinal tubules. PIPS appears to be most effective in killing the bacteria deep in the dentinal tubules.
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Affiliation(s)
- Adham A Azim
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Hacer Aksel
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Tingting Zhuang
- Department of Biostatistics, University at Buffalo School of Public Health and Health Professions, Buffalo, New York
| | - Terry Mashtare
- Department of Biostatistics, University at Buffalo School of Public Health and Health Professions, Buffalo, New York
| | - Jegdish P Babu
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee
| | - George T-J Huang
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee.
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Widbiller M, Eidt A, Hiller KA, Buchalla W, Schmalz G, Galler KM. Ultrasonic activation of irrigants increases growth factor release from human dentine. Clin Oral Investig 2016; 21:879-888. [DOI: 10.1007/s00784-016-1824-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/13/2016] [Indexed: 11/24/2022]
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38
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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: 1.9] [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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Peters OA, Galicia J, Arias A, Tolar M, Ng E, Shin SJ. Effects of two calcium silicate cements on cell viability, angiogenic growth factor release and related gene expression in stem cells from the apical papilla. Int Endod J 2015; 49:1132-1140. [DOI: 10.1111/iej.12571] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 10/30/2015] [Indexed: 12/30/2022]
Affiliation(s)
- O. A. Peters
- Department of Endodontics; University of the Pacific Arthur A. Dugonic School of Dentistry; San Francisco CA USA
| | - J. Galicia
- Department of Endodontics; University of the Pacific Arthur A. Dugonic School of Dentistry; San Francisco CA USA
| | - A. Arias
- Department of Endodontics; University of the Pacific Arthur A. Dugonic School of Dentistry; San Francisco CA USA
| | - M. Tolar
- Department of Orthodontics; University of the Pacific Arthur A. Dugonic School of Dentistry; San Francisco CA USA
| | - E. Ng
- Department of Endodontics; University of the Pacific Arthur A. Dugonic School of Dentistry; San Francisco CA USA
| | - S. J. Shin
- Department of Endodontics; University of the Pacific Arthur A. Dugonic School of Dentistry; San Francisco CA USA
- Department of Conservative Dentistry and Oral Science Research Center; College of Dentistry; Gangnam Severance Hospital; Yonsei University; Seoul Korea
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40
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Turk T, Ozisik B, Aydin B. Time-dependent effectiveness of the intracanal medicaments used for pulp revascularization on the dislocation resistance of MTA. BMC Oral Health 2015; 15:130. [PMID: 26496837 PMCID: PMC4619474 DOI: 10.1186/s12903-015-0117-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 10/15/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The aim of the present study was to evaluate the time-dependent effectiveness of the intracanal medicaments used in pulp revascularization on the dislocation resistance of mineral trioxide aggregate (MTA). METHODS One hundred ninety-two extracted human maxillary incisor teeth were sectioned apically 12 mm below and coronally 2 mm above the cemento-enamel junction. Roots were enlarged to size 40 (Protaper F4). Next, Peeso reamers from #1 to #5 were used sequentially. Sodium hypochlorite (2.5 %), EDTA (17 %), and distilled water were used in final irrigation. The specimens were randomly divided into four groups (n = 48): Group 1, in which triple antibiotic paste (TAP) (ciprofloxacin + metronidazole + minocycline) was prepared and delivered into the canals using a lentulo spiral; Group 2, in which double antibiotic paste (DAP) (ciprofloxacin + metronidazole) was placed into the canals; Group 3, in which calcium hydroxide paste (CH) (calcium hydroxide + distilled water) was introduced into the roots; and Group 4 (control), in which no medicament was applied into the root canals. Then, the samples were kept in saline solution for 2, 4, and 12 weeks, after which time 16 roots were selected randomly from each group, representing the samples of each time point. After removal of the medicaments, MTA was placed into the coronal third of the roots, and the samples were incubated for 7 days. A push-out test was used to measure the dislocation resistance (DR) of MTA. The data were analyzed using a two-way ANOVA followed by Tukey's pairwise comparisons (p = 0.05). RESULTS The time factor displayed a significant effect on the DR of MTA (p < 0.05). All medicaments resulted in significantly smaller DR values after 12 weeks compared to after 1 week (p < 0.05). A significant unfavorable effect of TAP and DAP was observed as early as 2 weeks after the application, while 2 and 4 weeks after the application of CH there was no effect on the DR of MTA. No significant differences were found between the time points in the control group (p > 0.05). CONCLUSION The type and the intracanal duration of medicaments used for pulp revascularization should be chosen carefully to provide maximum antimicrobial effect while creating a favorable environment both for stem cell attachment and MTA adhesion.
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Affiliation(s)
- Tugba Turk
- Department of Endodontology, Ege University, School of Dentistry, Izmir, Turkey.
| | - Beyza Ozisik
- Department of Endodontology, Ege University, School of Dentistry, Izmir, Turkey.
| | - Berdan Aydin
- Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, 801 S. Paulina St, Room 531, Chicago, IL, 60612, USA.
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Cao Y, Song M, Kim E, Shon W, Chugal N, Bogen G, Lin L, Kim R, Park NH, Kang M. Pulp-dentin Regeneration. J Dent Res 2015; 94:1544-51. [DOI: 10.1177/0022034515601658] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] 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 ΔN p63α, 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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Management of Teeth with Persistent Apical Periodontitis after Root Canal Treatment Using Regenerative Endodontic Therapy. J Endod 2015; 41:1743-8. [PMID: 26279479 DOI: 10.1016/j.joen.2015.07.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 07/07/2015] [Accepted: 07/11/2015] [Indexed: 12/16/2022]
Abstract
Regenerative endodontic therapy (RET) is currently used to treat immature teeth with necrotic pulp and/or apical periodontitis. However, recently RET has been used to treat mature teeth with necrotic pulp and/or apical periodontitis and resulted in regression of clinical signs and/or symptoms and resolution of apical periodontitis. The purpose of this case report was to describe the potential of using RET to treat 2 mature teeth with persistent apical periodontitis after root canal therapy using RET. Two male patients, one 26-year old and another 12-year old, presented for retreatment of persistent apical periodontitis after root canal treatment of 2 mature teeth (#9 and #19). The gutta-percha fillings in the canals of teeth #9 and #19 were removed with Carvene gutta-percha solvent (Prevest DenPro, Jammu, India) and ProTaper Universal rotary retreatment files (Dentsply Maillefer, Ballaigues, Switzerland). The canals of both teeth were further chemomechanically debrided with rotary retreatment files and copious amounts of sodium hypochlorite irrigation and dressed with Metapaste (Meta Biomed, Chungbuk, Korea). RET was performed on teeth #9 and #19. Periapical bleeding was provoked into the disinfected root canals. The blood clots were covered with mineral trioxide aggregate plugs, and the access cavities were restored with intermediate restorative material. Teeth #9 and #19 showed regression of clinical signs and/or symptoms and healing of apical periodontitis after 13-month and 14-month follow-ups, respectively. Tooth #9 revealed narrowing of the canal space and apical closure by deposition of hard tissue. RET has the potential to be used to retreat teeth with persistent apical periodontitis after root canal therapy.
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Hunter DJ, Bardet C, Mouraret S, Liu B, Singh G, Sadoine J, Dhamdhere G, Smith A, Tran XV, Joy A, Rooker S, Suzuki S, Vuorinen A, Miettinen S, Chaussain C, Helms JA. Wnt Acts as a Prosurvival Signal to Enhance Dentin Regeneration. J Bone Miner Res 2015; 30:1150-9. [PMID: 25556760 DOI: 10.1002/jbmr.2444] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 12/11/2014] [Accepted: 12/23/2014] [Indexed: 01/08/2023]
Abstract
Wnt proteins are lipid-modified, short-range signals that control stem cell self-renewal and tissue regeneration. We identified a population of Wnt responsive cells in the pulp cavity, characterized their function, and then created a pulp injury. The repair response was evaluated over time using molecular, cellular, and quantitative assays. We tested how healing was impacted by wound environments in which Wnt signaling was amplified. We found that a Wnt-amplified environment was associated with superior pulp healing. Although cell death was still rampant, the number of cells undergoing apoptosis was significantly reduced. This resulted in significantly better survival of injured pulp cells, and resulted in the formation of more tertiary dentin. We engineered a liposome-reconstituted form of WNT3A then tested whether this biomimetic compound could activate cells in the injured tooth pulp and stimulate dentin regeneration. Pulp cells responded to the elevated Wnt stimulus by differentiating into secretory odontoblasts. Thus, transiently amplifying the body's natural Wnt response resulted in improved pulp vitality. These data have direct clinical implications for treating dental caries, the most prevalent disease affecting mankind.
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Affiliation(s)
- Daniel J Hunter
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - Claire Bardet
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA.,EA 2496, Dental School, University Paris Descartes, Sorbonne Paris Cité, Montrouge, France
| | - Sylvain Mouraret
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA.,Department of Periodontology, Service of Odontology, Rothschild Hospital, Assistance Publique-Hôpitaux de Paris, Paris 7, Université Paris Diderot, Unité de Formation et de Recherche (UFR) of Odontology, Paris, France
| | - Bo Liu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - Gurpreet Singh
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - Jérémy Sadoine
- EA 2496, Dental School, University Paris Descartes, Sorbonne Paris Cité, Montrouge, France
| | - Girija Dhamdhere
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - Andrew Smith
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA.,Department of Biological Sciences, San Jose State University, San Jose, CA, USA
| | - Xuan Vinh Tran
- EA 2496, Dental School, University Paris Descartes, Sorbonne Paris Cité, Montrouge, France
| | - Adrienne Joy
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - Scott Rooker
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - Shigeki Suzuki
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA.,Department of Dental Science for Health Promotion, Division of Cervico-Gnathostomatology Hiroshima, University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Annukka Vuorinen
- BioMediTech, Adult Stem Cell Research, University of Tampere, Tampere, Finland.,Finnish Student Health Service, Tampere, Finland
| | - Susanna Miettinen
- BioMediTech, Adult Stem Cell Research, University of Tampere, Tampere, Finland.,Science Centre, University of Tampere, Tampere, Finland
| | - Catherine Chaussain
- EA 2496, Dental School, University Paris Descartes, Sorbonne Paris Cité, Montrouge, France
| | - Jill A Helms
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA
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Role of ALK5/Smad2/3 and MEK1/ERK Signaling in Transforming Growth Factor Beta 1-modulated Growth, Collagen Turnover, and Differentiation of Stem Cells from Apical Papilla of Human Tooth. J Endod 2015; 41:1272-80. [PMID: 26001858 DOI: 10.1016/j.joen.2015.03.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 03/13/2015] [Accepted: 03/29/2015] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Transforming growth factor β1 (TGF-β1) plays an important role in cell proliferation, matrix formation, and odontogenesis. This study investigated the effects of TGF-β1 on stem cells from apical papilla (SCAPs) and its signaling by MEK/ERK and Smad2. METHODS SCAPs were exposed to TGF-β1 with/without pretreatment and coincubation by SB431542 (an ALK5/Smad 2/3 inhibitor) or U0126 (a MEK/ERK inhibitor). Cell growth was examined by 3-(4,5-dimethylthiazol-2-yl)-2,5 diphenyl tetrazolium bromide assay or direct counting of viable cells. Collagen content was determined by using the Sircol collagen assay (Biocolor Ltd, Newtownabbey, Northern Ireland). Cell differentiation was evaluated by measuring alkaline phosphatase (ALP) activity. Smad2 and ERK1/2 phosphorylation was analyzed by Western blotting or PathScan phospho-enzyme-linked immunosorbent assay (Cell Signaling Technology Inc, Danvers, MA). RESULTS TGF-β1 stimulated the growth and collagen content of cultured SCAPs. TGF-β1 stimulated ERK1/2 and Smad2 phosphorylation within 60 minutes of exposure. Pretreatment by U0126 and SB431542 effectively prevented the TGF-β1-induced cell growth and collagen content in SCAPs. TGF-β1 stimulated ALP activity at lower concentrations (0.1-1 ng/mL) but down-regulated ALP at higher concentrations (>5 ng/mL). U0126 prevented 0.5 ng/mL TGF-β1-induced ALP activity but showed little effect on 10 ng/mL TGF-β1-induced decline of ALP in SCAPs. Interestingly, SB431542 attenuated both the stimulatory and inhibitory effects on ALP by TGF-β1. CONCLUSIONS TGF-β1 may affect the proliferation, collagen turnover, and differentiation of SCAPs via differential activation of ALK5/Smad2 and MEK/ERK signaling. These results highlight the future use of TGF-β1 and SCAP for engineering of pulpal regeneration and apexogenesis.
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Chen YJ, Zhao YH, Zhao YJ, Liu NX, Lv X, Li Q, Chen FM, Zhang M. Potential dental pulp revascularization and odonto-/osteogenic capacity of a novel transplant combined with dental pulp stem cells and platelet-rich fibrin. Cell Tissue Res 2015; 361:439-55. [DOI: 10.1007/s00441-015-2125-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 01/02/2015] [Indexed: 12/11/2022]
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Effects of ciprofloxacin-containing scaffolds on enterococcus faecalis biofilms. J Endod 2015; 41:710-4. [PMID: 25698261 DOI: 10.1016/j.joen.2014.12.025] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 10/30/2014] [Accepted: 12/29/2014] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Antibiotic-containing polymer-based nanofibers (hereafter referred to as scaffolds) have demonstrated great potential for their use in regenerative endodontics from both an antimicrobial and cytocompatibility perspective. This study sought to evaluate in vitro the effects of ciprofloxacin (CIP)-containing polymer scaffolds against Enterococcus faecalis biofilms. METHODS Human mandibular incisors were longitudinally sectioned to prepare radicular dentin specimens. Sterile dentin specimens were distributed in 24-well plates and inoculated with E. faecalis for biofilm formation. Infected dentin specimens were exposed to 3 groups of scaffolds, namely polydioxanone (PDS) (control), PDS + 5 wt% CIP, and PDS + 25 wt% CIP for 2 days. Colony-forming units (CFU/mL) (n = 10) and scanning electron microscopy (SEM) (n = 2) were performed to quantitatively and qualitatively assess the antimicrobial effectiveness, respectively. RESULTS PDS scaffold containing CIP at 25 wt% showed maximum bacteria elimination with no microbial growth, differing statistically (P < .05) from the control (PDS) and from PDS scaffold containing CIP at 5 wt%. Statistical differences (P < .05) were also seen for the CFU/mL data between pure PDS (5.92-6.02 log CFU/mL) and the PDS scaffold containing CIP at 5 wt% (5.39-5.87 log CFU/mL). SEM images revealed a greater concentration of bacteria on the middle third of the dentin specimen after 5 days of biofilm formation. On scaffold exposures, SEM images showed similar results when compared with the CFU/mL data. Dentin specimens exposed to PDS + 25 wt% CIP scaffolds displayed a practically bacteria-free surface. CONCLUSIONS On the basis of the data presented, newly developed antibiotic-containing electrospun scaffolds hold promise as an intracanal medicament to eliminate biofilm/infection before regenerative procedures.
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Saghiri MA, Asatourian A, Orangi J, Lotfi M, Soukup JW, Garcia-Godoy F, Sheibani N. Effect of particle size on calcium release and elevation of pH of endodontic cements. Dent Traumatol 2015; 31:196-201. [PMID: 25571910 DOI: 10.1111/edt.12160] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND/AIM Elevation of pH and calcium ion release are of great importance in antibacterial activity and the promotion of dental soft and hard tissue healing process. In this study, we evaluated the effect of particle size on the elevation of pH and the calcium ion release from calcium silicate-based dental cements. MATERIAL AND METHODS Twelve plastic tubes were divided into three groups, filled with white mineral trioxide aggregate (WMTA), WMTA plus 1% methylcellulose, and nano-modified WMTA (nano-WMTA), and placed inside flasks containing 10 ml of distilled water. The pH values were measured using a pH sensor 3, 24, 72, and 168 h after setting of the cements. The calcium ion release was measured using an atomic absorption spectrophotometer with same sample preparation method. Data were subjected to two-way analysis of variance (anova) followed by post hoc Tukey tests with significance level of P < 0.05. RESULTS Nano-WMTA showed significant pH elevation only after 24 h (P < 0.05) compared with WMTA, and after 3, 24, and 72 h compared with WMTA plus 1% methylcellulose (P < 0.05). Nano-WMTA showed significantly higher calcium ion release values compared to the other two groups (P < 0.05). CONCLUSIONS Nano-modification of WMTA remarkably increased the calcium ion release at all time intervals postsetting, which can significantly influence the osteogenic properties of human dental pulp cells and as a consequence enhance mineralized matrix nodule formation to achieve desirable clinical outcomes. However, the increase in pH values mainly occurred during the short time postsetting. Addition of 1% methylcellulose imposed a delay in elevation of pH and calcium ion release by WMTA.
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Affiliation(s)
- Mohammad Ali Saghiri
- Departments of Ophthalmology & Visual Sciences and Biomedical Engineering, University of Wisconsin School of Medicine and Public health, Madison, WI, USA
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Kamocki K, Nör JE, Bottino MC. Dental pulp stem cell responses to novel antibiotic-containing scaffolds for regenerative endodontics. Int Endod J 2014; 48:1147-56. [PMID: 25425048 DOI: 10.1111/iej.12414] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 11/20/2014] [Indexed: 11/30/2022]
Abstract
AIM To evaluate both the drug-release profile and the effects on human dental pulp stem cells' (hDPSC) proliferation and viability of novel bi-mix antibiotic-containing scaffolds intended for use as a drug delivery system for root canal disinfection prior to regenerative endodontics. METHODOLOGY Polydioxanone (PDS)-based fibrous scaffolds containing both metronidazole (MET) and ciprofloxacin (CIP) at selected ratios were synthesized via electrospinning. Fibre diameter was evaluated based on scanning electron microscopy (SEM) images. Pure PDS scaffolds and a saturated CIP/MET solution (i.e. 50 mg of each antibiotic in 1 mL) (hereafter referred to as DAP) served as both negative (nontoxic) and positive (toxic) controls, respectively. High-performance liquid chromatography (HPLC) was performed to investigate the amount of drug(s) released from the scaffolds. WST-1(®) proliferation assay was used to evaluate the effect of the scaffolds on cell proliferation. LIVE/DEAD(®) assay was used to qualitatively assess cell viability. Data obtained from drug release and proliferation assays were statistically analysed at the 5% significance level. RESULTS A burst release of CIP and MET was noted within the first 24 h, followed by a sustained maintenance of the drug(s) concentration for 14 days. A concentration-dependent trend was noticed upon hDPSCs' exposure to all CIP-containing scaffolds, where increasing the CIP concentration resulted in reduced cell proliferation (P < 0.05) and viability. In groups exposed to pure MET or pure PDS scaffolds, no changes in proliferation were observed. CONCLUSIONS Synthesized antibiotic-containing scaffolds had significantly lower effects on hDPSCs proliferation when compared to the saturated CIP/MET solution (DAP).
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Affiliation(s)
- K Kamocki
- Department of Restorative Dentistry, Division of Dental Biomaterials, Indiana University School of Dentistry (IUSD), Indianapolis, IN, USA
| | - J E Nör
- Department of Cariology, Restorative Sciences and Endodontics, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - M C Bottino
- Department of Restorative Dentistry, Division of Dental Biomaterials, Indiana University School of Dentistry (IUSD), Indianapolis, IN, USA
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Vanacker J, Viswanath A, De Berdt P, Everard A, Cani PD, Bouzin C, Feron O, Diogenes A, Leprince JG, des Rieux A. Hypoxia modulates the differentiation potential of stem cells of the apical papilla. J Endod 2014; 40:1410-8. [PMID: 25146023 DOI: 10.1016/j.joen.2014.04.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 04/23/2014] [Accepted: 04/28/2014] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Stem cells from the apical papilla (SCAP) are a population of mesenchymal stem cells likely involved in regenerative endodontic procedures and have potential use as therapeutic agents in other tissues. In these situations, SCAP are exposed to hypoxic conditions either within a root canal devoid of an adequate blood supply or in a scaffold material immediately after implantation. However, the effect of hypoxia on SCAP proliferation and differentiation is largely unknown. Therefore, the objective of this study was to evaluate the effect of hypoxia on the fate of SCAP. METHODS SCAP were cultured under normoxia (21% O2) or hypoxia (1% O2) in basal or differentiation media. Cellular proliferation, gene expression, differentiation, and protein secretion were analyzed by live imaging, quantitative reverse-transcriptase polymerase chain reaction, cellular staining, and enzyme-linked immunosorbent assay, respectively. RESULTS Hypoxia had no effect on SCAP proliferation, but it evoked the up-regulation of genes specific for osteogenic differentiation (runt-related transcription factor 2, alkaline phosphatase, and transforming growth factor-β1), neuronal differentiation ( 2'-3'-cyclic nucleotide 3' phosphodiesterase, SNAIL, neuronspecific enolase, glial cell-derived neurotrophic factor and neurotrophin 3), and angiogenesis (vascular endothelial growth factor A and B). Hypoxia also increased the sustained production of VEGFa by SCAP. Moreover, hypoxia augmented the neuronal differentiation of SCAP in the presence of differentiation exogenous factors as detected by the up-regulation of NSE, VEGFB, and GDNF and the expression of neuronal markers (PanF and NeuN). CONCLUSIONS This study shows that hypoxia induces spontaneous differentiation of SCAP into osteogenic and neurogenic lineages while maintaining the release of the proangiogenic factor VEGFa. This highlights the potential of SCAP to promote pulp-dentin regeneration. Moreover, SCAP may represent potential therapeutic agents for neurodegenerative conditions because of their robust differentiation potential.
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Affiliation(s)
- Julie Vanacker
- Pharmaceutics and Drug Delivery Unit, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium.
| | - Aiswarya Viswanath
- Pharmaceutics and Drug Delivery Unit, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Pauline De Berdt
- Pharmaceutics and Drug Delivery Unit, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Amandine Everard
- Metabolism and Nutrition Research Group, WELBIO (Walloon Excellence in Life Sciences and BIOtechnology), Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Patrice D Cani
- Metabolism and Nutrition Research Group, WELBIO (Walloon Excellence in Life Sciences and BIOtechnology), Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Caroline Bouzin
- Pole of Pharmacology, Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium
| | - Olivier Feron
- Pole of Pharmacology, Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium
| | - Anibal Diogenes
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Julian G Leprince
- Pharmaceutics and Drug Delivery Unit, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Anne des Rieux
- Pharmaceutics and Drug Delivery Unit, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium
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