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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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GÜLER D, ŞEN TUNÇ E. Lazer Doppler Flovmetre. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2019. [DOI: 10.17944/mkutfd.538803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Ong D, Itskovich Y, Dance G. Autotransplantation: a viable treatment option for adolescent patients with significantly compromised teeth. Aust Dent J 2016; 61:396-407. [DOI: 10.1111/adj.12420] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2016] [Indexed: 12/26/2022]
Affiliation(s)
- D Ong
- Orthodontic Department; School of Dentistry; The University of Queensland; Brisbane Queensland
| | - Y Itskovich
- Orthodontic Department; The University of Otago; Dunedin New Zealand
| | - G Dance
- Townsville Oral and Maxillofacial Surgery; Private Practice; Townsville Queensland Australia
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Pulp revascularization of immature permanent teeth: a review of the literature and a proposal of a new clinical protocol. ScientificWorldJournal 2014; 2014:737503. [PMID: 25383384 PMCID: PMC4212590 DOI: 10.1155/2014/737503] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 08/21/2014] [Indexed: 12/29/2022] Open
Abstract
Tissue engineering is a growing field. In the near future, it will probably be possible to generate a complete vital tooth from a single stem cell. Pulp revascularization is dependent on the ability of residual pulp and apical and periodontal stem cells to differentiate. These cells have the ability to generate a highly vascularized and a conjunctive rich living tissue. This one is able to colonize the available pulp space. Revascularization is a new treatment method for immature necrotic permanent teeth. Up to now, apexification procedures were applied for these teeth, using calcium dihydroxide or MTA to produce an artificial apical barrier. However, the pulp revascularization allows the stimulation of the apical development and the root maturation of immature teeth. Two pulp revascularization techniques are used in the literature, one using calcium dihydroxide and the second using a triple antibiotic paste. Based on these two different pulp revascularization protocols, which obtain the desired therapeutic success, the literature will be reviewed and analyzed according to the relevance of their choice of materials. Based on the literature, we propose a new relevant protocol and a new mixture of antibiotics.
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Improvement of the detection of human pulpal blood flow using a laser Doppler flowmeter modified for low flow velocity. Arch Oral Biol 2013; 59:199-206. [PMID: 24370192 DOI: 10.1016/j.archoralbio.2013.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 11/14/2013] [Accepted: 11/16/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Human pulpal blood flow (PBF) signals as measured by laser Doppler flowmeter (LDF) decrease with age. Although this decrease is considered to be due in part to slow blood flow, information regarding this velocity in humans has been lacking. The aims of the present study were to estimate the blood flow velocity in human dental pulp and to evaluate the validity of LDF modified for the measurement of slow blood flow. DESIGN Mean blood flow velocities at the upper central incisor, gingiva, fingertip and forearm of 28 volunteers (mean age: 38.6 years old) were estimated using LDF with a frequency analyser. Blood flow signals at these measurement areas were recorded using two different LDFs: (a) one with a standard blood flow range; and (b) one modified for low blood flow velocity. RESULTS The frequency range of the Doppler shift measured at the teeth with an opaque rubber dam was the narrowest (median: 4.3kHz) among all of the measurement areas. The estimated mean blood flow velocity was the slowest at the teeth with a dam (median: 0.18mm/s). LDF for low blood flow velocity detected larger and clearer pulsatile blood flow signals from the teeth with dams than did standard LDF. CONCLUSIONS The present results indicate that the velocity of PBF in humans is very low and that LDF modified for the measurement of slow blood flow is appropriate for PBF measurement in humans.
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Single-visit revascularization treatment of an immature permanent tooth with apical periodontitis: A case report. PEDIATRIC DENTAL JOURNAL 2013. [DOI: 10.1016/j.pdj.2013.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Pramila R, Muthu M. Regeneration potential of pulp-dentin complex: Systematic review. J Conserv Dent 2012; 15:97-103. [PMID: 22557803 PMCID: PMC3339021 DOI: 10.4103/0972-0707.94571] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 12/05/2011] [Accepted: 01/10/2012] [Indexed: 11/07/2022] Open
Abstract
Aim: The aim is to review and discuss the strategies available for the regeneration of tooth tissues based on principles of tissue engineering. Background: Tissue engineering is a multidisciplinary approach that aims to regenerate functional tooth-tissue structure based on the interplay of three basic key elements: Stem cells, morphogens and scaffolds. A number of recent clinical case reports have revealed the possibilities that many teeth that traditionally would be treated byapexification may be treated by apexogenesis. Materials and Methods: Electronic and hand search of scientific papers were carried out on the Entrez Pubmed, and the Cochrane Central Register of Controlled Trials databases using specific keywords. Specific inclusion and exclusion criteria were predetermined. The search yielded 1619 papers; out of which 65 were identified as conforming to the predetermined inclusion criteria and the remaining 1554 were excluded. Out of 65 papers, 34 papers were excluded again as different key words led to the same publications. Only 31 papers were selected, out of which 27 full-text papers were found and 4 papers were included based on only the abstracts. These 31 papers formed the basis of this review. The data were extracted from the selected studies. The data were synthesized by pooling the extracted data. Conclusion: The field of tissue engineering has recently shown promising results and is a good prospect in dentistry for the development of the ideal restorations to replace the lost tooth structure.
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Affiliation(s)
- R Pramila
- Department of Pedodontics and Preventive Dentistry, Saveetha Dental College and Hospital, Chennai, Tamil Nadu, India
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Chen E, Abbott PV. Evaluation of Accuracy, Reliability, and Repeatability of Five Dental Pulp Tests. J Endod 2011; 37:1619-23. [DOI: 10.1016/j.joen.2011.07.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 07/13/2011] [Accepted: 07/17/2011] [Indexed: 10/17/2022]
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Abstract
Dental pulp testing is a useful and essential diagnostic aid in endodontics. Pulp sensibility tests include thermal and electric tests, which extrapolate pulp health from sensory response. Whilst pulp sensibility tests are the most commonly used in clinical practice, they are not without limitations and shortcomings. Pulp vitality tests attempt to examine the presence of pulp blood flow, as this is viewed as a better measure of true health than sensibility. Laser Doppler flowmetry and pulse oximetry are examples of vitality tests. Whilst the prospect is promising, there are still many practical issues that need to be addressed before vitality tests can replace sensibility tests as the standard clinical pulp diagnostic test. With all pulp tests, the results need to be carefully interpreted and closely scrutinised as false results can lead to misdiagnosis which can then lead to incorrect, inappropriate, or unnecessary treatment.
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Mullane EM, Dong Z, Sedgley CM, Hu JCC, Botero TM, Holland GR, Nör JE. Effects of VEGF and FGF2 on the revascularization of severed human dental pulps. J Dent Res 2009; 87:1144-8. [PMID: 19029083 DOI: 10.1177/154405910808701204] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The long-term outcome of replanted avulsed permanent teeth is frequently compromised by lack of revascularization, resulting in pulp necrosis. The purpose of this study was to evaluate the effects of vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF-2) on the revascularization of severed human dental pulps. Tooth slices were prepared from non-carious human molars and treated with 0-50 ng/mL rhVEGF(165) or rhFGF-2 for 7 days in vitro. Both angiogenic factors enhanced pulp microvessel density compared with untreated controls (p < 0.05). Tooth slices were also treated with 0 or 50 ng/mL rhVEGF(165) for one hour prior to implantation into the subcutaneous space of immunodeficient mice. Treatment with rhVEGF(165) increased pulp microvessel density in vivo (p < 0.05). These results demonstrate that rhVEGF(165) enhanced neovascularization of severed human dental pulps and suggest that topical application of an angiogenic factor prior to replantation might be beneficial for the treatment of avulsed teeth.
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Affiliation(s)
- E M Mullane
- Department of Cariology, Restorative Sciences and Endodontics, University of Michigan School of Dentistry, 1011 N. University, Ann Arbor, MI 48109-1078, USA
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Murray PE, Garcia-Godoy F, Hargreaves KM. Regenerative endodontics: a review of current status and a call for action. J Endod 2007; 33:377-90. [PMID: 17368324 DOI: 10.1016/j.joen.2006.09.013] [Citation(s) in RCA: 495] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2006] [Revised: 09/10/2006] [Accepted: 09/18/2006] [Indexed: 12/16/2022]
Abstract
Millions of teeth are saved each year by root canal therapy. Although current treatment modalities offer high levels of success for many conditions, an ideal form of therapy might consist of regenerative approaches in which diseased or necrotic pulp tissues are removed and replaced with healthy pulp tissue to revitalize teeth. Researchers are working toward this objective. Regenerative endodontics is the creation and delivery of tissues to replace diseased, missing, and traumatized pulp. This review provides an overview of regenerative endodontics and its goals, and describes possible techniques that will allow regenerative endodontics to become a reality. These potential approaches include root-canal revascularization, postnatal (adult) stem cell therapy, pulp implant, scaffold implant, three-dimensional cell printing, injectable scaffolds, and gene therapy. These regenerative endodontic techniques will possibly involve some combination of disinfection or debridement of infected root canal systems with apical enlargement to permit revascularization and use of adult stem cells, scaffolds, and growth factors. Although the challenges of introducing endodontic tissue engineering therapies are substantial, the potential benefits to patients and the profession are equally ground breaking. Patient demand is staggering both in scope and cost, because tissue engineering therapy offers the possibility of restoring natural function instead of surgical placement of an artificial prosthesis. By providing an overview of the methodological issues required to develop potential regenerative endodontic therapies, we hope to present a call for action to develop these therapies for clinical use.
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Affiliation(s)
- Peter E Murray
- Department of Endodontics, College of Dental Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328, USA.
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Sun Y, Verbeuren TJ, Vallez MO, Nilsson GE, Sjöberg F. Volumetric flow mapping for microvascular networks by bimodality imaging with light microscope and Laser Doppler imager. Microsc Res Tech 2004; 65:130-8. [PMID: 15605418 DOI: 10.1002/jemt.20113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A method was developed to produce a composite image of microvascular networks with grayscales proportional to volumetric flows. Velocities in arterioles and venules were assessed with a high-resolution laser Doppler imager (LDI). The vascular structures were quantified from the micrograph with a computerized vessel detection algorithm. After registering the detected vascular network with the LDI scan, volumetric flows were calculated along the centerlines of the vessels. In vivo data were obtained from the hamster cheek pouch in 6 studies. Flow continuity of the flow map was evaluated by comparing the main flow (Q) with the sum of branch flows (Qs), averaging over the respective vessel segments incident to each bifurcation. The method was reproducible across the 6 studies with the correlation coefficient (r) between Qs and Q ranging from 0.913 to 0.986. In all, over 20,000 flow estimates from 360 vessel segments (24-160 microm in diameter) at 166 bifurcations were analyzed. With flow normalized between 0 and 1, the linear regression yielded: Qs = 1.03 Q + 0.006; r = 0.952, n = 166, P < 0.0005. The bimodality imaging method exploits a large amount of velocity and diameter data, and therefore should be useful for studying heterogeneous flows in the microvasculature.
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Affiliation(s)
- Ying Sun
- Biomedical Engineering Program, University of Rhode Island, Kingston, Rhode Island 02881, USA.
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