Recombinant study of the mouse molar cervical loop and dental papilla by renal transplantation

Current Applications and Future Prospects of Stem Cells in Dentistry

Stem cells are defined as clonogenic, unspecialized cells capable of both selt-renewal and multi-lineage differentiation, contributing to regenerating specific tissues. For years, restorative treatments have exploited the lifelong regenerative potential of dental pulp stem cells to give rise to tertiary dentine, which is therapeutically employed for direct and indirect pulp capping. Current applications of stem cells in endodontic research have revealed their potential to continue root development in necrotic immature teeth and transplanted/replanted teeth. Successful application of pulp revascularization is highlighted here with support of a clinical case report. This article also discusses the role of dental stem cells as a promising tool for regeneration of individual tissue types like dentine, pulp and even an entire functional tooth.

Dental-derived Stem Cells and whole Tooth Regeneration: an Overview

The need for new dental tissue-replacement therapies is evident in recent reports which reveal startling statistics regarding the high incidence of tooth decay and tooth loss. Recent advances in the identification and characterization of dental stem cells, and in dental tissue-engineering strategies, suggest that bioengineering approaches may successfully be used to regenerate dental tissues and whole teeth. Interest in dental tissue-regeneration applications continues to increase as clinically relevant methods for the generation of bioengineered dental tissues, and whole teeth, continue to improve. This paper is concerned about dental-derived stem cells and their characterization. Additionally, since conventional dental treatments partially serve the purpose for replacing missing teeth and always include possible failure rates, the potential of dental-derived stem cells in promoting whole tooth regeneration is also discussed.

KEYWORDS

Dental stem cells; Tissue engineering; Tooth regeneration.

Enamel-free teeth: Tbx1 deletion affects amelogenesis in rodent incisors

TBX1 is a principal candidate gene for DiGeorge syndrome, a developmental anomaly that affects the heart, thymus, parathyroid, face, and teeth. A mouse model carrying a deletion in a functional region of the Tbx1 gene has been extensively used to study anomalies related to this syndrome. We have used the Tbx1 null mouse to understand the tooth phenotype reported in patients afflicted by DiGeorge syndrome. Because of the early lethality of the Tbx1-/- mice, we used long-term culture techniques that allow the unharmed growth of incisors until their full maturity. All cultured incisors of Tbx1-/- mice were hypoplastic and lacked enamel, while thorough histological examinations demonstrated the complete absence of ameloblasts. The absence of enamel is preceded by a decrease in proliferation of the ameloblast precursor cells and a reduction in amelogenin gene expression. The cervical loop area of the incisor, which contains the niche for the epithelial stem cells, was either severely reduced or completely missing in mutant incisors. In contrast, ectopic expression of Tbx1 was observed in incisors from mice with upregulated Fibroblast Growth Factor signalling and was closely linked to ectopic enamel formation and deposition in these incisors. These results demonstrate that Tbx1 is essential for the maintenance of ameloblast progenitor cells in rodent incisors and that its deletion results in the absence of enamel formation.

Mouse embryonic diastema region is an ideal site for the development of ectopically transplanted tooth germ

The anterior eye chamber and the kidney capsule of the mouse have been traditionally used for long-term culture of tooth germ grafts. However, although these sites provide an excellent growth environment, they do not represent real in situ sites for the development of a grafted tooth germ. Here, we describe a protocol to transplant a tooth germ into the mandibular diastema region of mouse embryos using exo utero surgery. Our results demonstrate that the mouse embryonic diastema region represents a normal physiological environment for the development of transplanted tooth germs. Transplanted tooth germs developed synchronically with and became indistinguishable from the endogenous ones. These ectopic teeth were vascularized and surrounded with nerve fibers, and were able to erupt normally. Thus, the exo utero transplantation approach will provide a new avenue to study tooth development and regeneration.

Stem cells and tooth tissue engineering

The notion that teeth contain stem cells is based on the well-known repairing ability of dentin after injury. Dental stem cells have been isolated according to their anatomical locations, colony-forming ability, expression of stem cell markers, and regeneration of pulp/dentin structures in vivo. These dental-derived stem cells are currently under increasing investigation as sources for tooth regeneration and repair. Further attempts with bone marrow mesenchymal stem cells and embryonic stem cells have demonstrated the possibility of creating teeth from non-dental stem cells by imitating embryonic development mechanisms. Although, as in tissue engineering of other organs, many challenges remain, stem-cell-based tissue engineering of teeth could be a choice for the replacement of missing teeth in the future.

Regeneration of teeth using stem cell-based tissue engineering

Tooth autotransplantation, allotransplantation and dental implants have existed for many years, but have never been totally satisfactory. Thus, the development of new methods of tooth replacement has become desirable, and with the increasing knowledge of stem cell biology becomes a realistic possibility. Stem cell-based tissue engineering involving the recapitulation of the embryonic environment demonstrates that dental, non-dental, embryonic and adult stem cells can contribute to teeth formation in the appropriate setting. Evidence that stem cell populations may be present in human teeth provides the opportunity to consider biological tooth replacement 'new for old'.

The induction of enamel and dentin complexes by subcutaneous implantation of reconstructed human and murine tooth germ elements

Tooth induction by xenogenic graft of reconstructed human tooth germ components has never been attempted. Here we report our first attempt at a transplantation of human tooth germ components, heterologously recombined with mouse dental epithelia, into immunocompromised animals. Human third molar tooth germs enucleated from young patients as prophylactic treatment for orthodontic reasons were collected. The whole or minced human dental papilla was reconstructed with human- or mouse molar enamel epithelium, and transplanted in the dorsal aspect of C.B-17/Icr-scid Jcl mice. The transplant of human dental papilla reconstructed with human enamel epithelium formed thin dentin and immature enamel layers by 3 to 4 weeks, but remained extremely small in quantity due to a shortage of epithelial components in the graft. The addition of E16 mouse molar enamel organs (n=10-12) to each graft augmented the formation of tooth germ-like structures, but the differentiation of mouse molar ameloblasts was suppressed. However, once a solid layer of mineralized dentin was established, mouse ameloblasts accelerated their differentiation, and completed the enamel matrix formation and maturation within the following 4 weeks, whereas human ameloblasts, which had interacted with human dental papilla, remained in the stage of matrix formation during the same period. These data imply that, in reconstructed transplants, the differentiation of mouse dental epithelia is restrained by putative suppressive factors derived from human dental papilla until they are separated by mineralized dentin layers that serve as a diffusion barrier. The mouse enamel organ nevertheless retains its own phenotypic characteristics and intrinsic timing of cell differentiation and function.

In vitro development of lower first molars from the osteopetrotic microphthalmic (mi) mouse

While the precise mechanism of tooth eruption remains unknown it has been established that for tooth eruption to occur a functioning dental follicle is essential and normal bone resorption is required. In the osteopetrotic microphthalmic (mi) mouse, teeth fail to erupt and development is affected. In the present study, an organ culture technique was established to culture successfully lower first molars from normal and affected mi mice so as to determine if developmental defects were intrinsic to the dental tissue or whether such defects were a result of local environmental factors. Tissue was cultured for up to 13 days and development assessed morphologically at varying time intervals using standard light microscopy. Teeth developed similarly in both animal groups studied. The only variation in the appearance of cultured tissue occurred in the cervical loop region with more curling evident in dental tissue from the affected animals. The results of this study therefore showed that dental tissue from both normal and affected mi mice can be cultured for up to 13 days and that there is no difference in their development. It would appear that these teeth have the same ability to develop and consequently erupt, however the local environment influences tooth development and alters the eruption potential.

The development of mandibular molar tooth germs isografted in the mouse spleen

Tooth germs taken from 13-day-old embryonic mice and isografted in the spleen of adult mice were examined by light and electron microscopy. Well-organized tooth structures from the early cap stage to fully developed and mineralized mature teeth were obtained up to day 60 after transplantation. Germs on day 2 were similar to those prior to the onset of grafting but reached the late cap stage of development on day 4. On day 6, enamel and dentine formation were initiated and inner enamel epithelium and dental papilla cells were polarized. On days 10-15, enamel-matrix secretion was completed and almost all ameloblasts had become resorptive enamel epithelium. India ink injected from the recipient caudal vein accumulated to the capillaries within the pulp throughout the newly-formed vessels. On day 20, defined root formation had begun but occasionally irregular and cellular osteodentine was formed in root areas. On day 30, transplants were covered with reduced enamel epithelium and acellular cementum was formed at the root areas together with rudimentary periodontal ligament fibres. Cellular cementum became thicker up to day 40. There was little evidence of cellular infiltration from recipient tissue up to day 60. The spleen seems to be a suitable site for transplantation of tooth germs.