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Martín G, Preve V, Hargreaves K, Diogenes A, Inostroza C, Saint-Jean N, Brizuela C. Effect of Dentin Conditioning with EDTA and Diode Lasers on Expression of Odontoblast-like Cell Markers of Dental Pulp Stem Cells. Dent J (Basel) 2023; 11:210. [PMID: 37754330 PMCID: PMC10527775 DOI: 10.3390/dj11090210] [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: 06/09/2023] [Revised: 08/22/2023] [Accepted: 08/30/2023] [Indexed: 09/28/2023] Open
Abstract
Regenerative endodontic procedures rely on the delivery of mesenchymal stem cells into the root canal and on the effect of local growth factors from the dentin and blood clot. The aim of this study was to assess the effect of dentin conditioning with ethylenediamine tetraacetic acid (EDTA) and diode lasers with different wavelengths (808 nm and 980 nm) on the expression of odontoblast-like cell markers. Forty dentin cylinders were divided into four groups according to the irrigation protocol: EDTA, EDTA + 808 nm diode laser, EDTA + 980 nm diode laser, and phosphate-buffered saline as the control group. Dental pulp stem cells were seeded into the previously conditioned cylinders and incubated for 14 days. The quantitative real-time polymerase chain reaction was used to evaluate the expression of dentin sialophosphoprotein (DSPP), dentin morphoprotein-1 (DMP-1), and transforming growth factor-beta 1 (TGF-β1). Data analysis was performed using the Kruskal-Wallis test. The activation of EDTA with 980 nm and 808 nm diode lasers resulted in lower DSPP and DMP-1 expression than that for EDTA alone (p < 0.05 and p < 0.01, respectively). The expression of TGF was similar among all groups. The highest level of expression of odontoblast-like differentiation markers was observed with EDTA alone. However, the use of an 808 nm diode laser during EDTA irrigation reduced the expression of odontoblastic differentiation markers.
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Affiliation(s)
- Gabriela Martín
- Department of Endodontics, Universidad Católica de Córdoba, Córdoba 5000, Argentina
- Faculty of Dentistry, Universidad Nacional de Córdoba, Córdoba 5000, Argentina
| | | | - Kenneth Hargreaves
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA; (K.H.); (A.D.)
| | - Anibal Diogenes
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA; (K.H.); (A.D.)
| | - Carolina Inostroza
- Dental School, Universidad de los Andes, Santiago de Chile 7550000, Chile; (C.I.); (N.S.-J.); (C.B.)
| | - Nicole Saint-Jean
- Dental School, Universidad de los Andes, Santiago de Chile 7550000, Chile; (C.I.); (N.S.-J.); (C.B.)
| | - Claudia Brizuela
- Dental School, Universidad de los Andes, Santiago de Chile 7550000, Chile; (C.I.); (N.S.-J.); (C.B.)
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Effects of EDTA and saline as the final irrigation in regenerative endodontic procedures on the migration, proliferation, and differentiation of human stem cells from the apical papilla. Clin Oral Investig 2023; 27:1973-1980. [PMID: 36790627 DOI: 10.1007/s00784-023-04919-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/08/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVES To evaluate the effect of EDTA and saline as the final irrigation in regenerative endodontic procedures (REPS) on the attachment, proliferation, migration, and differentiation of stem cells from the apical papilla (SCAPs). MATERIALS AND METHODS Dentin specimens from 140 human third molars were irrigated with various protocols-group 1: normal sterile saline (NSS), group 2: EDTA, group 3: EDTA then 5 mL NSS, or group 4: EDTA then 20 mL NSS. The specimens were used in cell assays. For cell proliferation, SCAPs were seeded on dentin, and the cell viability on days 1, 3, and 7 was determined using an MTT assay. At day 3, the attached cells' morphology was observed using SEM, and cell migration was investigated using a transwell migration assay. The ALP activity and odonto/osteogenic differentiation gene expression were evaluated at days 7, 14, and 21 using an ALP activity assay and RT-qPCR. RESULTS On days 3 and 7, group 4 demonstrated more viable cells than group 1 (p < 0.01). The amount of migrated cells in groups 2, 3, and 4 was greater compared with group 1 (p < 0.05). Moreover, SCAP differentiation was similar between groups. CONCLUSIONS Irrigating dentin with EDTA alone or with EDTA then NSS promoted SCAP migration. However, a final irrigation with 20 mL NSS after EDTA promoted SCAP proliferation without affecting their differentiation. CLINICAL RELEVANCE When using a blood clot as a scaffold, a final flushing with 20 mL NSS after EDTA could be beneficial for clinical REP protocols.
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Effect of chitosan irrigant solutions on the release of bioactive proteins from root dentin. Clin Oral Investig 2023; 27:691-703. [PMID: 36401068 DOI: 10.1007/s00784-022-04787-1] [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: 04/04/2022] [Accepted: 11/10/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To identify the effect of two chitosan solutions on the release of root dentin matrix proteins and to describe the chemical changes observed following conditioning with chelating agents. MATERIALS AND METHODS The release of dentin sialoprotein (DSP), transforming growth factor-beta 1 (TGF-β1), vascular endothelial growth factor (VEGF), and platelet-derived growth factor-BB (PDGF-BB) with different chelating agents, including ethylenediaminetetraacetic acid (EDTA), chitosan solution (CS), and nanoparticulate chitosan (CSnp), was investigated. DSP was quantified using an enzyme-linked immunosorbent assay (ELISA). TGF-β1, VEGF, and PDGF-BB were quantified using a cytokine bead panel (CBA). Raman spectroscopy was performed to identify surface chemical changes. Statistical analysis was performed using Kruskal-Wallis test with Mann-Whitney-Wilcoxon rank-sum test (p < 0.05). RESULTS TGF-β1, VEGF, and DSP solubilized in all irrigants tested. CSnp showed the highest concentration of DSP. PDGF-BB did not exceed the detection limits. Raman spectroscopy revealed a decrease in the phosphate and carbonate peaks, representing the chelating effect of EDTA, CS, and CSnp. Additionally, CSnp showed the greatest preservation of the amide I and III content. CONCLUSION Proteins can be released from dentin via EDTA, CS, and CSnp conditioning. Raman spectroscopic revealed changes in the inorganic content of the root dentin after chelation. Furthermore, use of CSnp facilitated a preservation of the organic content. CLINICAL RELEVANCE Chelation allows the release of proteins, justifying the use of chelating agents in regenerative endodontics. The chitosan-dentin matrix interaction also promotes the protection of the organic content as an additional benefit to its protein releasing effect.
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Bioactivity of Dental Restorative Materials: FDI Policy Statement. Int Dent J 2022; 73:21-27. [PMID: 36577639 PMCID: PMC9875272 DOI: 10.1016/j.identj.2022.11.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/20/2022] [Indexed: 12/28/2022] Open
Abstract
The term bioactivity is being increasingly used in medicine and dentistry. Due to its positive connotation, it is frequently utilised for advertising dental restorative materials. However, there is confusion about what the term means, and concerns have been raised about its potential overuse. Therefore, FDI decided to publish a Policy Statement about the bioactivity of dental restorative materials to clarify the term and provide some caveats for its use in advertising. Background information for this Policy Statement was taken from the current literature, mainly from the PubMed database and the internet. Bioactive restorative materials should have beneficial/desired effects. These effects should be local, intended, and nontoxic and should not interfere with a material's principal purpose, namely dental tissue replacement. Three mechanisms for the bioactivity of such materials have been identified: purely biological, mixed biological/chemical, or strictly chemical. Therefore, when the term bioactivity is used in an advertisement or in a description of a dental restorative material, scientific evidence (in vitro or in situ, and preferably in clinical studies) should be provided describing the mechanism of action, the duration of the effect (especially for materials releasing antibacterial substances), and the lack of significant adverse biological side effects (including the development and spread of antimicrobial resistance). Finally, it should be documented that the prime purpose, for instance, to be used to rebuild the form and function of lost tooth substance or lost teeth, is not impaired, as demonstrated by data from in vitro and clinical studies. The use of the term bioactive dental restorative material in material advertisement/information should be restricted to materials that fulfil all the requirements as described in the FDI Policy Statement.
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Muacevic A, Adler JR, Madkaikar M, Devi RKS, Gada A, Bapat S. Assessment of the Influence of Various Concentrations of Sodium Hypochlorite on Stem Cell Derived From Human Exfoliated Deciduous Teeth (SHED) Proliferation and Differentiation. Cureus 2022; 14:e33024. [PMID: 36726895 PMCID: PMC9886376 DOI: 10.7759/cureus.33024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 12/27/2022] [Indexed: 12/29/2022] Open
Abstract
Objectives Previous research has established that sodium hypochlorite (NaOCl) has a detrimental effect on dental stem cell viability and maturation. However, a review of the literature revealed no study evaluating the response of NaOCl to the survival of stem cells derived from human exfoliated deciduous teeth (SHEDs). Hence, the aim of the present trial was to assess the influence of various dilutions of NaOCl on SHED proliferation and differentiation. Materials and Methods The 5.25% NaOCl solutions at concentrations of 0.5, 0.1, 0.025, 0.0125, and 0.005 mg/ml were used to assess the response to SHED proliferation and differentiation through methyl tetrazolium (MTT) assay, alkaline phosphatase (ALP) assay, and reverse transcription polymerase chain reaction gene expression analysis at various time point intervals. Results MTT assay showed that the viability of SHEDs decreased with an increase in the concentration of NaOCl and an increase in incubation time. The ALP activity decreased with an increase in the concentration of NaOCl up to 14 days of incubation. However, the ALP activity of all the test specimens further decreased after 14 days of incubation. The gene expression levels of osteocalcin, dentin sialophosphoprotein, and STRO-1 were statistically significant when compared to the control after one, three, and seven days of incubation. Conclusion Different doses of NaOCl other than 0.5 mg/ml revealed encouraging outcomes in terms of proliferation, long-term ALP functioning, and odontogenic differentiation potential when cultivated in SHEDs.
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The Immunomodulatory and Regenerative Effect of Biodentine™ on Human THP-1 Cells and Dental Pulp Stem Cells: In Vitro Study. BIOMED RESEARCH INTERNATIONAL 2022; 2022:2656784. [PMID: 36093401 PMCID: PMC9462999 DOI: 10.1155/2022/2656784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/09/2022] [Accepted: 08/18/2022] [Indexed: 11/17/2022]
Abstract
Background Pulp tissue affected by deep caries and trauma can be protected by vital pulp therapies in which pulp regeneration success depends on the degree of pulp inflammation and the presence of regenerative signals. Reparative dentinogenesis requires dental pulp stem cell (DPSC) activity which can be stimulated by many bioactive molecules to repair the dentine, mediating a balance between the inflammatory response and the reparative events. Therefore, this study was performed in order to investigate the immune-inflammatory effect of Biodentine capping material on DPSCs and macrophages. Method THP-1, a human monocytic cell line, was differentiated to macrophages, and flow cytometry was used to analyze the expressions of specific macrophage markers. LPS-mediated infection was created for macrophages and DPSCs followed by treatment with Biodentine. CBA array was used to investigate the cytokine secretion followed by qPCR. Migration potential of treated DPSCs was also determined. Results Our results showed that THP-1 cell line was successfully differentiated into macrophages as shown by surface marker expression. CBA array and qPCR results showed that Biodentine-treated DPSCs and macrophages upregulated anti-inflammatory cytokines and downregulated proinflammatory cytokines. Also, Biodentine enhances the migration potential of treated DPSCs. Conclusion Biodentine capping material mediated the polarization of M1 to M2 macrophages suggestive of tissue repair properties of macrophages and enhanced the anti-inflammatory cytokines of DPSCs responsible for dentine-pulp regeneration.
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Agrawal P, Nikhade P, Chandak M, Ikhar A, Bhonde R. Dentin Matrix Metalloproteinases: A Futuristic Approach Toward Dentin Repair and Regeneration. Cureus 2022; 14:e27946. [PMID: 36120221 PMCID: PMC9464706 DOI: 10.7759/cureus.27946] [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: 07/31/2022] [Accepted: 08/12/2022] [Indexed: 11/05/2022] Open
Abstract
Matrix metalloproteinases (MMPs) have been linked to modulating healing during the production of tertiary dentin, as well as the liberation of physiologically active molecules and the control of developmental processes. Although efforts to protect dentin have mostly centered on preventing these proteases from doing their jobs, their role is actually much more intricate and crucial for dentin healing than anticipated. The role of MMPs as bioactive dentin matrix components involved in dentin production, repair, and regeneration is examined in the current review. The mechanical characteristics of dentin, especially those of reparative and reactionary dentin, and the established functions of MMPs in dentin production are given particular attention. Because they are essential parts of the dentin matrix, MMPs should be regarded as leading applicants for dentin regeneration.
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Sadaghiani L, Alshumrani AM, Gleeson HB, Ayre WN, Sloan AJ. Growth Factor release and dental pulp stem cell attachment following dentine conditioning- an in vitro study. Int Endod J 2022; 55:858-869. [PMID: 35638345 PMCID: PMC9541952 DOI: 10.1111/iej.13781] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 05/13/2022] [Accepted: 05/13/2022] [Indexed: 12/02/2022]
Abstract
Aim The aim of the study was to investigate the effect of dentine conditioning agents on growth factor liberation and settlement of dental pulp progenitor cells (DPSCs) on dentine surfaces. Methodology The agents used included ethylenediaminetetraacetic acid (EDTA; 10%, pH 7.2), phosphoric acid (37%, pH < 1), citric acid (10%, pH 1.5) and polyacrylic acid (25%, pH 3.9). Human dentine slices were conditioned for exaggerated conditioning times of 5 and 10 min, so that the growth factor liberation reached quantifiable levels above the limit of detection of the laboratory methods employed. Transforming growth factor beta‐1 (TGF‐β1) release and surface exposure were quantified by enzyme‐linked immunosorbent assay (ELISA) and immunogold labelling. Scanning electron microscopy (SEM) was used to assess the morphology of cells and coverage by DPSCs cultured on dentine surfaces for 8 days. Results After 5‐min conditioning of dentine slices, citric acid was the most effective agent for growth factor release into the aqueous environment as measured by ELISA (Mann–Whitney U with Bonferroni correction, p < .01 compared with phosphoric and polyacrylic acid). As well as this, dentine slices treated with phosphoric acid for the same period, displayed significantly less TGF‐β1 on the surface compared with the other agents used, as measured by immunogold labelling (MWU with Bonferroni correction, p < .05). After 8 days, widespread coverage by DPSCs on dentine surfaces conditioned with citric acid and EDTA were evident under SEM. On dentine surfaces conditioned with phosphoric and polyacrylic acid, respectively, less spread cells and inconsistent cell coverage were observed. Conclusions Based on the findings of this in vitro study, a desirable biological growth factor‐mediated effect may be gained when conditioning dentine by milder acidic or chelating agents such as citric acid and EDTA. The results must be interpreted in the context that the potential of the applied materials inducing a desirable biological response in DPSCs is only one consideration amongst other important ones in a clinical setting. However, it is crucial to look beyond the mere physical effects of materials and move towards biologically based treatment approaches as far as the restorative management of teeth with viable dental pulps are concerned.
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Affiliation(s)
- L Sadaghiani
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, UK
| | | | - H B Gleeson
- Department of General Dentistry and Orthodontics, Addenbrookes Hospital, Cambridge University Hospitals NHS foundation trust, UK
| | - W Nishio Ayre
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, UK
| | - A J Sloan
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
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Markandey S, Das Adhikari H. Evaluation of blood clot, platelet-rich plasma, and platelet-rich fibrin–mediated regenerative endodontic procedures in teeth with periapical pathology: a CBCT study. Restor Dent Endod 2022; 47:e41. [DOI: 10.5395/rde.2022.47.e41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/19/2021] [Accepted: 01/03/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
- Swati Markandey
- Department of Conservative Dentistry and Endodontics, Dr. R. Ahmed Dental College and Hospital, Kolkata, India
| | - Haridas Das Adhikari
- Department of Conservative Dentistry and Endodontics, Dr. R. Ahmed Dental College and Hospital, Kolkata, India
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Effect of Different Root Canal Irrigant Solutions on the Release of Dentin-Growth Factors: A Systematic Review and Meta-Analysis. MATERIALS 2021; 14:ma14195829. [PMID: 34640224 PMCID: PMC8510123 DOI: 10.3390/ma14195829] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/22/2021] [Accepted: 09/29/2021] [Indexed: 01/07/2023]
Abstract
Irrigant solutions are used to promote dentin-growth factors (GF) release for regenerative endodontics. This review aimed to evaluate the reports comparing the release of GFs using different root canal irrigant solutions. Eligible studies compared the in vitro GF release in human teeth after the use of at least two distinct solutions. A search was conducted on Pubmed, Scopus, Web of Science, and Lilacs on 11 August 2021. Risk of bias was assessed using SciRAP. Study characteristics and quantitative data were extracted, and meta-analyses were performed for the mean difference (95% confidence interval) of the release of transforming growth factors Beta 1 (TGF-β1) by EDTA compared to other irrigants. Of sixteen eligible studies, eight were included in quantitative analysis. ELISA assays showed higher TGF-β1 release from 10% EDTA compared to 10% citric acid (p < 0.00001). Immunogold assays showed higher levels of TGF-β1 for 17% EDTA (p < 0.00001) compared to 10% citric acid. GRADE identified a low to very low certainty of evidence. These results point to an increased release of TGF-β1 in dentin treated with EDTA. The high heterogeneity and very low certainty of the evidence demand further studies before EDTA indication as a better irrigant for regenerative endodontics. Registration: CRD42020160871 (PROSPERO).
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Scelza P, Gonçalves F, Caldas I, Nunes F, Lourenço ES, Tavares S, Magno M, Pintor A, Montemezzi P, Edoardo ED, Mourão CFDAB, Alves G, Scelza MZ. Prognosis of Regenerative Endodontic Procedures in Mature Teeth: A Systematic Review and Meta-Analysis of Clinical and Radiographic Parameters. MATERIALS 2021; 14:ma14164418. [PMID: 34442940 PMCID: PMC8398537 DOI: 10.3390/ma14164418] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/20/2021] [Accepted: 08/04/2021] [Indexed: 12/13/2022]
Abstract
This work aimed to investigate the use of Regenerative Endodontic Procedures (REP) on the treatment of pulp necrosis in mature teeth through systematic review and meta-analysis of evidence on clinical and radiographic parameters before and after REP. A search was performed in different databases on 9 September 2020, including seven clinical studies and randomized controlled trials (RCT). The methodological quality was assessed using Revised Cochrane risk-of-bias (RoB 2) and Before-and-After tools. Meta-analyses were performed to evaluate the success incidences regarding the reduction of periapical lesion and recovery of sensitivity. The certainty of the evidence was assessed using GRADE. Meta-analysis showed a high overall success of 0.95 (0.92, 0.98) I2 = 6%, with high periapical lesion reduction at 12 months (0.93 (0.86, 0.96) I2 = 37%) and by the end of follow-up (0.91 (0.83, 0.96) I2 = 13%). Lower incidences of positive sensitivity response were identified for the electrical (0.58 (0.46, 0.70) I2 = 51%) and cold tests (0.70 (0.54, 0.84) I2 = 68%). The calculated levels of REP success were similar to those reported for immature teeth. With a very low certainty of evidence, the meta-analysis showed a high incidence of REP’s success for mature teeth with necrotic pulp evidenced by periapical lesion reduction and moderate positive responses to sensitivity tests.
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Affiliation(s)
- Pantaleo Scelza
- Geriatric Dentistry Department, Universidade Federal Fluminense, Niterói 24020-140, RJ, Brazil; (P.S.); (I.C.); (F.N.)
| | - Fabiano Gonçalves
- Post-Graduate Program in Dentistry, Universidade Federal Fluminense, Niterói 24020-140, RJ, Brazil; (F.G.); (E.S.L.); (S.T.)
| | - Isleine Caldas
- Geriatric Dentistry Department, Universidade Federal Fluminense, Niterói 24020-140, RJ, Brazil; (P.S.); (I.C.); (F.N.)
| | - Fernanda Nunes
- Geriatric Dentistry Department, Universidade Federal Fluminense, Niterói 24020-140, RJ, Brazil; (P.S.); (I.C.); (F.N.)
| | - Emanuelle Stellet Lourenço
- Post-Graduate Program in Dentistry, Universidade Federal Fluminense, Niterói 24020-140, RJ, Brazil; (F.G.); (E.S.L.); (S.T.)
| | - Sandro Tavares
- Post-Graduate Program in Dentistry, Universidade Federal Fluminense, Niterói 24020-140, RJ, Brazil; (F.G.); (E.S.L.); (S.T.)
| | - Marcela Magno
- Department of Pediatric Dentistry and Orthodontics, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, RJ, Brazil; (M.M.); (A.P.)
| | - Andrea Pintor
- Department of Pediatric Dentistry and Orthodontics, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, RJ, Brazil; (M.M.); (A.P.)
| | | | | | - Carlos Fernando de Almeida Barros Mourão
- Clinical Research Unit of the Antonio Pedro Hospital, Universidade Federal Fluminense, Niterói 24033-900, RJ, Brazil;
- Correspondence: (C.F.d.A.B.M.); (M.Z.S.); Tel.: +1-941-(830)-1302 (C.F.d.A.B.M.); +55-21-99984-0270 (M.Z.S.)
| | - Gutemberg Alves
- Clinical Research Unit of the Antonio Pedro Hospital, Universidade Federal Fluminense, Niterói 24033-900, RJ, Brazil;
| | - Miriam Zaccaro Scelza
- Laboratory of Experimental Culture Cell (LECCel), Department of Endodontics, Faculty of Dentistry, Universidade Federal Fluminense, Niterói 24020-140, RJ, Brazil
- Correspondence: (C.F.d.A.B.M.); (M.Z.S.); Tel.: +1-941-(830)-1302 (C.F.d.A.B.M.); +55-21-99984-0270 (M.Z.S.)
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Özcan M, Garcia LDFR, Volpato CAM. Bioactive Materials for Direct and Indirect Restorations: Concepts and Applications. FRONTIERS IN DENTAL MEDICINE 2021. [DOI: 10.3389/fdmed.2021.647267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Currently, minimally invasive restorations could be made in dentistry applying adhesive materials and adhesion principles to the dental structures. Following this philosophy, endodontic interventions have been avoided largely, preserving hard tissues, and maintaining dental vitality. Advances in biologically favorable bioactive materials enabled clinicans to induce repair and regeneration of dental tissues. Such materials are primarily used for pulp protection and cementation of indirect restorations. This review highlights current bioactive materials available, principles of bioactivity and their mechanisms of action.
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Hancerliogullari D, Erdemir A, Kisa U. The effect of different irrigation solutions and activation techniques on the expression of growth factors from dentine of extracted premolar teeth. Int Endod J 2021; 54:1915-1924. [PMID: 34115394 DOI: 10.1111/iej.13589] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 01/23/2023]
Abstract
AIM To evaluate in a laboratory study, the effect of different canal irrigant solutions and activation techniques on transforming growth factor (TGF-β1), insulin growth factor-1 (IGF-1), bone morphogenetic protein-7 (BMP-7) and vascular endothelial growth factor-A (VEGF-A) release levels from the dentine of extracted premolar teeth. METHODOLOGY Seventy premolar teeth with single root and canal were used. The lengths of the root segments were standardized to 12 mm, and the root canals were prepared up to size 100 with hand files. All surfaces of the teeth were covered with nail polish except the inner root canal surface. The root canals were irrigated with 1.5% NaOCl. Ten teeth were allocated to the control group. The remaining sixty teeth were divided into 2 main groups according to the chelating agent used (17% EDTA, 10% Citric acid; CA) and 3 subgroups (n = 10) according to irrigation activation technique (conventional syringe irrigation (CSI), passive ultrasonic irrigation (PUI) and Er:YAG laser activation). After the activation procedure, the root segments were placed into eppendorf tubes containing 1 mL of phosphate-buffered saline solution and kept at 37℃. TGF-β1, IGF-1, BMP-7 and VEGF-A release levels from dentine were measured using the enzyme-linked immunosorbent assay (ELISA) method at 24 h and at day 7. The volume of root canals was calculated using cone-beam computed tomography. The growth factor levels were calculated in ng/mL except VEGF-A (pg/ml). Normality analysis of the data was evaluated with the Kolmogorov-Smirnov test. Statistical analysis was performed using the Mann-Whitney-U and Wilcoxon tests. RESULTS Regardless of the activation type and sampling time, EDTA caused significantly more IGF release than did CA, whereas EDTA and CA were equally effective for the release of the other growth factors. For either EDTA or CA, the lowest and highest growth factor release levels were observed in the CSI and Er:YAG laser groups, respectively (p < .05). All of the growth factors were released significantly more at 24 h than on day 7 (p < .05). CONCLUSIONS Irrigation activation techniques with EDTA or CA increased the release levels of all growth factors from the dentine of canal walls in extracted premolar teeth.
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Affiliation(s)
- Dilek Hancerliogullari
- Department of Endodontics, Faculty of Dentistry, Kirikkale University, Kirikkale, Turkey
| | - Ali Erdemir
- Department of Endodontics, Faculty of Dentistry, Kirikkale University, Kirikkale, Turkey
| | - Ucler Kisa
- Department of Biochemistry, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
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Khan JA, Hasan A, Dossa S, Ali B. Effect of Natural and Artificial Dentin Conditioners on the Release of Vascular Endothelial Growth Factor. J Endod 2021; 47:800-805. [PMID: 33581196 DOI: 10.1016/j.joen.2021.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/15/2020] [Accepted: 02/04/2021] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The purpose of this study was to observe the release of vascular endothelial growth factor (VEGF) after conditioning with etidronic acid (also known as 1-hydroxyethylidene-1 and 1-bisphosphonate [HEDP]) and phytic acid (inositol hexakisphosphate [IP6]) in comparison with EDTA on human dentin disks and cylinders. METHODS Human dentin disks were disinfected and prepared by the standardized method. Seventeen percent EDTA, 9% HEDP, 1% IP6, and distilled water (5 minutes) were used to immerse dentin disks. The dentin cylinders were prepared by following disinfection and the standardized preparation method to achieve a truncated cone-shaped canal with a 1-mm open apex. The dentin cylinder samples were irrigated with sodium hypochlorite (5 mL/5 minutes) and then rinsed with 17% EDTA, 9% HEDP, 1% IP6 and distilled water (5 mL/5 min). Enzyme-linked immunosorbent essay was performed to measure VEGF release. One-way analysis of variance was used to compare the mean release of VEGF between study groups and controls at a significance level of .05. A post hoc Tukey test was used for multiple comparisons between study groups. RESULTS Among conditioners, HEDP released more VEGF from both disks and cylinders. In cylinders, VEGF release by HEDP was significantly greater than the other conditioners, whereas in disks the release of VEGF was similar with all conditioners. CONCLUSIONS The release of VEGF by 9% HEDP and 1% IP6 was comparable with 17% EDTA from dentin disks; however, HEDP demonstrated more release from dentin cylinders than EDTA and IP6.
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Affiliation(s)
- Javeria Ali Khan
- Department of Operative Dentistry, Dow Dental College, Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | - Arshad Hasan
- Department of Operative Dentistry, Dow Dental College, Dow University of Health Sciences, Karachi, Sindh, Pakistan.
| | - Sumaiya Dossa
- Department of Operative Dentistry, Dow Dental College, Advanced Research Laboratory, Laboratory Animal Sciences, Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | - Batool Ali
- Department of Orthodontics, Dow Dental College, Dow University of Health Sciences, Karachi, Sindh, Pakistan
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EDTA Promotes the Mineralization of Dental Pulp In Vitro and In Vivo. J Endod 2020; 47:458-465. [PMID: 33352150 DOI: 10.1016/j.joen.2020.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/09/2020] [Accepted: 12/12/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Dentin regeneration is one of the main goals of vital pulp treatment in which the biological properties of dental pulp cells (DPCs) need to be considered. In our previous study, we showed that EDTA could enhance the stromal cell-derived factor 1 alpha-induced migration of DPCs. The purpose of this study was to explore the effects of EDTA on the mineralization of dental pulp in vitro and in vivo. METHODS DPCs were obtained from human premolars or third molars. Alkaline phosphatase assays and alizarin red S staining were used to examine the degree of differentiation and mineralized nodule formation of DPCs. Real-time polymerase chain reaction and Western blot analysis were performed to detect the messenger RNA and protein expressions of mineralization-related markers in DPCs. Extracellular-regulated protein kinase and Smad inhibitors were used to study the roles of these 2 signaling pathways in this process. In addition, pulp exposures were created on 18 premolars of 2 beagle dogs (>12 months) using a high-speed dental handpiece. The experimental group (n = 9) was treated with 12% EDTA for 5 minutes, and the control group (n = 9) was treated with sterile saline for the same duration. Mineral trioxide aggregate was used for direct pulp capping followed by glass ionomer cement sealing. Samples were collected 3 months later, and the regenerated dentin was assessed by micro-computed tomographic and histologic analyses. RESULTS Exposure to 12% EDTA promoted the activity of alkaline phosphatase, the formation of mineralized nodules, and the messenger RNA and protein expressions of mineralization-related markers in DPCs. Furthermore, the process of 12% EDTA enhancing the differentiation of DPCs was mediated by the extracellular-regulated protein kinase 1/2 signaling pathway and inhibited by the Smad2/3 signaling pathway. In vivo, compared with the control group, more regenerated dentin that had fewer tunnel defects was formed in the 12% EDTA-treated group. CONCLUSIONS Our results showed that 12% EDTA could promote the mineralization of dental pulp in vitro and in vivo.
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Fischer NG, Münchow EA, Tamerler C, Bottino MC, Aparicio C. Harnessing biomolecules for bioinspired dental biomaterials. J Mater Chem B 2020; 8:8713-8747. [PMID: 32747882 PMCID: PMC7544669 DOI: 10.1039/d0tb01456g] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Dental clinicians have relied for centuries on traditional dental materials (polymers, ceramics, metals, and composites) to restore oral health and function to patients. Clinical outcomes for many crucial dental therapies remain poor despite many decades of intense research on these materials. Recent attention has been paid to biomolecules as a chassis for engineered preventive, restorative, and regenerative approaches in dentistry. Indeed, biomolecules represent a uniquely versatile and precise tool to enable the design and development of bioinspired multifunctional dental materials to spur advancements in dentistry. In this review, we survey the range of biomolecules that have been used across dental biomaterials. Our particular focus is on the key biological activity imparted by each biomolecule toward prevention of dental and oral diseases as well as restoration of oral health. Additional emphasis is placed on the structure-function relationships between biomolecules and their biological activity, the unique challenges of each clinical condition, limitations of conventional therapies, and the advantages of each class of biomolecule for said challenge. Biomaterials for bone regeneration are not reviewed as numerous existing reviews on the topic have been recently published. We conclude our narrative review with an outlook on the future of biomolecules in dental biomaterials and potential avenues of innovation for biomaterial-based patient oral care.
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Affiliation(s)
- Nicholas G Fischer
- Minnesota Dental Research Center for Biomaterials and Biomechanics, University of Minnesota, 16-250A Moos Tower, 515 Delaware St. SE, Minneapolis, Minnesota 55455, USA.
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Ferreira LN, Puppin-Rontani RM, Pascon FM. Effect of Intracanal Medicaments and Irrigants on the Release of Transforming Growth Factor Beta 1 and Vascular Endothelial Growth Factor from Cervical Root Dentin. J Endod 2020; 46:1616-1622. [PMID: 32795548 DOI: 10.1016/j.joen.2020.07.034] [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: 04/27/2020] [Revised: 07/13/2020] [Accepted: 07/24/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION This study aimed to evaluate (1) the effect of irrigating solutions and intracanal medicaments on the release of transforming growth factor beta 1 (TGF-β1) and vascular endothelial growth factor (VEGF) from cervical root dentin and (2) the effect of associating triple antibiotic paste (TAP) and calcium hydroxide paste (CH) with 2% chlorhexidine (CHX) on TGF-β1 release. METHODS First, 119 specimens from roots (cervical thirds) were obtained and were distributed into 5 groups: 2% CHX, 2.5% sodium hypochlorite, TAP, CH, and 10% EDTA by each growth factor (TGF-β1 [n = 8] and VEGF [n = 8]). Then, specimens were distributed as follows (n = 13): TAP + 2% CHX, CH + 2% CHX, and 10% EDTA and treated with irrigating solutions and intracanal medicaments. After the treatments, the specimens were immersed in 10% EDTA (20 minutes), and the solution was analyzed using the enzyme-linked immunosorbent assay. The data were submitted to normality, homogeneity of variance, and Mann-Whitney tests (P < .05). RESULTS Significant differences were found between the irrigating solutions (P < .05) and intracanal medicaments for TGF-β1 (P < .05). No VEGF release was detected for any group. Our results showed no significant differences among the TAP + 2% CHX and EDTA groups for TGF-β1 but a significant difference between CH + 2% CHX and the other groups (P < .05). CONCLUSIONS The use of 2% CHX as the irrigating solution, CH as the intracanal medicament, and 10% EDTA as the final irrigation provides higher TGF-β1 release from the cervical root dentin, whereas VEGF was not detected. Moreover, TAP and 2% CHX with 10% EDTA as the final irrigation resulted in greater TGF-β1 release from cervical root dentin than CH + 2% CHX.
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Affiliation(s)
- Lívia Nazareth Ferreira
- Department of Health Sciences and Pediatric Dentistry, Piracicaba Dental School, Faculdade de Odontologia de Piracicaba, University of Campinas, Piracicaba, Brazil
| | - Regina Maria Puppin-Rontani
- Department of Health Sciences and Pediatric Dentistry, Piracicaba Dental School, Faculdade de Odontologia de Piracicaba, University of Campinas, Piracicaba, Brazil
| | - Fernanda Miori Pascon
- Department of Health Sciences and Pediatric Dentistry, Piracicaba Dental School, Faculdade de Odontologia de Piracicaba, University of Campinas, Piracicaba, Brazil.
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Ayoub S, Cheayto A, Bassam S, Najar M, Berbéri A, Fayyad-Kazan M. The Effects of Intracanal Irrigants and Medicaments on Dental-Derived Stem Cells Fate in Regenerative Endodontics: An update. Stem Cell Rev Rep 2020; 16:650-660. [PMID: 32394343 DOI: 10.1007/s12015-020-09982-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Regenerative endodontics is a biologically based treatment designed for immature permanent teeth with necrotic pulp to replace dentin and root structures, as well as dental pulp cells. This procedure has become a part of novel modality in endodontics therapeutic manner, and it is considered as an alternative to apexification. In the last decade, numerous case reports, which describe this procedure, have been published. This therapeutic approach succeeded due to its lower financial cost and ease of performance. Although the clinical protocol of this procedure is not standardized and the effects of irrigants and medicaments on dental stem cells fate remain somewhat ambiguous, however when successful, it is an improvement of endodontics treatment protocols which leads to continued root development, increased dentinal wall thickness, and apical closure of immature teeth. To ensure a successful regenerative procedure, it is essential to investigate the appropriate disinfection protocols and the use of biocompatible molecules in order to control the release of growth factors and the differentiation of stem cells. This is the first review in the literature to summarize the present knowledge regarding the effect of intracanal irrigants and medicaments on the dental derived stem cells fate in regenerative endodontic procedures.
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Affiliation(s)
- Sara Ayoub
- Department of Prosthodontics, Faculty of Dental Medicine, Lebanese University, Hadath, Beirut, Lebanon
| | - Ali Cheayto
- Department of Restorative Dentistry and Endodontics, Faculty of Dental Medicine, Lebanese University, Hadath, Beirut, Lebanon
| | - Sanaa Bassam
- Department of Restorative Dentistry and Endodontics, Faculty of Dental Medicine, Lebanese University, Hadath, Beirut, Lebanon
| | - Mehdi Najar
- Genetics and Immune Cell Therapy Unit, Faculty of Sciences, University Mohammed Premier, Oujda, Morocco.,Osteoarthritis Research Unit, Department of Medicine, Research Center (CRCHUM), University of Montreal Hospital, University of Montreal, Montreal, QC, Canada
| | - Antoine Berbéri
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Lebanese University, Hadath, Beirut, Lebanon
| | - Mohammad Fayyad-Kazan
- Laboratory of Cancer biology and Molecular Immunology, Faculty of Sciences-I, Lebanese University, Hadath, Beirut, Lebanon. .,Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon.
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Liu L, Leng S, Yue J, Lu Q, Xu W, Yi X, Huang D, Zhang L. EDTA Enhances Stromal Cell–derived Factor 1α–induced Migration of Dental Pulp Cells by Up-regulating Chemokine Receptor 4 Expression. J Endod 2019; 45:599-605.e1. [DOI: 10.1016/j.joen.2019.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 12/12/2018] [Accepted: 01/08/2019] [Indexed: 12/18/2022]
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Regenerative Endodontic Procedures Using Contemporary Endodontic Materials. MATERIALS 2019; 12:ma12060908. [PMID: 30893790 PMCID: PMC6471897 DOI: 10.3390/ma12060908] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 02/28/2019] [Accepted: 03/13/2019] [Indexed: 12/12/2022]
Abstract
Calcium hydroxide apexification and Mineral Trioxide Aggregate (MTA) apexification are classical treatments for necrotic immature permanent teeth. The first tend to fail for lack of compliance given the high number of sessions needed; the second has technical difficulties such as material manipulation and overfilling. With both techniques, the root development is interrupted leaving the tooth with a fragile root structure, a poor crown-to-root ratio, periodontal breakdown, and high risk of fracture, compromising long-term prognosis of the tooth. New scientific literature has described a procedure that allows complete root development of these specific teeth. This regenerative endodontic procedure (REP) proposes the use of a combination of antimicrobials and irrigants, no canal walls instrumentation, induced apical bleeding to form a blood clot and a tight seal into the root canal to promote healing. MTA is the most used material to perform this seal, but updated guidelines advise the use of other bioactive endodontic cements that incorporate calcium and silicate in their compositions. They share most of their characteristics with MTA but claim to have fewer drawbacks with regards to manipulation and aesthetics. The purpose of the present article is to review pertinent literature and to describe the clinical procedures protocol with its variations, and their clinical application.
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Biomimetic Conditioning of Human Dentin Using Citric Acid. J Endod 2019; 45:45-50. [DOI: 10.1016/j.joen.2018.09.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/20/2018] [Accepted: 09/23/2018] [Indexed: 12/27/2022]
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Tziafas D, Kodonas K, Gogos C, Tziafa C, Papadimitriou S. EDTA conditioning of circumpulpal dentine induces dentinogenic events in pulpotomized miniature swine teeth. Int Endod J 2018; 52:656-664. [PMID: 30474281 DOI: 10.1111/iej.13048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 11/21/2018] [Indexed: 11/28/2022]
Affiliation(s)
- D. Tziafas
- Hamdan Bin Mohammed College of Dental Medicine Mohammed Bin Rashid University of Medicine and Health Sciences Dubai United Arab Emirates
| | | | | | | | - S. Papadimitriou
- School of Veterinary Medicine Aristotle University of Thessaloniki Thessaloniki Greece
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Imaging of growth factors on a human tooth root canal by surface-enhanced Raman spectroscopy. Anal Bioanal Chem 2018; 410:7113-7120. [DOI: 10.1007/s00216-018-1311-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/30/2018] [Accepted: 08/06/2018] [Indexed: 12/28/2022]
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Miller AA, Takimoto K, Wealleans J, Diogenes A. Effect of 3 Bioceramic Materials on Stem Cells of the Apical Papilla Proliferation and Differentiation Using a Dentin Disk Model. J Endod 2018; 44:599-603. [DOI: 10.1016/j.joen.2017.12.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 11/20/2017] [Accepted: 12/19/2017] [Indexed: 12/23/2022]
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Biological response to self-etch adhesive after partial caries removal in rats. Clin Oral Investig 2018; 22:2161-2173. [PMID: 29380132 DOI: 10.1007/s00784-017-2303-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 12/07/2017] [Indexed: 01/14/2023]
Abstract
OBJECTIVES The purposes of this study were to evaluate a model of slow caries progression and to investigate the performance of a self-etch adhesive system for partial caries removal. MATERIALS AND METHODS Rat molars were infected with Streptococcus sobrinus 6715 culture. Different time points were analyzed: days 78, 85, and 95 (± 2). After this, the samples were processed for morphological analysis. Additionally, the first molars were restored with zinc oxide and eugenol (IRM™; Dentsply; Brazil) or adhesive system (Clearfil SE Bond™; Kuraray Medical; Japan) 78 days after caries induction. After, 3 or 15 days post-treatment, the animals were euthanized, and their mandibles were processed for morphological analysis, classified by means of scores, and submitted to statistical analysis. Subsequently, immunohistochemical analysis was performed for osteonectin (OSN) and transforming growth factor-ß1 (TGF-ß1) expression. RESULTS According to the caries induction model used, on day 95 greater inflammatory infiltration (p < 0.001), and more extensive degradation of secondary/primary dentin were demonstrated than on day 78 (p < 0.05). Furthermore, the restorative materials presented similar performance (p > 0.05) and proved to be fundamental to control the carious lesion. The TGF-ß1 and OSN were shown to be active during the caries process. CONCLUSIONS The slow caries lesion model was feasible for morphological analysis of the dentin-pulp complex. The self-etch adhesive system triggered no acute inflammatory infiltration or pulp necrosis, instead it seemed to stimulate early pulp repair. CLINICAL RELEVANCE Clearfil SE Bond™ applied directly on caries-affected dentin did not predispose to pulp inflammation; instead, it appeared to provide early biological benefits.
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Lee JY, Kersten DD, Mines P, Beltran TA. Regenerative Endodontic Procedures among Endodontists: A Web-based Survey. J Endod 2017; 44:250-255. [PMID: 29229459 DOI: 10.1016/j.joen.2017.09.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 09/10/2017] [Accepted: 09/22/2017] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The protocols that endodontists implement for regenerative endodontic procedures (REPs) are unknown. The aim of this study was to examine current REP protocols among practicing endodontists in the United States. METHODS A Web-based survey was sent to 4060 active members of the American Association of Endodontists (AAE). A total of 850 participants completed the survey, representing a 20.9% response rate. RESULTS Responses indicated 60% reported having performed REPs; most performed 1 to 3 per year. The most commonly selected source (60.8%) for the clinical protocol was the "AAE Clinical Considerations for a Regenerative Procedure." Time constraints were the most common reason why 92.4% of respondents did not report their REP cases to the AAE.org database; additionally, 15.5% were unaware of it. Almost half (49.8%) of the participants reported they would attempt an REP on a patient of any age. The most commonly used irrigants were >3% sodium hypochlorite at the first appointment and EDTA at the scaffold formation appointment. As the intracanal medicament, 52.2% used calcium hydroxide, whereas 23.5% used triple antibiotic paste. At the scaffold formation appointment, 77.1% used a local anesthetic without a vasoconstrictor, and 94.3% used a blood clot as the scaffold. Mineral trioxide aggregate was the coronal barrier most often selected. Considering factors most likely to encourage the use of REPs in the future, 79.8% reported the availability of good candidates followed by 40.1% who desired better evidence. CONCLUSIONS Based on the results of this survey, REP protocols appear to be heterogeneous and do not strictly conform to the "AAE Clinical Considerations for a Regenerative Procedure."
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Affiliation(s)
- Jonathan Y Lee
- United States Army Endodontic Residency Program, Fort Bragg, North Carolina; Uniformed Services University of the Health Sciences, Bethesda, Maryland.
| | - Daniel D Kersten
- United States Army Endodontic Residency Program, Fort Bragg, North Carolina; Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Pete Mines
- United States Army Endodontic Residency Program, Fort Bragg, North Carolina; Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Thomas A Beltran
- Department of Clinical Investigation, Womack Army Medical Center, Fort Bragg, North Carolina
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Hashemi-Beni B, Khoroushi M, Foroughi MR, Karbasi S, Khademi AA. Tissue engineering: Dentin - pulp complex regeneration approaches (A review). Tissue Cell 2017; 49:552-564. [PMID: 28764928 DOI: 10.1016/j.tice.2017.07.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/06/2017] [Accepted: 07/07/2017] [Indexed: 01/04/2023]
Abstract
Dental pulp is a highly specialized tissue that preserves teeth. It is important to maintain the capabilities of dental pulp before a pulpectomy by creating a local restoration of the dentin-pulp complex from residual dental pulp. The articles identified were selected by two reviewers based on entry and exit criteria. All relevant articles indexed in PubMed, Springer, Science Direct, and Scopus with no limitations from 1961 to 2016 were searched. Factors investigated in the selected articles included the following key words: Dentin-Pulp Complex, Regeneration, Tissue Engineering, Scaffold, Stem Cell, and Growth Factors. Of the 233 abstracts retrieved, the papers which were selected had evaluated the clinical aspects of the application of dentin-pulp regeneration. Generally, this study has introduced a new approach to provoke the regeneration of the dentin-pulp complex after a pulpectomy, so that exogenous growth factors and the scaffold are able to induce cells and blood vessels from the residual dental pulp in the tooth root canal. This study further presents a new strategy for local regeneration therapy of the dentin-pulp complex. This review summarizes the current knowledge of the potential beneficial effects derived from the interaction of dental materials with the dentin-pulp complex as well as potential future developments in this exciting field.
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Affiliation(s)
- Batool Hashemi-Beni
- Torabinejad Dentistry Research Center and Department of Anatomical Sciences and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Khoroushi
- Dental Materials Research Center and Department of Operative and Art, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Foroughi
- Dental Materials Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Saeed Karbasi
- Department of Biomaterials and Tissue Engineering, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abbas Ali Khademi
- Torabinejad Dentistry Research Center and Department of Endodonics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
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Regenerative Endodontic Procedures: A Perspective from Stem Cell Niche Biology. J Endod 2017; 43:52-62. [DOI: 10.1016/j.joen.2016.09.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 08/19/2016] [Accepted: 09/09/2016] [Indexed: 12/14/2022]
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Gonçalves LF, Fernandes AP, Cosme-Silva L, Colombo FA, Martins NS, Oliveira TM, Araujo TH, Sakai VT. Effect of EDTA on TGF-β1 released from the dentin matrix and its influence on dental pulp stem cell migration. Braz Oral Res 2016; 30:e131. [PMID: 28001241 DOI: 10.1590/1807-3107bor-2016.vol30.0131] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 10/04/2016] [Indexed: 02/06/2023] Open
Abstract
Bioactive molecules stored in dentin, such as transforming growth factor beta1 (TGF-b1), may be involved in the signaling events related to dental tissue repair. The authors conducted an in vitro evaluation of the amount of TGF-b1 released from dentin slices after treatment with 10% ethylenediaminetetraacetic acid (EDTA), 2.5% sodium hypochlorite (NaOCl) or phosphate-buffered saline (PBS), and the effect of this growth factor on stem cell migration from human exfoliated deciduous teeth (SHED). Sixty 1-mm-thick tooth slices were prepared with or without the predentin layer, and treated with either 10% EDTA for 1 minute, 2.5% NaOCl for 5 days or kept in PBS. Tooth slice conditioned media were prepared and used for TGF-b1 ELISA and migration assays. Culture medium with different concentrations of recombinant human TGF-b1 (0.5, 1.0, 5.0 or 10.0 ng/mL) was also tested by migration assay. The data were evaluated by ANOVA and Tukey's test. Optical density values corresponding to media conditioned by tooth slices either containing or not containing the predentin layer and treated with 10% EDTA were statistically greater than the other groups and close to 1 ng/mL. Increased rates of migration toward media conditioned by tooth slices containing the predentin layer and treated with PBS, 10% EDTA or 2.5% NaOCl were observed. Recombinant human TGF-b1 also stimulated migration of SHED, irrespective of the concentration used. EDTA may be considered an effective extractant of TGF-b1 from the dentin matrix. However, it does not impact SHED migration, suggesting that other components may account for the cell migration.
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Affiliation(s)
- Lidiany Freitas Gonçalves
- Universidade Federal de Alfenas, School of Dentistry, Department of Clinics and Surgery, Alfenas, MG, Brazil
| | - Ana Paula Fernandes
- Universidade de São Paulo - USP, Bauru School of Dentistry, Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru, SP, Brazil
| | - Leopoldo Cosme-Silva
- Universidade Federal de Alfenas, School of Dentistry, Department of Clinics and Surgery, Alfenas, MG, Brazil
| | - Fabio Antonio Colombo
- Universidade Federal de Alfenas, Institute of Biomedical Sciences, Department of Pathology and Parasitology, Alfenas, MG, Brazil
| | | | - Thais Marchini Oliveira
- Universidade de São Paulo - USP, Bauru School of Dentistry, Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru, SP, Brazil
| | - Tomaz Henrique Araujo
- Universidade Federal de Alfenas, Institute of Biomedical Sciences, Department for Cell, Tissue and Developmental Biology, Alfenas, MG, Brazil
| | - Vivien Thiemy Sakai
- Universidade Federal de Alfenas, School of Dentistry, Department of Clinics and Surgery, Alfenas, MG, Brazil
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Histologic tissue response to furcation perforation repair using mineral trioxide aggregate or dental pulp stem cells loaded onto treated dentin matrix or tricalcium phosphate. Clin Oral Investig 2016; 21:1579-1588. [PMID: 27761672 PMCID: PMC5442265 DOI: 10.1007/s00784-016-1967-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/27/2016] [Indexed: 12/14/2022]
Abstract
Objectives The aim of this study is to compare the effect of treated dentine matrix (TDM) and tricalcium phosphate (TCP) scaffolds on odontogenic differentiation and mineralization of dental pulp stem cells (DPSCs) in furcation perforations created in the pulp chamber floor of premolar teeth in dogs. Material and methods DPSCs were isolated and cultured from the dental pulp of the maxillary left second and third premolars of dogs. The DPSCs were loaded on TCP (SC+TCP) and TDM (SC+TDM) scaffolds and inserted into intentionally perforated pulp chamber floors of premolars in dogs; six teeth were used for each group. Three more groups of six specimens were created, and mineral trioxide aggregate (MTA), TDM, and TCP were inserted into the perforations to act as controls. An intact premolar and no treatment in the perforation site were used as positive and negative controls respectively. After 3 months, the animals were sacrificed and the type of inflammation, presence of dentine, continuation and type of cementum, type of connective tissue, and presence of foreign body reaction were evaluated, and significant differences were between groups determined using the Fisher’s exact test. The evaluation of the amount of inflammation and the percentage of new bone formation was evaluated using the Mann-Whitney U test. Results The negative control group was associated with severe inflammation and granulation tissue formation. In the positive control group, intact periodontal tissues and no inflammation were observed. Dentine bridge formation was not seen in specimens of any group. The specimens in the SC+TDM group were associated with significantly more bone formation than other groups (P < 0.001). The amount of inflammation was less than 10 % in specimens of all groups with the exception of three specimens in the TCP group that were categorized as 10–30 %. Chronic inflammation without foreign body reactions was the major pattern of inflammation in groups. Formation of cementum with a cellular and continuous appearance was seen in all specimens. Conclusions SC+TDM was associated with significantly more bone formation when used to repair uninfected furcation perforations in the premolar teeth of dogs. Clinical relevance Application of TDM as a biological scaffold in combination with DPSCs may offer an advantage during the repair of root perforation defects.
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Ruangsawasdi N, Zehnder M, Patcas R, Ghayor C, Weber FE. Regenerative Dentistry: Animal Model for Regenerative Endodontology. Transfus Med Hemother 2016; 43:359-364. [PMID: 27790081 DOI: 10.1159/000447644] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 06/10/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ectopic tissue has been observed frequently in human root canal specimens when cell homing studies were performed at the dorsum of rodents. In contrast, pulp-like tissue formed when immature teeth were implanted on top of the rat calvaria. It was surmised, yet not tested, that the implantation site might affect tissue ingrowth. METHODS Four root sections from human immature molars cleaned with 5% sodium hypochlorite (NaOCl) followed by 17% ethylenediaminetetraacetic acid (EDTA) were implanted per rat (n = 5). Two specimens were placed at the dorsum (control), while the other two specimens were implanted at the calvaria. After 6 weeks, the specimens were investigated for histological structure, immunoreactivity to dentine sialoprotein (DSP) and bone sialoprotein (BSP), per-area percentage of tissue ingrowth, and gene expression (DSPP, COL1, NGF and VEGF). Data were statistically compared. RESULTS Tooth specimens placed at the calvaria generally showed pulp-like tissue and odontoblast-like cells at the dentinal wall where DSP and BSP immunoreactivity were intense. The area of tissue ingrowth was significantly larger in the specimens placed at the calvaria compared to those placed at the dorsum. DSPP was the only gene that was upregulated significantly when specimens were implanted at the calvaria. CONCLUSION Our findings suggest that the calvarial site is superior to the dorsum to study pulp regeneration in human teeth in the rat.
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Affiliation(s)
- Nisarat Ruangsawasdi
- Oral Biotechnology & Bioengineering, Cranio-Maxillofacial and Oral Surgery, Center for Dental Medicine, University of Zurich, Zurich, Switzerland; Department of Pharmacology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Matthias Zehnder
- Preventive Dentistry, Periodontology, and Cariology, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Raphael Patcas
- Orthodontics and Pediatric Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Chafik Ghayor
- Oral Biotechnology & Bioengineering, Cranio-Maxillofacial and Oral Surgery, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Franz E Weber
- Oral Biotechnology & Bioengineering, Cranio-Maxillofacial and Oral Surgery, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
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Saghiri MA, Asatourian A, Garcia-Godoy F, Sheibani N. Effect of biomaterials on angiogenesis during vital pulp therapy. Dent Mater J 2016; 35:701-709. [PMID: 27546854 DOI: 10.4012/dmj.2015-332] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This review intended to provide an overview of the effects of dental materials, used in dentin-pulp complex and dental pulp regeneration, on angiogenesis processes during regenerative endodontic procedures. An electronic search was performed in PubMed and MEDLINE databases via OVID using the keywords mentioned in the PubMed and MeSH headings for English language published articles from January 2005-April 2014 that evaluated the angiogenic properties of different dental materials used in regenerative endodontic procedures. Of the articles identified in an initial search, only 40 articles met the inclusion criteria set for this review. Vital pulp therapy materials might have positive effects on angiogenesis events, while most of the canal irrigating solutions and antibiotic pastes have anti-angiogenic activity except for EDTA. Future clinical studies will be helpful in defining the mechanisms of action for dental materials that promote or inhibit angiogenesis events at applied areas.
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Affiliation(s)
- Mohammad Ali Saghiri
- Departments of Ophthalmology and Visual Science and Biomedical Engineering, University of Wisconsin, School of Medicine and Public Health
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Schmalz G, Smith AJ. Pulp development, repair, and regeneration: challenges of the transition from traditional dentistry to biologically based therapies. J Endod 2016; 40:S2-5. [PMID: 24698689 DOI: 10.1016/j.joen.2014.01.018] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The traditional concept of replacing diseased tooth/pulp tissues by inert materials (restoration) is being challenged by recent advances in pulp biology leading to regenerative strategies aiming at the generation of new vital tissue. New tissue formation in the pulp chamber can be observed after adequate infection control and the formation of a blood clot. However, differentiation of true odontoblasts is still more speculative, and the approach is largely limited to immature teeth with open apices. A more systematic approach may be provided by the adoption of the tissue engineering concepts of using matrices, suitable (stem) cells, and signaling molecules to direct tissue events. With these tools, pulplike constructs have already been generated in experimental animals. However, a number of challenges still remain for clinical translation of pulp regeneration (eg, the cell source [resident vs nonresident stem cells, the latter associated with cell-free approaches], mechanisms of odontoblast differentiation, the pulp environment, the role of infection and inflammation, dentin pretreatment to release fossilized signaling molecules from dentin, and the provision of suitable matrices). Transition as a process, defined by moving from one form of "normal" to another, is based not only on the progress of science but also on achieving change to established treatment concepts in daily practice. However, it is clear that the significant recent achievements in pulp biology are providing an exciting platform from which clinical translation of dental pulp regeneration can advance.
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Affiliation(s)
- Gottfried Schmalz
- Department of Operative Dentistry and Periodontology, University Medical Centre Regensburg, Regensburg, Germany.
| | - Anthony J Smith
- Oral Biology, School of Dentistry, University of Birmingham, St Chads Queensway, Birmingham, United Kingdom
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Clinical Perspective of Electrospun Nanofibers as a Drug Delivery Strategy for Regenerative Endodontics. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s40496-016-0103-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kishen A, Peters OA, Zehnder M, Diogenes AR, Nair MK. Advances in endodontics: Potential applications in clinical practice. J Conserv Dent 2016; 19:199-206. [PMID: 27217630 PMCID: PMC4872571 DOI: 10.4103/0972-0707.181925] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Contemporary endodontics has seen an unprecedented advance in technology and materials. This article aimed to review some of the challenges and advances in the following sections: (1) endodontic imaging, (2) root canal preparation, (3) root canal disinfection, (4) root canal filling, and (4) regenerative endodontic procedures (REPs). Jointly, these advances are aimed at improving the state of the art and science of root canal treatment.
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Affiliation(s)
- Anil Kishen
- Department of Endodontics, University of Toronto, Toronto, Ontario, Canada
| | - Ove A Peters
- Department of Endodontics, Arthur A Dugoni School of Dentistry, University of the Pacific, San Francisco, California, USA
| | - Matthias Zehnder
- Department of Preventive Dentistry, Periodontology and Cariology, Division of Endodontology, University of Zürich Center for Dental Medicine, Zürich, Switzerland
| | - Anibal R Diogenes
- Department of Endodontics, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Madhu K Nair
- Department of Radiology, College of Medicine, University of Florida, Gainesville, Florida, USA
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Altaii M, Cathro P, Broberg M, Richards L. Endodontic regeneration and tooth revitalization in immature infected sheep teeth. Int Endod J 2016; 50:480-491. [DOI: 10.1111/iej.12645] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 04/06/2016] [Indexed: 01/13/2023]
Affiliation(s)
- M. Altaii
- School of Dentistry; University of Adelaide; Adelaide SA Australia
| | - P. Cathro
- School of Dentistry; University of Adelaide; Adelaide SA Australia
| | - M. Broberg
- School of Dentistry; University of Adelaide; Adelaide SA Australia
| | - L. Richards
- School of Dentistry; University of Adelaide; Adelaide SA Australia
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Dentin Conditioning with Bioactive Molecule Releasing Nanoparticle System Enhances Adherence, Viability, and Differentiation of Stem Cells from Apical Papilla. J Endod 2016; 42:717-23. [PMID: 26960576 DOI: 10.1016/j.joen.2016.01.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 01/30/2016] [Accepted: 01/30/2016] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Temporal-controlled bioactive molecule (BM) releasing systems allow the delivery of appropriate concentration of BM to enhance the interaction of stem cells to dentin matrix and subsequent odontogenic differentiation in regenerative endodontics. OBJECTIVES The goal of this study was to evaluate the effect of dentin conditioning with 2 variants of dexamethasone (Dex) releasing chitosan nanoparticles (CSnp), (1) Dex-CSnpI (slow releasing) and (2) Dex-CSnpII (rapid releasing), on adherence, viability, and differentiation of stem cells from apical papilla (SCAP) on root dentin exposed to endodontic irrigants. METHODS Slab-shaped dentin specimens were prepared parallel to the root canal and treated with 5.25% sodium hypochlorite (NaOCl) for 10 minutes and/or 17% EDTA for 2 minutes. Dentin was then conditioned accordingly by (1) no nanoparticle treatment, (2) CSnp, (3) Dex-CSnpI, and (4) Dex-CSnpII. The effect of nanoparticle conditioning on SCAP viability was determined by cell count and a circularity index. SCAP adherence and viability on dentin were assessed by fluorescence and scanning electron microscopy and odontogenic differentiation by immunofluorescence. RESULTS SCAP on dentin treated with NaOCl alone or NaOCl as the last irrigant showed the least adherence, minimal cytoplasmic extensions, and higher circularity. SCAP adherence and viability on Dex-CSnpI and Dex-CSnpII conditioned dentin were increased and had a well-developed cytoplasmic matrix and significantly lower circularity (P < .05). SCAP cultured in Dex-CSnpII group expressed higher levels for DSPP and DMP-1 than in CSnp or Dex-CSnpI groups. CONCLUSIONS Dex-CSnpI and Dex-CSnpII conditioning of dentin enhanced SCAP adherence and viability. Temporal-controlled release of Dex from Dex-CSnpII enhanced odontogenic differentiation of SCAP. This study highlighted the ability of dentin conditioning with temporal-controlled BM releasing nanoparticles to improve the local environment in regenerative endodontics.
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Smith AJ, Duncan HF, Diogenes A, Simon S, Cooper PR. Exploiting the Bioactive Properties of the Dentin-Pulp Complex in Regenerative Endodontics. J Endod 2016; 42:47-56. [DOI: 10.1016/j.joen.2015.10.019] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 10/29/2015] [Accepted: 10/29/2015] [Indexed: 02/06/2023]
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Liu G, Xu G, Gao Z, Liu Z, Xu J, Wang J, Zhang C, Wang S. Demineralized Dentin Matrix Induces Odontoblastic Differentiation of Dental Pulp Stem Cells. Cells Tissues Organs 2015; 201:65-76. [DOI: 10.1159/000440952] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2015] [Indexed: 11/19/2022] Open
Abstract
The aim of this study was to investigate the effect of demineralized dentin matrix (DDM) on dental pulp stem cells (DPSCs) and the potential of complexes with DPSCs and DDM for mineralized tissue formation. Stem cells derived from the dental pulp of healthy pigs aged 18 months were isolated and cultured. DPSCs were incubated with alpha-minimum essential medium treated with DDM extract at 1 mg/ml (DDM1) or 10 mg/ml (DDM10). The concentrations of 3 growth factors in DDM extract was measured by enzyme-linked immunosorbent assay. Adhesion of DPSCs on DDM and hydroxyapatite-tricalcium phosphate (HA-TCP) surfaces was observed using scanning electron microscopy. Cell proliferation was evaluated with cell counting kit-8 and migration by Transwell migration assays. Odontoblastic differentiation was assessed by alkaline phosphatase (ALP) and alizarin red staining, ALP activity and real-time polymerase chain reaction analysis of markers of ALP, runt-related transcription factor 2, type I collagen, dentin matrix acidic phosphoprotein-1, osteonectin and dentin sialophosphoprotein (DSPP). Finally, DPSCs were combined with DDM and placed subcutaneously in nude mice for 12 weeks; DPSCs combined with HA-TCP and DDM alone served as controls. DDM could promote DPSC adhesion, migration and odontoblastic differentiation. Mineralized tissue formation was observed with the DPSC and DDM combination and the DPSC and HA-TCP combination. The mineralized tissue of the DPSC + DDM combination stained positive for DSPP, similar to the dentin tissue. These results indicate that DDM induces DPSC odontoblastic differentiation, suggesting applications for dentin regeneration.
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Galler KM, Widbiller M, Buchalla W, Eidt A, Hiller KA, Hoffer PC, Schmalz G. EDTA conditioning of dentine promotes adhesion, migration and differentiation of dental pulp stem cells. Int Endod J 2015; 49:581-90. [DOI: 10.1111/iej.12492] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 06/19/2015] [Indexed: 01/20/2023]
Affiliation(s)
- K. M. Galler
- Department of Conservative Dentistry and Periodontology; University Medical Center; Regensburg Germany
| | - M. Widbiller
- Department of Conservative Dentistry and Periodontology; University Medical Center; Regensburg Germany
| | - W. Buchalla
- Department of Conservative Dentistry and Periodontology; University Medical Center; Regensburg Germany
| | - A. Eidt
- Department of Conservative Dentistry and Periodontology; University Medical Center; Regensburg Germany
| | - K. -A. Hiller
- Department of Conservative Dentistry and Periodontology; University Medical Center; Regensburg Germany
| | - P. C. Hoffer
- Department of Conservative Dentistry and Periodontology; University Medical Center; Regensburg Germany
| | - G. Schmalz
- Department of Conservative Dentistry and Periodontology; University Medical Center; Regensburg Germany
- School of Dental Medicine; ZMK Bern; University of Bern; Bern Switzerland
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Farhad AR, Shokraneh A, Shekarchizade N. Regeneration or replacement? A case report and review of literature. Dent Traumatol 2015; 32:71-9. [DOI: 10.1111/edt.12200] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Ali Reza Farhad
- Torabinejad Dental Research Center and Department of Endodontics; School of Dentistry; Isfahan University of Medical Sciences; Isfahan Iran
| | | | - Neda Shekarchizade
- Department of Endodontics; School of Dentistry; Isfahan University of Medical Sciences; Isfahan Iran
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Lei L, Chen Y, Zhou R, Huang X, Cai Z. Histologic and Immunohistochemical Findings of a Human Immature Permanent Tooth with Apical Periodontitis after Regenerative Endodontic Treatment. J Endod 2015; 41:1172-9. [DOI: 10.1016/j.joen.2015.03.012] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 03/06/2015] [Accepted: 03/13/2015] [Indexed: 12/23/2022]
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Galler KM, Buchalla W, Hiller KA, Federlin M, Eidt A, Schiefersteiner M, Schmalz G. Influence of Root Canal Disinfectants on Growth Factor Release from Dentin. J Endod 2015; 41:363-8. [DOI: 10.1016/j.joen.2014.11.021] [Citation(s) in RCA: 145] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 11/07/2014] [Accepted: 11/21/2014] [Indexed: 01/23/2023]
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Lee LW, Hsiao SH, Hung WC, Lin YH, Chen PY, Chiang CP. Clinical outcomes for teeth treated with electrospun poly(ε-caprolactone) fiber meshes/mineral trioxide aggregate direct pulp capping. J Endod 2015; 41:628-36. [PMID: 25687364 DOI: 10.1016/j.joen.2015.01.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 12/15/2014] [Accepted: 01/06/2015] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Mineral trioxide aggregate (MTA) is a biocompatible material for direct pulp capping. This study was designed to compare the clinical outcomes of pulp-exposed teeth treated with either poly(ε-caprolactone) fiber mesh (PCL-FM) as a barrier for MTA (so-called PCL-FM/MTA) or MTA direct pulp capping. METHODS Sixty human vital teeth were evenly divided into 4 groups (n = 15 in each group). Teeth in groups 1 and 3 had pulp exposure <1 mm in diameter, whereas teeth in groups 2 and 4 had pulp exposure of 1-1.5 mm in diameter. Teeth in groups 1 and 2 were treated with PCL-FM/MTA direct pulp capping, and those in groups 3 and 4 were treated with MTA direct pulp capping. RESULTS Teeth treated with PCL-FM/MTA direct pulp capping needed a significantly shorter mean duration for dentin bridge formation than teeth treated with MTA direct pulp capping. Moreover, teeth with pulp exposure <1.0 mm in diameter needed a significantly shorter mean duration for dentin bridge formation than teeth with pulp exposure of 1-1.5 mm in diameter after either PCL-FM/MTA or MTA direct pulp capping treatment. In addition, teeth treated with PCL-FM/MTA direct pulp capping formed an approximately 3-fold thicker dentin bridge than teeth treated with MTA direct pulp capping 8 weeks or 3 months later. Furthermore, none of the teeth treated with PCL-FM/MTA direct pulp capping showed tooth discoloration after treatment for 3 months. CONCLUSIONS PCL-FM/MTA is a better combination material than MTA alone for direct pulp capping of human permanent teeth.
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Affiliation(s)
- Li-Wan Lee
- Department of Dentistry, Taipei City Hospital, Renai Branch, Taipei, Taiwan
| | - Sheng-Huang Hsiao
- Department of Neurosurgery, Taipei City Hospital, Renai Branch, Taipei, Taiwan; Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Chiang Hung
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan; Division of Endodontics, Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yun-Ho Lin
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan; Division of Oral Pathology, Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan
| | - Po-Yu Chen
- Institute of Polymer Science and Engineering, National Taiwan University, Taipei, Taiwan
| | - Chun-Pin Chiang
- Graduate Institute of Oral Biology, School of Dentistry, National Taiwan University, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
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Ricucci D, Loghin S, Lin LM, Spångberg LSW, Tay FR. Is hard tissue formation in the dental pulp after the death of the primary odontoblasts a regenerative or a reparative process? J Dent 2014; 42:1156-70. [PMID: 25008021 DOI: 10.1016/j.jdent.2014.06.012] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 05/19/2014] [Accepted: 06/30/2014] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Conceptually, two types of tertiary dentine may be produced in response to caries and environmental irritations: "reactionary dentine" that is secreted by existing primary odontoblasts and "reparative dentine", formed after the death of the odontoblasts by proliferation and differentiation of progenitor cells into odontoblast-like cells. Because histologic evidence for tubular dentine generated by newly differentiated odontoblast-like cells is lacking in human teeth, the present study examined pulpal cellular changes associated with caries/restorations, in the presence or absence of pulpal exposures. METHODS Ninety-six extracted human teeth were histologically processed and serial sectioned for light microscopy: 65 contained untreated enamel/dentine caries; 20 were heavily restored and 11 had carious exposures managed by direct pulp-capping. RESULTS Sparsely distributed, irregularly arranged dentinal tubules were identified from the tertiary dentine formed in teeth with unexposed medium/deep caries and in restored teeth; those tubules were continuous with the tubules of secondary dentine; in some cases, tubules were absent. The palisade odontoblast layer was reduced to a single layer of flattened cells. In direct pulp-capping of pulp exposures, the defects were repaired by the deposition of an amorphous dystrophic calcified tissue that resembled pulp stones more than dentine, sometimes entrapping pulpal remnants. This atubular hard tissue was lined by fibroblasts and collagen fibrils. CONCLUSIONS Histological evidence from the present study indicates that reparative dentinogenesis cannot be considered as a regenerative process since the so-formed hard tissue lacks tubular features characteristic of genuine dentine. Rather, this process represents a repair response that produces calcified scar tissues by pulpal fibroblasts. CLINICAL SIGNIFICANCE Formation of hard tissue in the dental pulp after the death of the primary odontoblasts has often been regarded by clinicians as regeneration of dentine. If the objective of the clinical procedures involved is to induce healing, reduce dentine hypersensitivity, or minimise future bacteria exposure, such procedures may be regarded as clinical success. However, current clinical treatment procedures are not adept at regenerating physiological dentne because the tissues formed in the dental pulp are more likely the result of repair responses via the formation of calcified scar tissues.
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Affiliation(s)
| | | | - Louis M Lin
- Department of Endodontics, New York University, New York, USA
| | - Larz S W Spångberg
- Division of Endodontology, University of Connecticut School of Dental Medicine, Farmington, CT, USA
| | - Franklin R Tay
- Department of Endodontics, College of Dental Medicine, Georgia Regents University, Augusta, GA, USA.
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Management of 2 Teeth Diagnosed with Dens Invaginatus with Regenerative Endodontics and Apexification in the Same Patient: A Case Report and Review. J Endod 2014; 40:725-31. [DOI: 10.1016/j.joen.2013.10.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 10/06/2013] [Accepted: 10/18/2013] [Indexed: 12/15/2022]
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Abstract
Emerging understanding about interactions between stem cells, scaffolds, and morphogenic factors has accelerated translational research in the field of dental pulp tissue engineering. Dental pulp stem cells constitute a subpopulation of cells endowed with self-renewal and multipotency. Dental pulp stem cells seeded in biodegradable scaffolds and exposed to dentin-derived morphogenic factors give rise to a pulplike tissue capable of generating new dentin. Notably, dentin-derived proteins are sufficient to induce dental pulp stem cell differentiation into odontoblasts. Ongoing work is focused on developing ways of mobilizing dentin-derived proteins and disinfecting the root canal of necrotic teeth without compromising the morphogenic potential of these signaling molecules. On the other hand, dentin by itself does not appear to be capable of inducing endothelial differentiation of dental pulp stem cells despite the well-known presence of angiogenic factors in dentin. This is particularly relevant in the context of dental pulp tissue engineering in full root canals in which access to blood supply is limited to the apical foramina. To address this challenge, scientists are looking at ways to use the scaffold as a controlled-release device for angiogenic factors. The aim of this article was to present and discuss current strategies to functionalize injectable scaffolds and customize them for dental pulp tissue engineering. The long-term goal of this work is to develop stem cell-based therapies that enable the engineering of functional dental pulps capable of generating new tubular dentin in humans.
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Affiliation(s)
- Evandro Piva
- Department of Operative Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil; Department of Cariology, Restorative Sciences, Endodontics, University of Michigan School of Dentistry, Ann Arbor, Michigan
| | - Adriana F Silva
- Department of Operative Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil; Department of Cariology, Restorative Sciences, Endodontics, University of Michigan School of Dentistry, Ann Arbor, Michigan
| | - Jacques E Nör
- Department of Cariology, Restorative Sciences, Endodontics, University of Michigan School of Dentistry, Ann Arbor, Michigan; Department of Biomedical Engineering, University of Michigan College of Engineering, Ann Arbor, Michigan; Department of Otolaryngology, University of Michigan School of Medicine, Ann Arbor, Michigan.
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