Biomedical Application of Dental Tissue-Derived Induced Pluripotent Stem Cells

Stem Cells and Their Derivatives-Implications for Alveolar Bone Regeneration: A Comprehensive Review

Oral and craniofacial bone defects caused by congenital disease or trauma are widespread. In the case of severe alveolar bone defect, autologous bone grafting has been considered a “gold standard”; however, the procedure has several disadvantages, including limited supply, resorption, donor site morbidity, deformity, infection, and bone graft rejection. In the last few decades, bone tissue engineering combined with stem cell-based therapy may represent a possible alternative to current bone augmentation techniques. The number of studies investigating different cell-based bone tissue engineering methods to reconstruct alveolar bone damage is rapidly rising. As an interdisciplinary field, bone tissue engineering combines the use of osteogenic cells (stem cells/progenitor cells), bioactive molecules, and biocompatible scaffolds, whereas stem cells play a pivotal role. Therefore, our work highlights the osteogenic potential of various dental tissue-derived stem cells and induced pluripotent stem cells (iPSCs), the progress in differentiation techniques of iPSCs into osteoprogenitor cells, and the efforts that have been made to fabricate the most suitable and biocompatible scaffold material with osteoinductive properties for successful bone graft generation. Moreover, we discuss the application of stem cell-derived exosomes as a compelling new form of “stem-cell free” therapy.

Strategies for differentiation of hiPSCs into dental epithelial cell lineage

Different stem cell-based strategies, especially induced pluripotent stem cells (iPSCs), have been exploited to regenerate teeth or restore biological and physiological functions after tooth loss. Further research is needed to establish an optimized protocol to effectively differentiate human iPSCs (hiPSCs) into dental epithelial cells (DECs). In this study, various factors were precisely modulated to facilitate differentiation of hiPSCs into DECs, which are essential for the regeneration of functional teeth. Embryoid bodies (EBs) were formed from hiPSCs as embryo-like aggregates, retinoic acid (RA) was used as an early ectodermal inducer, and bone morphogenic protein 4 (BMP4) activity was manipulated. The characteristics of DECs were enhanced and preserved after culture in keratinocyte serum-free medium (K-SFM). The yielded cell population exhibited noticeable DEC characteristics, consistent with the expression of epithelial cell and ameloblast markers. DECs demonstrated odontogenic abilities by exerting an inductive effect on human dental pulp stem cells (hDPSCs) and forming a tooth-like structure with the mouse tooth mesenchyme. Overall, our differentiation protocol provides a practical approach for applying hiPSCs for tooth regeneration.

Dentine sialophosphoprotein signal in dentineogenesis and dentine regeneration

Dentineogenesis starts on odontoblasts, which synthesise and secrete non-collagenous proteins (NCPs) and collagen. When dentine is injured, dental pulp progenitors/mesenchymal stem cells (MSCs) can migrate to the injured area, differentiate into odontoblasts and facilitate formation of reactionary dentine. Dental pulp progenitor cell/MSC differentiation is controlled at given niches. Among dental NCPs, dentine sialophosphoprotein (DSPP) is a member of the small integrin-binding ligand N-linked glycoprotein (SIBLING) family, whose members share common biochemical characteristics such as an Arg-Gly-Asp (RGD) motif. DSPP expression is cell- and tissue-specific and highly seen in odontoblasts and dentine. DSPP mutations cause hereditary dentine diseases. DSPP is catalysed into dentine glycoprotein (DGP)/sialoprotein (DSP) and phosphoprotein (DPP) by proteolysis. DSP is further processed towards active molecules. DPP contains an RGD motif and abundant Ser-Asp/Asp-Ser repeat regions. DPP-RGD motif binds to integrin αVβ3 and activates intracellular signalling via mitogen-activated protein kinase (MAPK) and focal adhesion kinase (FAK)-ERK pathways. Unlike other SIBLING proteins, DPP lacks the RGD motif in some species. However, DPP Ser-Asp/Asp-Ser repeat regions bind to calcium-phosphate deposits and promote hydroxyapatite crystal growth and mineralisation via calmodulin-dependent protein kinase II (CaMKII) cascades. DSP lacks the RGD site but contains signal peptides. The tripeptides of the signal domains interact with cargo receptors within the endoplasmic reticulum that facilitate transport of DSPP from the endoplasmic reticulum to the extracellular matrix. Furthermore, the middle- and COOH-terminal regions of DSP bind to cellular membrane receptors, integrin β6 and occludin, inducing cell differentiation. The present review may shed light on DSPP roles during odontogenesis.

Therapeutic Functions of Stem Cells from Oral Cavity: An Update

Adult stem cells have been developed as therapeutics for tissue regeneration and immune regulation due to their self-renewing, differentiating, and paracrine functions. Recently, a variety of adult stem cells from the oral cavity have been discovered, and these dental stem cells mostly exhibit the characteristics of mesenchymal stem cells (MSCs). Dental MSCs can be applied for the replacement of dental and oral tissues against various tissue-damaging conditions including dental caries, periodontitis, and oral cancers, as well as for systemic regulation of excessive inflammation in immune disorders, such as autoimmune diseases and hypersensitivity. Therefore, in this review, we summarized and updated the types of dental stem cells and their functions to exert therapeutic efficacy against diseases.

Tooth Formation: Are the Hardest Tissues of Human Body Hard to Regenerate?

With increasing life expectancy, demands for dental tissue and whole-tooth regeneration are becoming more significant. Despite great progress in medicine, including regenerative therapies, the complex structure of dental tissues introduces several challenges to the field of regenerative dentistry. Interdisciplinary efforts from cellular biologists, material scientists, and clinical odontologists are being made to establish strategies and find the solutions for dental tissue regeneration and/or whole-tooth regeneration. In recent years, many significant discoveries were done regarding signaling pathways and factors shaping calcified tissue genesis, including those of tooth. Novel biocompatible scaffolds and polymer-based drug release systems are under development and may soon result in clinically applicable biomaterials with the potential to modulate signaling cascades involved in dental tissue genesis and regeneration. Approaches for whole-tooth regeneration utilizing adult stem cells, induced pluripotent stem cells, or tooth germ cells transplantation are emerging as promising alternatives to overcome existing in vitro tissue generation hurdles. In this interdisciplinary review, most recent advances in cellular signaling guiding dental tissue genesis, novel functionalized scaffolds and drug release material, various odontogenic cell sources, and methods for tooth regeneration are discussed thus providing a multi-faceted, up-to-date, and illustrative overview on the tooth regeneration matter, alongside hints for future directions in the challenging field of regenerative dentistry.

Induced Pluripotent Stem Cells in Dental and Nondental Tissue Regeneration: A Review of an Unexploited Potential

Cell-based therapies currently represent the state of art for tissue regenerative treatment approaches for various diseases and disorders. Induced pluripotent stem cells (iPSCs), reprogrammed from adult somatic cells, using vectors carrying definite transcription factors, have manifested a breakthrough in regenerative medicine, relying on their pluripotent nature and ease of generation in large amounts from various dental and nondental tissues. In addition to their potential applications in regenerative medicine and dentistry, iPSCs can also be used in disease modeling and drug testing for personalized medicine. The current review discusses various techniques for the production of iPSC-derived osteogenic and odontogenic progenitors, the therapeutic applications of iPSCs, and their regenerative potential in vivo and in vitro. Through the present review, we aim to explore the potential applications of iPSCs in dental and nondental tissue regeneration and to highlight different protocols used for the generation of different tissues and cell lines from iPSCs.

Depth-Dependent Cellular Response from Dental Bulk-Fill Resins in Human Dental Pulp Stem Cells

The proper choice of dental composite resins is necessary based on the minimal cytotoxicity and antiodontogenesis on human dental pulp stem cells for dental pulp-dentin tissue repair and regeneration. The aim of this study was to evaluate the cytotoxicity and antidifferentiation effects of dental bulk-fill resins, able to be polymerized as a bulk status for filling deep cavity of a tooth by single light curing, against human dental pulp stem cells (hDPSCs) from three compartments corresponding to depth (0-2, 2-4, and 4-6 mm) from the light-curing site. Three bulk-fill composite resins (SDR, Venus bulk-fill (VBF), and Beautifil Bulk Flowable (BBF)) and a conventional flowable composite resin (Filtek Z350 XT flowable restorative (ZFF)) were individually filled into a cylindrical hole (h = 2 mm, Ф = 10 mm), and three compartments (total ~6 mm of height) were combined as a single assembly for light curing. The resin samples from the three layers were separated and eluted in the culture medium. The extracts were exposed to hDPSCs, and cytotoxicity and differentiation capability were evaluated. Depth of cure and surface hardness according to depth were determined. All bulk-fill resins except BBF revealed cytotoxicity from 4 to 6 or 2 to 4 mm, while ZFF was cytotoxic at over 2 mm. Depth of cure was detected from 3.55 to 4.02 mm in the bulk-fill resins (vs. ~2.25 mm in conventional resin), and 80% hardness compared with that of a fully polymerized top surface was determined from 4.2 to 6 mm in the bulk-fill resin (vs. 2.4 mm in conventional resin). Antidifferentiation was revealed at a depth of 4-6 mm in the bulk-fill resin. There was a difference in depth of cytotoxicity and antidifferentiation between the bulk-fill composite resins, which was mainly due to different cure depths and ingredients. Therefore, careful consideration of choice of bulk-fill resins is necessary especially for restoration of deep cavities for maintaining the viability and differentiation ability of dental pulp stem cells.

Comparative Analysis of the Water Sorption and Cytotoxicity of Two different Denture Base Systems: An in vitro Study

AIM

Different biomaterials and techniques have been introduced in the field of prosthetic dentistry with the purpose of replacement and rehabilitation of the edentulous areas. Due to their shorter setting time, the light-activated restorative and prosthetic materials have the capability of releasing few amount of cytotoxic materials in the oral cavity. Polymer materials [urethane dimethacrylate (UDMA) and bis-acryl] are assumed to have high mechanical properties. Polymethyl methacrylate (PMMA) offers numerous advantages of being highly esthetic in nature and at the same time being cost-effective. Hence, this study aimed to assess and compare the water sorption and cytotoxicity of light-activated UDMA denture base resin and conventional heat-activated PMMA resin.

MATERIALS AND METHODS

This study included assessment and comparison of water sorption and cytotoxicity of heat-activated PMMA resin and light-activated UDMA denture base system. Fabrication of heat-activated PMMA resin and UDMA specimens was done by investing the wax patterns in stone molds using manufacturer's instructions. Contraction of the specimens was done for assessment of cytotoxicity and water resorption of the UDMA and PMMA resin samples. All the results were analyzed by Statistical Package for the Social Sciences software version 18.0. Chi-square test and one-way analysis of variance tests were used for the assessment of the level of significance; p < 0.05 was taken as significant.

RESULTS

Mean lysis score observed in the PMMA and UDMA groups was 0.4 and 0.3 respectively. While observing at the 3 months time, the mean water resorption in the PMMA and UDMA groups was found to be 37.9 and 40.2 respectively. Significant difference in relation to water resorption was observed between the two study groups only at 3 months time.

CONCLUSION

Both materials used in this study are nontoxic. Furthermore, UDMA resin materials exhibited lower water resorption after more than 1 month of time of storage.

CLINICAL SIGNIFICANCE

Water resorption is similar for different denture base resin systems till 1 months time.

Evaluation of Light-Activated Provisional Resin Materials for Periodontal Soft Tissue Management

The purpose of this study was to determine mechanical properties using a compressive test with cylinder specimen (h = 6 mm and ϕ = 4 mm) as well as cytotoxicity using elutes from disk specimen (ϕ = 10 mm and h = 2 mm) against human gingival fibroblasts and oral keratinocytes with light-activated provisional resin materials (Revotek LC and Luxatemp Solar) compared to chemically activated counterpart (Snap, Trim II, and Jet). Significantly increased compressive strength (210~280 MPa) was detected in light-activated products compared to chemically activated ones (20~65 MPa, P < 0.05) and similar compressive modulus was detected in both types (0.8~1.5 and 0.5~1.3 GPa). Simultaneously, the light-activated products showed less adverse effects on the periodontal soft tissue cells in any polymerization stage compared to the chemically activated products. Particularly, chemically activated products had significantly greater adverse effects during the “polymerizing” phase compared to those that were “already set” (P < 0.05), as shown in confocal microscopic images of live and dead cells. In conclusion, light-activated provisional resin materials have better mechanical properties as well as biocompatibility against two tested types of oral cells compared to the chemically activated counterpart, which are considered as more beneficial choice for periodontal soft tissue management.

Corrigendum to "Biomedical Application of Dental Tissue-Derived Induced Pluripotent Stem Cells"

[This corrects the article DOI: 10.1155/2016/9762465.].