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Shi X, Hu X, Jiang N, Mao J. Regenerative endodontic therapy: From laboratory bench to clinical practice. J Adv Res 2024:S2090-1232(24)00267-4. [PMID: 38969092 DOI: 10.1016/j.jare.2024.07.001] [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: 04/16/2024] [Revised: 06/16/2024] [Accepted: 07/01/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Maintaining the vitality and functionality of dental pulp is paramount for tooth integrity, longevity, and homeostasis. Aiming to treat irreversible pulpitis and necrosis, there has been a paradigm shift from conventional root canal treatment towards regenerative endodontic therapy. AIM OF REVIEW This extensive and multipart review presents crucial laboratory and practical issues related to pulp-dentin complex regeneration aimed towards advancing clinical translation of regenerative endodontic therapy and enhancing human life quality. KEY SCIENTIFIC CONCEPTS OF REVIEW In this multipart review paper, we first present a panorama of emerging potential tissue engineering strategies for pulp-dentin complex regeneration from cell transplantation and cell homing perspectives, emphasizing the critical regenerative components of stem cells, biomaterials, and conducive microenvironments. Then, this review provides details about current clinically practiced pulp regenerative/reparative approaches, including direct pulp capping and root revascularization, with a specific focus on the remaining hurdles and bright prospects in developing such therapies. Next, special attention was devoted to discussing the innovative biomimetic perspectives opened in establishing functional tissues by employing exosomes and cell aggregates, which will benefit the clinical translation of dental pulp engineering protocols. Finally, we summarize careful consideration that should be given to basic research and clinical applications of regenerative endodontics. In particular, this review article highlights significant challenges associated with residual infection and inflammation and identifies future insightful directions in creating antibacterial and immunomodulatory microenvironments so that clinicians and researchers can comprehensively understand crucial clinical aspects of regenerative endodontic procedures.
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Affiliation(s)
- Xin Shi
- Center of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan 430022, China
| | - Xiaohan Hu
- Outpatient Department Office, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Nan Jiang
- Central Laboratory, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing 100081, China.
| | - Jing Mao
- Center of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan 430022, China.
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Seang S, Chenboonthai N, Nisaeh N, Teantongdee A, Jamsai S, Changgnam C, Yoongkiew K, Yodsanga S, Kamolratanakul P, Thaweesapphithak S, Pornthaveetus T, Everts V, Osathanont T, Limjeerajarus CN. The prostacyclin analogue iloprost promotes cementum formation and collagen reattachment of replanted molars and upregulates mineralization by human periodontal ligament cells. J Endod 2022; 48:1046-1054. [PMID: 35568156 DOI: 10.1016/j.joen.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/03/2022] [Accepted: 05/03/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study evaluated the use of the prostacyclin analogue, iloprost, as a root surface treatment agent in promoting acellular cementum(AC) formation and collagen reattachment following tooth replantation in vivo. In addition, its effect on human periodontal ligament cell(hPDLC) mineralization was assessed in vitro. METHODS First molars of 8-weeks-old Wistar rats were extracted. In one group, the root surfaces were treated with Hank's Balanced Salt Solution(HBSS) and the other group's root surfaces were treated with 10-6 M iloprost before re-plantation. At day 30, maxillae were prepared for microCT and histomorphometric analysis. The effect of iloprost on mineralization by hPDLCs were analyzed by mineralized nodule formation and qPCR at 7 and 14 days. RESULTS MicroCT demonstrated a significant higher bone-volume in the iloprost-groups, whereas the HBSS-groups had extensive bone and root resorption. Histologic analysis revealed deposition of a thick AC layer along the root in iloprost-group with well-organized PDL fibers inserted into the cementum. The HBSS-group demonstrated more osteoclasts than the iloprost-group. In vitro, iloprost-treated hPDLCs had a significantly increased RUNX2, OSX, BSP, and ALP gene expression that coincided with an increased deposition of mineralized nodules. These effects were abrogated by a PGI2-receptor inhibitor. CONCLUSION Our results revealed that iloprost promoted PDL regeneration in replanted molars. Furthermore, resorption of the roots was decreased, whereas AC deposition was stimulated. Iloprost-treatment increased hPDLC mineralization and was mediated by PGI2-receptor activation. These observations indicate that iloprost may be a promising root surface treatment agent.
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Affiliation(s)
- Sonntana Seang
- Department of Oral and Maxillofacial Surgery and Dentistry, Khmer-Soviet Friendship Hospital, Phnom Penh, Cambodia; Dental Stem Cell Biology Research Unit, Faculty of Dentistry, Chulalongkorn University, Bangkok, 10330, Thailand
| | | | - Natnicha Nisaeh
- Dental School, Faculty of Dentistry, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Araya Teantongdee
- Dental School, Faculty of Dentistry, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Saharat Jamsai
- Dental School, Faculty of Dentistry, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Chanunchida Changgnam
- Dental School, Faculty of Dentistry, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Kanika Yoongkiew
- Dental School, Faculty of Dentistry, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Somchai Yodsanga
- Department of Oral Pathology, Faculty of Dentistry, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Paksinee Kamolratanakul
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Sermporn Thaweesapphithak
- Genomics and Precision Dentistry Research Unit, Faculty of Dentistry, Chulalongkorn, University, Bangkok, 10330, Thailand
| | - Thantrira Pornthaveetus
- Genomics and Precision Dentistry Research Unit, Faculty of Dentistry, Chulalongkorn, University, Bangkok, 10330, Thailand
| | - Vincent Everts
- Department of Oral Cell Biology, Faculty of Dentistry, University of Amsterdam and Vrije, Universiteit, Amsterdam, The Netherlands
| | - Thanaphum Osathanont
- Dental Stem Cell Biology Research Unit, Faculty of Dentistry, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Chalida Nakalekha Limjeerajarus
- Genomics and Precision Dentistry Research Unit, Faculty of Dentistry, Chulalongkorn, University, Bangkok, 10330, Thailand; Dental Stem Cell Biology Research Unit, Faculty of Dentistry, Chulalongkorn University, Bangkok, 10330, Thailand; Department of Physiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, 10330, Thailand.
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The additive effect of iloprost on the biological properties of Mineral trioxide aggregate on mesenchymal stem cells. J Dent Sci 2022; 17:225-232. [PMID: 35028042 PMCID: PMC8739256 DOI: 10.1016/j.jds.2021.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/28/2021] [Indexed: 12/30/2022] Open
Abstract
Background/purpose Iloprost has been proposed as a potential biomaterial owing to angiogenic and odontogenic properties. However, the liquid form can limit its use during clinical applications. Mineral trioxide aggregate (MTA) has been used for various dental applications in which cell–material interaction is essential. This study aimed to investigate additive effects of iloprost on the biological properties of MTA on the viability, attachment, migration and differentiation of human mesenchymal stem cells (hMSCs). Materials and methods Standardized human dentin disks were prepared. MTA was prepared by mixing distilled water or iloprost solution, and the lumen of the disks was filled with MTA or MTA-iloprost. hMSCs on disk alone and hMSCs on culture plates were used as controls. Cell viability and attachment were measured after 1, 7 and 14 days using AlamarBlue assay and scanning electron microscopy (SEM). Cell migration in MTA or MTA-iloprost extracts was determined using a wound-healing model. Osteogenic differentiation was evaluated by real-time reverse transcriptase polymerase chain reaction for alkaline phosphatase (ALP), bone sialoprotein (BSP), osteocalcin (OCN), and osteopontin (OSP) gene expressions after 7 and 14 days of osteogenic induction. Results Cells on MTA-iloprost surface showed similar viability with MTA at 1 and 14 days but enhanced cellular viability and cell spreading compared to MTA at 7 days (p < 0.05). Cell migration was similar by MTA-iloprost and MTA extracts (p > 0.05). MTAiloprost significantly upregulated BSP, OCN and OSP expressions compared to MTA (p < 0.05). Conclusion The addition of iloprost to MTA improved the initial cell viability and osteogenic potential of hMSCs.
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Pulpal Response to the Combined Use of Mineral Trioxide Aggregate and Iloprost for Direct Pulp Capping. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11083702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose: The present study aims to assess the combined effects of mineral trioxide aggregate (MTA) and iloprost when used as a pulp capping material on pulpal inflammation and tertiary dentin formation compared with MTA and iloprost alone in rat molar teeth. Methods: Eighty maxillary first molar rat teeth were exposed and capped with iloprost solution, MTA, or MTA mixed with iloprost (MTA-iloprost). The cavities were then filled with resin-modified glass ionomer. The cavity was restored with glass ionomer without the use of pulp capping agent in the control group. The rats were sacrificed after one and four weeks. Block sections of the molar specimens were prepared and subjected to hematoxylin and eosin staining for evaluation. Statistical analysis was done using the Kruskal–Wallis test, followed by Dunnett’s test. Results: At week one, the control group showed significantly more severe pulpal inflammatory reactions than the iloprost (p = 0.00), MTA (p = 0.04), and MTA-iloprost (p = 0.00) groups. Hard tissue formation was commonly found in the iloprost, MTA, and MTA-iloprost groups. After four weeks, pulpal tissue degeneration was observed in the control group. Complete hard tissue barriers were found in 50%, 72.7%, and 77.8% of the specimens in iloprost, MTA, and MTA-iloprost groups, respectively, with no significant differences among the experimental groups. The dentinal tubule patterns were mostly regular in the MTA-iloprost group and irregular in the iloprost and MTA groups. Conclusions: The application of iloprost, MTA, and MTA-iloprost as a pulp capping material resulted in similar pulpal responses in the mechanically exposed pulp of rat molars. Therefore, mixing MTA with iloprost might not be clinically significant.
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da Silva GS, Moreira MS, Fukushima KA, Raggio DP, V Mello-Moura AC, Lara JS, Gimenez T, Junior SA, Morimoto S, Tedesco TK. Current evidence of tissue engineering for dentine regeneration in animal models: a systematic review. Regen Med 2020; 15:1345-1360. [PMID: 32148166 DOI: 10.2217/rme-2019-0005] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Aim: The aim of this study is to verify the type of scaffold effect on tissue engineering for dentine regeneration in animal models. Materials & methods: Strategic searches were conducted through MEDLINE/PubMed, Web of Science and Scopus databases. The studies were included with the following eligibility criteria: studies evaluating dentine regeneration, and being an in vivo study. Results: From 1392 identified potentially relevant studies, 15 fulfilled the eligibility criteria. All studies described characteristics of neoformed dentine, being that the most reported reparative dentine formation. Most of included studies presented moderate risk of bias. Conclusion: Up to date scientific evidence shows a positive trend to dentine regeneration when considering tissue engineering in animal models, regardless the type of scaffolds used.
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Affiliation(s)
- Gabriela S da Silva
- Graduate Program in Dentistry, Ibirapuera University, São Paulo, SP, 04661-100, Brazil
| | - Maria Stella Moreira
- Graduate Program in Dentistry, Ibirapuera University, São Paulo, SP, 04661-100, Brazil
| | - Karen A Fukushima
- Graduate Program in Dentistry, Ibirapuera University, São Paulo, SP, 04661-100, Brazil
| | - Daniela P Raggio
- Department of Orthodontic & Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, SP, 05508-000, Brazil
| | | | - Juan S Lara
- Department of Cariology, Operative Dentistry & Dental Public Health, School of Dentistry, Indiana University, Indianapolis, IN 46202-2876, USA
| | - Thais Gimenez
- Graduate Program in Dentistry, Ibirapuera University, São Paulo, SP, 04661-100, Brazil
| | | | - Susana Morimoto
- Graduate Program in Dentistry, Ibirapuera University, São Paulo, SP, 04661-100, Brazil
| | - Tamara K Tedesco
- Graduate Program in Dentistry, Ibirapuera University, São Paulo, SP, 04661-100, Brazil
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Payahoo S, Jamali S, Jabbari G, Jamee A. Efficacy of Lasers Treatment of Exposed Pulps to Stimulate Healing: A Systematic Review and Meta-Analysis. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2020. [DOI: 10.1590/pboci.2020.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | - Azad Jamee
- Urmia University of Medical Sciences, Iran
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Prostacyclin Analog Promotes Human Dental Pulp Cell Migration via a Matrix Metalloproteinase 9–related Pathway. J Endod 2019; 45:873-881. [DOI: 10.1016/j.joen.2019.03.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/22/2019] [Accepted: 03/28/2019] [Indexed: 01/28/2023]
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