Crucial Triad in Pulp-Dentin Complex Regeneration: Dental Stem Cells, Scaffolds, and Signaling Molecules

Abstract

BACKGROUND: Pulp damage can lead to dentinogenesis impairment, irreversible pulpitis, or pulp necrosis. Despite being the most used endodontic procedure to treat damaged pulp, root canal therapy only results in nonvital teeth which are prone to fractures and secondary infection. Pulp-dentin regeneration has a potential to regenerate structure similar to normal pulp-dentin complex, and can be achieved by combining dental stem cells, scaffold, and signaling molecules. This article reviews the role of various types of dental stem cells, scaffolds, signaling molecules, and their combinations in regenerating pulp-dentin complex.CONTENT: Dental pulp stem cell (DPSC), stem cell from human exfoliated deciduous teeth (SHED), and dental follicle stem cell (DFSC) were reported to regenerate pulp-dentin complex in situ. SHED might be more promising than DPSCs and DFSCs for regenerating pulp-dentin complex, since SHED have a higher proliferation potential and higher expression levels of signaling molecules. Scaffolds have characteristics resembling extracellular matrix, thus providing a suitable microenvironment for transplanted dental stem cells. To accelerate the regeneration process, exogenous signaling molecules are often delivered together with dental stem cells. Scaffolds and signaling molecules have different regenerative potential, including induction of cell proliferation and migration, formation of pulp- and/or dentin-like tissue, as well as angiogenesis and neurogenesis promotion.SUMMARY: Combinations of dental stem cells, scaffold, and signaling molecules are important to achieve the functional pulp-dentin complex formation. Current trends and future directions on regenerative endodontics should be explored. The right combination of dental stem cells, scaffold, and signaling molecules could be determined based on the patients’ characteristics. Incomplete pulp-dentin regeneration could be overcome by applying dental stem cells, scaffold, and/or signaling molecules in multiple visits.KEYWORDS: pulp-dentin regeneration, regenerative endodontics, dental stem cells, scaffold, signaling molecules

Regenerative Endodontics -Present Practice to Promising Prospects: A Literature Review

“…They play a role in wound healing and tissue repair. In regenerative endodontics, PDGFs can be used to enhance the regenerative process by stimulating cell proliferation and tissue formation [20]. Insulin-like Growth Factor (IGF): IGF is essential for the growth and development of various tissues.…”

“…Insulin-like Growth Factor (IGF): IGF is essential for the growth and development of various tissues. It can be utilized to promote the differentiation and proliferation of dental pulp stem cells, contributing to the regeneration of dental tissues [20]. Epidermal Growth Factor (EGF): EGF is known for its role in cell growth and proliferation [18][19][20].…”

“…It can be utilized to promote the differentiation and proliferation of dental pulp stem cells, contributing to the regeneration of dental tissues [20]. Epidermal Growth Factor (EGF): EGF is known for its role in cell growth and proliferation [18][19][20]. It can be applied in regenerative endodontics to encourage the proliferation of cells involved in the regeneration of dental pulp and dentin.…”

“…Composite scaffolds combine different materials, enabling tailored mechanical and bioactive properties. Decellularized Extracellular Matrix (ECM) scaffolds, derived from natural tissues, retain native tissue architecture and composition, creating an optimal microenvironment for cell colonization and regeneration [18][19][20]. Each scaffold type presents distinct advantages, allowing for tailored approaches to tissue engineering in regenerative endodontics.…”