Decellularized Swine Dental Pulp Tissue for Regenerative Root Canal Therapy

Abstract

In the current theme of dental pulp regeneration, biological and synthetic scaffolds are becoming a potential therapy for pulp revitalization. The goal is to provide a suitable environment for cellular infiltration, proliferation, and differentiation. The extracellular matrix (ECM) represents a natural scaffold material resembling the native tissue chemical and mechanical properties. In the past few years, ECM-based scaffolds have shown promising results in terms of progenitor cells recruitment, promotion of constructive remodeling, and modulation of host response. These properties make ECM-derived scaffolds an ideal candidate for pulp regenerative therapy. Development of strategies for clinically relevant tissue engineering using dental pulp extracellular matrix (DP-ECM) can provide an alternative to conventional root canal treatment. In this work, we successfully decellularized ECM derived from porcine dental pulp. The resulting scaffold was characterized using immunostaining (collagen type I, dentin matrix protein 1, dentin sialoprotein, and Von Willebrand factor) and enzyme-linked immunosorbent assay (transforming growth factor β, vascular endothelial growth factor, and basic fibroblast growth factor) for extracellular proteins where the ECM retained its proteins and significant amount of growth factors. Furthermore, a pilot in vivo study was conducted where the matrix was implanted for 8 wk in a dog root canal model. Our in vitro and preliminary in vivo data show that the decellularized ECM supports cellular infiltration together with the expression of pulp-dentin and vascular markers (DSP and CD31) compared to the controls. Herein, we show the feasibility to produce a decellularized ECM scaffold and validate the concept of using ECM-based scaffolds for pulp regeneration.

Cell-Free Approaches for Dental Pulp Tissue Engineering

“…In terms of cell homing, resident stem cells can be recruited from the dental pulp 21 or the periapical tissues 22 . Various sophisticated injectable and custom-made scaffolds have been developed for pulp tissue engineering lately including composite materials 23,24 , bioprinted materials 25 , decellularized matrix of dental pulp, or the dentin matrix after demineralization 23,26,27 . A comparison of different scaffold materials in terms of cytocompatibility showed higher cell viability in natural (collagen and fibrin) compared with synthetic hydrogels (modified polyethylene glycol or self-assembling peptides) and identified fibrin-based materials as promising candidates for dental pulp tissue engineering 28 .…”

The role of inflammation modulation in dental pulp regeneration

“…The success rate of this procedure ranges from bone healing, apex maturation (though unpredictable) and ultimately tooth positive response to vitality tests -indicating innervation (Ray et al, 2016;Staffoli et al, 2019) DP regeneration strategies in mature teeth In the case of adult mature teeth, pulp regeneration is primarily challenged by narrowing of the canal anatomy through dentineal sclerosis and the minimal (Alqahtani et al, 2018). Although ectopic, bone/cementum-like intracanal calcifications (IC) within a remodelling pulp are a common observation in pulp regeneration literature and are considered signs of an active regenerative process (Alqahtani et al, 2018;Skoglund and Tronstad, 1981;Zaky et al, 2020). Hence, it is suggested to include cementogenesis inhibitor molecules while attempting pulp regeneration procedures by periapical cells homing (Zizka and Sedy, 2017).…”

“…Cell homing is defined as the active recruitment of stem/progenitor endogenous cells into an anatomical compartment (Laird et al, 2008). Studies attempting DP regeneration by cell homing also report promising results in terms of development of pulp-like tissue that develops from recruited periapical/periodontal cells through a manipulated and widened apical foramen to colonise the root canals up to the pulp chamber (Alqahtani et al, 2018;Eramo et al, 2018;Huang et al, 2020). Interestingly, a blood clot formation within the debrided root canal and chamber is enough to support the regeneration process that occurs regardless of the different types of inserted scaffolds (Zaky et al, 2020) (Fig.…”

Potential Application of Human β-Defensin 4 in Dental Pulp Repair

“…Cells on the underside of the membrane were stained and counted under a microscope in three random fields. The experiments were performed in triplicate (Alqahtani et al, 2018;Cheng et al, 2019).…”