Pulp–Dentin Tissue Healing Response: A Discussion of Current Biomedical Approaches

Abstract

Dental pulp tissue exposed to mechanical trauma or cariogenic process results in root canal and/or periapical infections, and conventionally treated with root canal procedures. The more recent regenerative endodontic procedure intends to achieve effective root canal disinfection and adequate pulp–dentin tissue regeneration; however, numerous limitations are reported. Because tooth is composed of vital soft pulp enclosed by the mineralized hard tissue in a highly organized structure, complete pulp–dentin tissue regeneration has been challenging to achieve. In consideration of the limitations and unique dental anatomy, it is important to understand the healing and repair processes through inflammatory-proliferative-remodeling phase transformations of pulp–dentin tissue. Upon cause by infectious and mechanical stimuli, the innate defense mechanism is initiated by resident pulp cells including immune cells through chemical signaling. After the expansion of infection and damage to resident pulp–dentin cells, consequent chemical signaling induces pluripotent mesenchymal stem cells (MSCs) to migrate to the injury site to perform the tissue regeneration process. Additionally, innovative biomaterials are necessary to facilitate the immune response and pulp–dentin tissue regeneration roles of MSCs. This review highlights current approaches of pulp–dentin tissue healing process and suggests potential biomedical perspective of the pulp–dentin tissue regeneration.

Mesoporous Bioactive Glass Nanoparticles Promote Odontogenesis and Neutralize Pathophysiological Acidic pH

“…Dentin protects the dental pulp, and odontogenic differentiation of dental pulp stem cells is crucial for the maintenance and regeneration of dentin (Shah et al, 2020). Therefore, the biomaterials used for pulp-dentin revitalization should have odontogenic potential.…”

“…Bacterial infection, inflammation, acidic pH, and immune reaction are the main factors affecting pulp-dentin regeneration (Schmalz and Smith, 2014;Jung et al, 2019;Shah et al, 2020). Synergistic activity of immune cells, mesenchymal stem cells, angiogenic, and neurogenic processes are involved in pulp-dentin restoration (Shah et al, 2020).…”

“…Bacterial infection, inflammation, acidic pH, and immune reaction are the main factors affecting pulp-dentin regeneration (Schmalz and Smith, 2014;Jung et al, 2019;Shah et al, 2020). Synergistic activity of immune cells, mesenchymal stem cells, angiogenic, and neurogenic processes are involved in pulp-dentin restoration (Shah et al, 2020). BG had shown potential for immunomodulation, inflammation mitigation, odontogenesis, angiogenesis, neuron regeneration, and inhibition of microbial growth (Marquardt et al, 2014;Drago et al, 2015;Yu et al, 2016;Barbeck et al, 2017;Zhao et al, 2018;Farano et al, 2019;Gomez-Cerezo et al, 2019).…”

“…Dentin and pulp tissue damage are mainly caused by bacterial activity, chemical erosion, and trauma. Dentin and pulp tissue damage are among the most common dental problems that substantially impact patient oral health and quality of life (Shah et al, 2020). After the introduction of restorative mineral trioxide aggregate (MTA) as a sealing agent in the early 1990s, pulpotomy to protect the damaged tooth entered a new era (Lee et al, 1993).…”

“…BG is analogous to MTA, except the MTA has crystalline calcium phosphates structure, and BG has siliconoxygen inorganic networks containing amorphous structure with robust biological activity. Dentin and pulp tissue regeneration are complex biological processes, involving odontogenesis, angiogenesis, immunomodulation, inflammation, and neuronal signaling (Shah et al, 2020). BG biomaterials had shown promising potential to regenerate various tissue, including bone, cartilage, skin, nerve, and periodontal tissue (Marquardt et al, 2014;Yu et al, 2016;Barbeck et al, 2017;Farano et al, 2019;Gomez-Cerezo et al, 2019).…”