Regenerative Endodontic Therapy in Mature Teeth Using Human-Derived Composite Amnion-Chorion Membrane as a Bioactive Scaffold: A Pilot Animal Investigation

Biomaterial scaffolds for clinical procedures in endodontic regeneration

“…The amniotic membrane represents the innermost layer of the placenta, which consists of a single epithelial layer, a thick basement membrane and an avascular stromal matrix [ 210 ]. The embryonic ectodermal-derived amniotic epithelial cells in the epithelial layer and the embryonic mesodermal-derived mesenchymal stromal cells in the stromal layer maintain multipotent/pluripotent characteristics for tissue regeneration [ [210] , [211] , [212] , [213] ]. The biological molecules within the membrane such as growth factors (i.e., vascular endothelial growth factor, platelet-derived growth factor, transforming growth factor-β1and basic fibroblast growth factor) and anti-inflammatory cytokines (i.e., interleukin-4, -6, -8 and -10) have been shown to mobilize hematopoietic and mesenchymal stem cells and promote cellular growth and differentiation [ [210] , [211] , [212] , [213] ].…”

“…The embryonic ectodermal-derived amniotic epithelial cells in the epithelial layer and the embryonic mesodermal-derived mesenchymal stromal cells in the stromal layer maintain multipotent/pluripotent characteristics for tissue regeneration [ [210] , [211] , [212] , [213] ]. The biological molecules within the membrane such as growth factors (i.e., vascular endothelial growth factor, platelet-derived growth factor, transforming growth factor-β1and basic fibroblast growth factor) and anti-inflammatory cytokines (i.e., interleukin-4, -6, -8 and -10) have been shown to mobilize hematopoietic and mesenchymal stem cells and promote cellular growth and differentiation [ [210] , [211] , [212] , [213] ]. It has been shown that both basement membrane side and stromal side of the acellular amniotic membrane matrix could promote the osteogenic differentiation of human dental apical papilla cells.…”

Polymeric Scaffolds for Dental, Oral, and Craniofacial Regenerative Medicine

“…The main goals of regenerative endodontics are to close the root apex, increase root length, thicken root canal walls, and achieve pulp regeneration, all while maintaining biocompatibility. REP was originally developed to treat immature necrotic teeth, but recently, they have also been performed on necrotic permanent teeth, vital mature permanent teeth, and resorbed teeth with a history of trauma [134].…”

“…Human composite ACM is a scaffold that contains a combination of growth factors and cytokines that can facilitate the controlled recruitment of progenitor stem cells and thus enhance pulp regeneration. In fact, when compared to using a blood clot alone or using a blood clot with collagen membrane for pulp regeneration in mature teeth, ACM produced more intracanal fibrous tissue and odontoblast-like cell lining [134]. Finally, angiogenic hydrogels have similar material properties to that of the native dental pulp and can promote ideal biointegration and soft tissue regeneration.…”

“…For one, many membranes are still in their original phases and being tested in vitro. For these newer scaffolds, the successful results obtained from in vitro assays will form the basis for future studies as they will require more thorough in-vivo analysis of their effectiveness, as well as further preclinical and clinical studies [134,143]. For another, many studies showed a negative response to pulp vitality assessments during the follow-up period despite demonstrating apical closure and resolution of the periapical lesion on radiographic examination.…”