Regenerative Endodontic: Cell-Based Versus Cell-Free Approach
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Published:
Oct 9, 2018
Keywords:
Regenerative endodontics, pulp regeneration, cell-based approach, cell-free approach
Main Article Content
Abstract
In regenerative endodontics, the cell-based and cell-free approach in immature permanent teeth is a novel root canal treatment that attempts to regenerate a functional pulp rather than a mere prosthetic material in the root canal system. However, the outcomes of this treatment are still uncertain as they depend on various factors. Accordingly, there is a need for better understanding the biology behind pulp regeneration as well as an improving tissue ingrowth into the pulp space. This review will focus on the update horizon of alternative approaches in regenerative endodontic and provide the insight into the account of pulp tissue engineering.
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How to Cite
1.
Ruangsawasdi N, Kaewprag J. Regenerative Endodontic: Cell-Based Versus Cell-Free Approach. M Dent J [Internet]. 2018 Oct. 9 [cited 2024 May 1];38(3):313-20. Available from: https://he02.tci-thaijo.org/index.php/mdentjournal/article/view/132348
Section
Review articles
References
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2. Sonoyama W, Liu Y, Yamaza T, Tuan RS, Wang S, Shi S, et al. Characterization of the apical papilla and its residing stem cells from human immature permanent teeth: a pilot study. J Endod. 2008;34(2):166-71.
3. Simon SR, Tomson PL, Berdal A. Regenerative endodontics: regeneration or repair? J Endod. 2014;40(4 Suppl):S70-5.
4. Nosrat A, Homayounfar N, Oloomi K. Drawbacks and unfavorable outcomes of regenerative endodontic treatments of necrotic immature teeth: a literature review and report of a case. J Endod. 2012;38(10):1428-34.
5. Ishizaka R, Iohara K, Murakami M, Fukuta O, Nakashima M. Regeneration of dental pulp following pulpectomy by fractionated stem/progenitor cells from bone marrow and adipose tissue. Biomaterials. 2012;33(7):2109-18.
6. Galler KM, Eidt A, Schmalz G. Cell-free approaches for dental pulp tissue engineering. J Endod. 2014;40(4 Suppl):S41-5.
7. Andreasen JO, Farik B, Munksgaard EC. Long-term calcium hydroxide as a root canal dressing may increase risk of root fracture. Dent Traumatol. 2002;18(3):134-7.
8. Nikhil V, Jha P, Aggarwal A. Comparative evaluation of fracture resistance of simulated immature teeth restored with glass fiber posts, intracanal composite resin, and experimental dentine posts. ScientificWorldJournal. 2015;2015:751425.
9. Cvek M. Prognosis of luxated non-vital maxillary incisors treated with calcium hydroxide and filled with gutta-percha. A retrospective clinical study. Endod Dent Traumatol. 1992;8(2):45-55.
10. Maroto M, Barberia E, Planells P, Vera V. Treatment of a non-vital immature incisor with mineral trioxide aggregate (MTA). Dent Traumatol. 2003;19(3):165-9.
11. Torneck CD. Reaction of rat connective tissue to polyethylene tube implants. I. Oral Surg Oral Med Oral Pathol. 1966;21(3):379-87.
12. Nygaard-Ostby B, Hjortdal O. Tissue formation in the root canal following pulp removal. Scand J Dent Res. 1971;79(5):333-49.
13. Pan S, Dangaria S, Gopinathan G, Yan X, Lu X, Kolokythas A, et al. SCF promotes dental pulp progenitor migration, neovascularization, and collagen remodeling - potential applications as a homing factor in dental pulp regeneration. Stem Cell Rev. 2013;9(5):655-67.
14. Iwaya SI, Ikawa M, Kubota M. Revascularization of an immature permanent tooth with apical periodontitis and sinus tract. Dent Traumatol. 2001;17(4):185-7.
15. Banchs F, Trope M. Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol? J Endod. 2004;30(4):196-200.
16. Jeeruphan T, Jantarat J, Yanpiset K, Suwannapan L, Khewsawai P, Hargreaves KM. Mahidol study 1: comparison of radiographic and survival outcomes of immature teeth treated with either regenerative endodontic or apexification methods: a retrospective study. J Endod. 2012;38(10):1330-6.
17. Petrino JA, Boda KK, Shambarger S, Bowles WR, McClanahan SB. Challenges in regenerative endodontics: a case series. J Endod. 2010;36(3):536-41.
18. Chen MY, Chen KL, Chen CA, Tayebaty F, Rosenberg PA, Lin LM. Responses of immature permanent teeth with infected necrotic pulp tissue and apical periodontitis/abscess to revascularization procedures. Int Endod J. 2012;45(3):294-305.
19. Lovelace TW, Henry MA, Hargreaves KM, Diogenes A. Evaluation of the delivery of mesenchymal stem cells into the root canal space of necrotic immature teeth after clinical regenerative endodontic procedure. J Endod. 2011;37(2):133-8.
20. Chrepa V, Henry MA, Daniel BJ, Diogenes A. Delivery of Apical Mesenchymal Stem Cells into Root Canals of Mature Teeth. J Dent Res. 2015;94(12):1653-9.
21. Alobaid AS, Cortes LM, Lo J, Nguyen TT, Albert J, Abu-Melha AS, et al. Radiographic and clinical outcomes of the treatment of immature permanent teeth by revascularization or apexification: a pilot retrospective cohort study. J Endod. 2014;40(8):1063-70.
22. Nagy MM, Tawfik HE, Hashem AA, Abu-Seida AM. Regenerative potential of immature permanent teeth with necrotic pulps after different regenerative protocols. J Endod. 2014;40(2):192-8.
23. Nakashima M, Iohara K, Sugiyama M. Human dental pulp stem cells with highly angiogenic and neurogenic potential for possible use in pulp regeneration. Cytokine Growth Factor Rev. 2009;20(5-6):435-40.
24. Huang GT, Garcia-Godoy F. Missing Concepts in De Novo Pulp Regeneration. J Dent Res. 2014;93(8):717-24.
25. Huang GT, Yamaza T, Shea LD, Djouad F, Kuhn NZ, Tuan RS, et al. Stem/progenitor cell-mediated de novo regeneration of dental pulp with newly deposited continuous layer of dentin in an in vivo model. Tissue Eng Part A. 2010;16(2):605-15.
26. Iohara K, Zheng L, Ito M, Ishizaka R, Nakamura H, Into T, et al. Regeneration of dental pulp after pulpotomy by transplantation of CD31(-)/CD146(-) side population cells from a canine tooth. Regen Med. 2009;4(3):377-85.
27. Kim SG, Zheng Y, Zhou J, Chen M, Embree MC, Song K, et al. Dentin and dental pulp regeneration by the patient's endogenous cells. Endod Topics. 2013;28(1):106-17.
28. Iohara K, Murakami M, Takeuchi N, Osako Y, Ito M, Ishizaka R, et al. A novel combinatorial therapy with pulp stem cells and granulocyte colony-stimulating factor for total pulp regeneration. Stem Cells Transl Med. 2013;2(7):521-33.
29. Nakashima M, Iohara K. Mobilized dental pulp stem cells for pulp regeneration: initiation of clinical trial. J Endod. 2014;40(4 Suppl):S26-32.
30. Iohara K, Nakashima M, Ito M, Ishikawa M, Nakasima A, Akamine A. Dentin regeneration by dental pulp stem cell therapy with recombinant human bone morphogenetic protein 2. J Dent Res. 2004;83(8):590-5.
31. Nakashima M, Iohara K, Murakami M, Nakamura H, Sato Y, Ariji Y, et al. Pulp regeneration by transplantation of dental pulp stem cells in pulpitis: a pilot clinical study. Stem Cell Res Ther. 2017;8(1):61.
32. Janmey PA, Winer JP, Weisel JW. Fibrin gels and their clinical and bioengineering applications. J R Soc Interface. 2009;6(30):1-10.
33. Altaii M, Cathro P, Broberg M, Richards L. Endodontic regeneration and tooth revitalization in immature infected sheep teeth. Int Endod J. 2017;50(5):480-91.
34. Nosrat A, Kolahdouzan A, Hosseini F, Mehrizi EA, Verma P, Torabinejad M. Histologic Outcomes of Uninfected Human Immature Teeth Treated with Regenerative Endodontics: 2 Case Reports. J Endod. 2015;41(10):1725-9.
35. Torabinejad M, Turman M. Revitalization of tooth with necrotic pulp and open apex by using platelet-rich plasma: a case report. J Endod. 2011;37(2):265-8.
36. Torabinejad M, Faras H. A clinical and histological report of a tooth with an open apex treated with regenerative endodontics using platelet-rich plasma. J Endod. 2012;38(6):864-8.
37. Mao JJ, Kim SG, Zhou J, Ye L, Cho S, Suzuki T, et al. Regenerative endodontics: barriers and strategies for clinical translation. Dent Clin North Am. 2012;56(3):639-49.
38. Galler KM, Hartgerink JD, Cavender AC, Schmalz G, D'Souza RN. A customized self-assembling peptide hydrogel for dental pulp tissue engineering. Tissue Eng Part A. 2012;18(1-2):176-84.
39. Yu HY, Ma DD, Wu BL. [Gelatin/alginate hydrogel scaffolds prepared by 3D bioprinting promotes cell adhesion and proliferation of human dental pulp cells in vitro]. Nan Fang Yi Ke Da Xue Xue Bao. 2017;37(5):668-72.
40. Germain L, De Berdt P, Vanacker J, Leprince J, Diogenes A, Jacobs D, et al. Fibrin hydrogels to deliver dental stem cells of the apical papilla for regenerative medicine. Regen Med. 2015;10(2):153-67.
41. Palma PJ, Ramos JC, Martins JB, Diogenes A, Figueiredo MH, Ferreira P, et al. Histologic Evaluation of Regenerative Endodontic Procedures with the Use of Chitosan Scaffolds in Immature Dog Teeth with Apical Periodontitis. J Endod. 2017;43(8):1279-87.
42. Galler KM, Brandl FP, Kirchhof S, Widbiller M, Eidt A, Buchalla W, et al. Suitability of Different Natural and Synthetic Biomaterials for Dental Pulp Tissue Engineering. Tissue Eng Part A. 2018;24(3-4):234-44.
43. Ruangsawasdi N, Zehnder M, Weber FE. Fibrin gel improves tissue ingrowth and cell differentiation in human immature premolars implanted in rats. J Endod. 2014;40(2):246-50.
44. Ruangsawasdi N, Zehnder M, Patcas R, Ghayor C, Siegenthaler B, Gjoksi B, et al. Effects of Stem Cell Factor on Cell Homing During Functional Pulp Regeneration in Human Immature Teeth. Tissue Eng Part A. 2017;23(3-4):115-23.
45. Fouad AF. The microbial challenge to pulp regeneration. Adv Dent Res. 2011;23(3):285-9.
46. Trevino EG, Patwardhan AN, Henry MA, Perry G, Dybdal-Hargreaves N, Hargreaves KM, et al. Effect of irrigants on the survival of human stem cells of the apical papilla in a platelet-rich plasma scaffold in human root tips. J Endod. 2011;37(8):1109-15.
47. Ruparel NB, Teixeira FB, Ferraz CC, Diogenes A. Direct effect of intracanal medicaments on survival of stem cells of the apical papilla. J Endod. 2012;38(10):1372-5.
48. Galler KM, D'Souza RN, Federlin M, Cavender AC, Hartgerink JD, Hecker S, et al. Dentin conditioning codetermines cell fate in regenerative endodontics. J Endod. 2011;37(11):1536-41.
49. Sloan AJ. Biology of the pulp-dentin complex. Stem cell biology and tissue engineering in dental sciences. New York: Elsevier; 2015. p. 371-78.
50. Zhao S, Sloan AJ, Murray PE, Lumley PJ, Smith AJ. Ultrastructural localisation of TGF-beta exposure in dentine by chemical treatment. Histochem J. 2000;32(8):489-94.
51. Jung HJ, Seo I, Jha BK, Suh SI, Suh MH, Baek WK. Minocycline inhibits angiogenesis in vitro through the translational suppression of HIF-1alpha. Arch Biochem Biophys. 2014;545:74-82.
2. Sonoyama W, Liu Y, Yamaza T, Tuan RS, Wang S, Shi S, et al. Characterization of the apical papilla and its residing stem cells from human immature permanent teeth: a pilot study. J Endod. 2008;34(2):166-71.
3. Simon SR, Tomson PL, Berdal A. Regenerative endodontics: regeneration or repair? J Endod. 2014;40(4 Suppl):S70-5.
4. Nosrat A, Homayounfar N, Oloomi K. Drawbacks and unfavorable outcomes of regenerative endodontic treatments of necrotic immature teeth: a literature review and report of a case. J Endod. 2012;38(10):1428-34.
5. Ishizaka R, Iohara K, Murakami M, Fukuta O, Nakashima M. Regeneration of dental pulp following pulpectomy by fractionated stem/progenitor cells from bone marrow and adipose tissue. Biomaterials. 2012;33(7):2109-18.
6. Galler KM, Eidt A, Schmalz G. Cell-free approaches for dental pulp tissue engineering. J Endod. 2014;40(4 Suppl):S41-5.
7. Andreasen JO, Farik B, Munksgaard EC. Long-term calcium hydroxide as a root canal dressing may increase risk of root fracture. Dent Traumatol. 2002;18(3):134-7.
8. Nikhil V, Jha P, Aggarwal A. Comparative evaluation of fracture resistance of simulated immature teeth restored with glass fiber posts, intracanal composite resin, and experimental dentine posts. ScientificWorldJournal. 2015;2015:751425.
9. Cvek M. Prognosis of luxated non-vital maxillary incisors treated with calcium hydroxide and filled with gutta-percha. A retrospective clinical study. Endod Dent Traumatol. 1992;8(2):45-55.
10. Maroto M, Barberia E, Planells P, Vera V. Treatment of a non-vital immature incisor with mineral trioxide aggregate (MTA). Dent Traumatol. 2003;19(3):165-9.
11. Torneck CD. Reaction of rat connective tissue to polyethylene tube implants. I. Oral Surg Oral Med Oral Pathol. 1966;21(3):379-87.
12. Nygaard-Ostby B, Hjortdal O. Tissue formation in the root canal following pulp removal. Scand J Dent Res. 1971;79(5):333-49.
13. Pan S, Dangaria S, Gopinathan G, Yan X, Lu X, Kolokythas A, et al. SCF promotes dental pulp progenitor migration, neovascularization, and collagen remodeling - potential applications as a homing factor in dental pulp regeneration. Stem Cell Rev. 2013;9(5):655-67.
14. Iwaya SI, Ikawa M, Kubota M. Revascularization of an immature permanent tooth with apical periodontitis and sinus tract. Dent Traumatol. 2001;17(4):185-7.
15. Banchs F, Trope M. Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol? J Endod. 2004;30(4):196-200.
16. Jeeruphan T, Jantarat J, Yanpiset K, Suwannapan L, Khewsawai P, Hargreaves KM. Mahidol study 1: comparison of radiographic and survival outcomes of immature teeth treated with either regenerative endodontic or apexification methods: a retrospective study. J Endod. 2012;38(10):1330-6.
17. Petrino JA, Boda KK, Shambarger S, Bowles WR, McClanahan SB. Challenges in regenerative endodontics: a case series. J Endod. 2010;36(3):536-41.
18. Chen MY, Chen KL, Chen CA, Tayebaty F, Rosenberg PA, Lin LM. Responses of immature permanent teeth with infected necrotic pulp tissue and apical periodontitis/abscess to revascularization procedures. Int Endod J. 2012;45(3):294-305.
19. Lovelace TW, Henry MA, Hargreaves KM, Diogenes A. Evaluation of the delivery of mesenchymal stem cells into the root canal space of necrotic immature teeth after clinical regenerative endodontic procedure. J Endod. 2011;37(2):133-8.
20. Chrepa V, Henry MA, Daniel BJ, Diogenes A. Delivery of Apical Mesenchymal Stem Cells into Root Canals of Mature Teeth. J Dent Res. 2015;94(12):1653-9.
21. Alobaid AS, Cortes LM, Lo J, Nguyen TT, Albert J, Abu-Melha AS, et al. Radiographic and clinical outcomes of the treatment of immature permanent teeth by revascularization or apexification: a pilot retrospective cohort study. J Endod. 2014;40(8):1063-70.
22. Nagy MM, Tawfik HE, Hashem AA, Abu-Seida AM. Regenerative potential of immature permanent teeth with necrotic pulps after different regenerative protocols. J Endod. 2014;40(2):192-8.
23. Nakashima M, Iohara K, Sugiyama M. Human dental pulp stem cells with highly angiogenic and neurogenic potential for possible use in pulp regeneration. Cytokine Growth Factor Rev. 2009;20(5-6):435-40.
24. Huang GT, Garcia-Godoy F. Missing Concepts in De Novo Pulp Regeneration. J Dent Res. 2014;93(8):717-24.
25. Huang GT, Yamaza T, Shea LD, Djouad F, Kuhn NZ, Tuan RS, et al. Stem/progenitor cell-mediated de novo regeneration of dental pulp with newly deposited continuous layer of dentin in an in vivo model. Tissue Eng Part A. 2010;16(2):605-15.
26. Iohara K, Zheng L, Ito M, Ishizaka R, Nakamura H, Into T, et al. Regeneration of dental pulp after pulpotomy by transplantation of CD31(-)/CD146(-) side population cells from a canine tooth. Regen Med. 2009;4(3):377-85.
27. Kim SG, Zheng Y, Zhou J, Chen M, Embree MC, Song K, et al. Dentin and dental pulp regeneration by the patient's endogenous cells. Endod Topics. 2013;28(1):106-17.
28. Iohara K, Murakami M, Takeuchi N, Osako Y, Ito M, Ishizaka R, et al. A novel combinatorial therapy with pulp stem cells and granulocyte colony-stimulating factor for total pulp regeneration. Stem Cells Transl Med. 2013;2(7):521-33.
29. Nakashima M, Iohara K. Mobilized dental pulp stem cells for pulp regeneration: initiation of clinical trial. J Endod. 2014;40(4 Suppl):S26-32.
30. Iohara K, Nakashima M, Ito M, Ishikawa M, Nakasima A, Akamine A. Dentin regeneration by dental pulp stem cell therapy with recombinant human bone morphogenetic protein 2. J Dent Res. 2004;83(8):590-5.
31. Nakashima M, Iohara K, Murakami M, Nakamura H, Sato Y, Ariji Y, et al. Pulp regeneration by transplantation of dental pulp stem cells in pulpitis: a pilot clinical study. Stem Cell Res Ther. 2017;8(1):61.
32. Janmey PA, Winer JP, Weisel JW. Fibrin gels and their clinical and bioengineering applications. J R Soc Interface. 2009;6(30):1-10.
33. Altaii M, Cathro P, Broberg M, Richards L. Endodontic regeneration and tooth revitalization in immature infected sheep teeth. Int Endod J. 2017;50(5):480-91.
34. Nosrat A, Kolahdouzan A, Hosseini F, Mehrizi EA, Verma P, Torabinejad M. Histologic Outcomes of Uninfected Human Immature Teeth Treated with Regenerative Endodontics: 2 Case Reports. J Endod. 2015;41(10):1725-9.
35. Torabinejad M, Turman M. Revitalization of tooth with necrotic pulp and open apex by using platelet-rich plasma: a case report. J Endod. 2011;37(2):265-8.
36. Torabinejad M, Faras H. A clinical and histological report of a tooth with an open apex treated with regenerative endodontics using platelet-rich plasma. J Endod. 2012;38(6):864-8.
37. Mao JJ, Kim SG, Zhou J, Ye L, Cho S, Suzuki T, et al. Regenerative endodontics: barriers and strategies for clinical translation. Dent Clin North Am. 2012;56(3):639-49.
38. Galler KM, Hartgerink JD, Cavender AC, Schmalz G, D'Souza RN. A customized self-assembling peptide hydrogel for dental pulp tissue engineering. Tissue Eng Part A. 2012;18(1-2):176-84.
39. Yu HY, Ma DD, Wu BL. [Gelatin/alginate hydrogel scaffolds prepared by 3D bioprinting promotes cell adhesion and proliferation of human dental pulp cells in vitro]. Nan Fang Yi Ke Da Xue Xue Bao. 2017;37(5):668-72.
40. Germain L, De Berdt P, Vanacker J, Leprince J, Diogenes A, Jacobs D, et al. Fibrin hydrogels to deliver dental stem cells of the apical papilla for regenerative medicine. Regen Med. 2015;10(2):153-67.
41. Palma PJ, Ramos JC, Martins JB, Diogenes A, Figueiredo MH, Ferreira P, et al. Histologic Evaluation of Regenerative Endodontic Procedures with the Use of Chitosan Scaffolds in Immature Dog Teeth with Apical Periodontitis. J Endod. 2017;43(8):1279-87.
42. Galler KM, Brandl FP, Kirchhof S, Widbiller M, Eidt A, Buchalla W, et al. Suitability of Different Natural and Synthetic Biomaterials for Dental Pulp Tissue Engineering. Tissue Eng Part A. 2018;24(3-4):234-44.
43. Ruangsawasdi N, Zehnder M, Weber FE. Fibrin gel improves tissue ingrowth and cell differentiation in human immature premolars implanted in rats. J Endod. 2014;40(2):246-50.
44. Ruangsawasdi N, Zehnder M, Patcas R, Ghayor C, Siegenthaler B, Gjoksi B, et al. Effects of Stem Cell Factor on Cell Homing During Functional Pulp Regeneration in Human Immature Teeth. Tissue Eng Part A. 2017;23(3-4):115-23.
45. Fouad AF. The microbial challenge to pulp regeneration. Adv Dent Res. 2011;23(3):285-9.
46. Trevino EG, Patwardhan AN, Henry MA, Perry G, Dybdal-Hargreaves N, Hargreaves KM, et al. Effect of irrigants on the survival of human stem cells of the apical papilla in a platelet-rich plasma scaffold in human root tips. J Endod. 2011;37(8):1109-15.
47. Ruparel NB, Teixeira FB, Ferraz CC, Diogenes A. Direct effect of intracanal medicaments on survival of stem cells of the apical papilla. J Endod. 2012;38(10):1372-5.
48. Galler KM, D'Souza RN, Federlin M, Cavender AC, Hartgerink JD, Hecker S, et al. Dentin conditioning codetermines cell fate in regenerative endodontics. J Endod. 2011;37(11):1536-41.
49. Sloan AJ. Biology of the pulp-dentin complex. Stem cell biology and tissue engineering in dental sciences. New York: Elsevier; 2015. p. 371-78.
50. Zhao S, Sloan AJ, Murray PE, Lumley PJ, Smith AJ. Ultrastructural localisation of TGF-beta exposure in dentine by chemical treatment. Histochem J. 2000;32(8):489-94.
51. Jung HJ, Seo I, Jha BK, Suh SI, Suh MH, Baek WK. Minocycline inhibits angiogenesis in vitro through the translational suppression of HIF-1alpha. Arch Biochem Biophys. 2014;545:74-82.