Abstract
Dental pulp as a source of nutrition for the whole tooth is vulnerable to trauma and bacterial invasion, which causes irreversible pulpitis and pulp necrosis. Dental pulp regeneration is a valuable method of restoring the viability of the dental pulp and even the whole tooth. Odontogenic mesenchymal stem cells (MSCs) residing in the dental pulp environment have been widely used in dental pulp regeneration because of their immense potential to regenerate pulp-like tissue. Furthermore, the regenerative abilities of odontogenic MSCs are easily affected by the microenvironment in which they reside. The natural environment of the dental pulp has been proven to be capable of regulating odontogenic MSC homeostasis, proliferation, and differentiation. Therefore, various approaches have been applied to mimic the natural dental pulp environment to optimize the efficacy of pulp regeneration. In addition, odontogenic MSC aggregates/spheroids similar to the natural dental pulp environment have been shown to regenerate well-organized dental pulp both in preclinical and clinical trials. In this review, we summarize recent progress in odontogenic MSC-mediated pulp regeneration and focus on the effect of the microenvironment surrounding odontogenic MSCs in the achievement of dental pulp regeneration.
Highlights
Being the source of nutrition for the whole tooth, the dental pulp is the residence of a large number of odontogenic mesenchymal stem cells (MSCs), which play an important role in the process of tooth development and injury repair (Lambrichts et al, 2017)
The efficacy of dental pulp regeneration depends on the biological properties of the odontogenic MSCs involved in the regeneration process, and the natural dental pulp microenvironment of odontogenic MSCs is essential to regulate their homeostasis, proliferation, and differentiation; mimicking the natural pulp microenvironment is the key to realizing pulp regeneration
When cell aggregates were implanted into the root canal, the interaction between cell aggregates and the treated dentin is similar to that between the newly formed dentin and the apical papilla, which is the aggregate of odontogenic MSCs in the early stage of tooth development
Summary
Being the source of nutrition for the whole tooth, the dental pulp is the residence of a large number of odontogenic mesenchymal stem cells (MSCs), which play an important role in the process of tooth development and injury repair (Lambrichts et al, 2017). As recently reviewed by Moussa and Aparicio (2019), the scaffold materials applied for dental pulp regeneration mainly include: (1) naturally derived polymeric scaffolds like collagen, fibrin, decellularized dental pulp tissue (Alqahtani et al, 2018; Bakhtiar et al, 2020), and treated dentin matrix (TDM) (Yang et al, 2012; Meng et al, 2020); (2) synthetically engineered polymeric scaffolds such as polylactic acid, polyglycolic acid, and ceramic scaffolds; and (3) composite scaffolds that balance the advantages and disadvantages of individual material, improving the overall material performance (Moussa and Aparicio, 2019) These scaffold materials rebuild a suitable environment for odontogenic MSCs to regenerate dental pulp tissue by changing mechanical properties, composition, and structure and combining them with cytokines and other scaffold materials. These studies suggest that exogenous odontogenic MSC implantation may be an effective approach to regenerate functional dental pulp, and the application of odontogenic MSC aggregates may be a promising method for future regenerative endodontics in clinical settings
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