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.
Highlights
Dental infection is demonstrated as a bacteria mediated destruction of periapical tissue, including dental pulp, apex, and periodontium, accompanied by pain, swelling, mobility, and abscess formation [1]
Due to the dental pulp being confined by mineralized tissue, the initial inflammatory/immunological reaction increases intra-canal pressure, and the pressure extends toward the root apex down the root canal, causing periapical abscess [35,41,42]
Pulp–dentin tissue regeneration is the series of healing progression from an inflammatory response, immune signaling, and cellular interaction accompanying tissue restoration upon infectious exposure
Summary
Dental infection is demonstrated as a bacteria mediated destruction of periapical tissue, including dental pulp, apex, and periodontium, accompanied by pain, swelling, mobility, and abscess formation [1]. Tooth abscess with immature root (open apex, Figure 1A) can be treated with the regenerative endodontic procedure (REP). Despite some favorable clinical outcomes, failure rate ups for the Adverse results include tooth discoloration [9,10,11], root fracture [12,13,14,15], bone-like, and cementum-like. When pulp–dentin tissue is exposed to trauma or bacterial infection, regardless of the acute of chronic the acute or chronic stages, odontoblasts recognize pathogenic signals initiateinnate the localized or stages, odontoblasts recognize pathogenic signals and initiate theand localized healing innate healing response [29,30]. Depending on the depth of caries or bacterial penetration, the healing interface could be the line of defense and found as multiple loci from the coronal part to the root apex in any area of pulp–dentin tissue
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