Abstract
Dental caries and trauma always lead to pulp necrosis and subsequent root development arrest of young permanent teeth. The traditional treatment, apexification, with the absence of further root formation, results in abnormal root morphology and compromises long-term prognosis. Regeneration endodontics procedures (REPs) have been developed and considered as an alternative strategy for management of immature permanent teeth with pulpal necrosis, including cell-free and cell-based REPs. Cell-free REPs, including revascularization and cell homing with molecules recruiting endogenous mesenchymal stem cells (MSCs), have been widely applied in clinical treatment, showing optimistic periapical lesion healing and continued root development. However, the regenerated pulp–dentin complex is still absent in these cases. Dental MSCs, as one of the essentials of tissue engineering, are vital seed cells in regenerative medicine. Dental MSC–based REPs have presented promising potential with pulp–dentin regeneration in large animal studies and clinical trials via cell transplantation. In the present review, we summarize current understanding of the biological basis of clinical treatments for immature necrotic permanent teeth and the roles of dental MSCs during this process and update the progress of MSC-based REPs in the administration of immature necrotic permanent teeth.
Highlights
Immature permanent teeth are prone to pulpal necrosis due to caries, trauma, or developmental malformation. These cases always lead to arrest of root formation, accompanied by thin root dentinal walls and open apices, which has been a challenge in endodontics (Shabahang, 2012)
We briefly summarize the current understanding of the biological basis of clinical treatments for immature permanent teeth with pulpal necrosis and the roles of dental mesenchymal stem cells (MSCs) during this process and update the progress of MSC-based Regeneration endodontics procedures (REPs) in the treatment of immature necrotic permanent teeth
Cell-free REPs, including revascularization and cell homing with molecules recruiting endogenous MSCs, are successful in resolving apical periodontitis and arrested root formation, which are eventually clinical regenerative endodontics and widely applied in treating immature permanent teeth with necrotic pulp
Summary
Immature permanent teeth are prone to pulpal necrosis due to caries, trauma, or developmental malformation. In the latest clinical study (Xuan et al, 2018), implantation of autologous SHED aggregates generated pulp–dentin complex in immature necrotic permanent incisors of pediatric patients, including functional dental pulp tissue regeneration with vasculature, innervation, and the lining odontoblast layer. DPSCs, dental pulp stem cells; SHED, stem cells of human exfoliated deciduous teeth; SCAP, stem cells from apical papilla; PDLSCs, periodontal ligament stem cells; DFSCs, dental follicle stem cells; HFG, hepatocyte growth factor; IDO, indole amine 2,3-dioxygenase; IFN, interferon; IL, interleukin; PGE2, prostaglandin E2; TGF-β, transforming growth factor beta; Th17, T-helper 17; TLR, Toll-like receptor; PBMCs, peripheral blood mononuclear cells. SHED are capable of forming functional dental pulp tissue, containing odontoblasts to regenerate tubular dentin in fulllength root canals combined with collagen type I (Cordeiro et al, 2008). Several clinical case reports show that root formation continues in some necrotic immature permanent teeth, indicating that
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