Healthy Pulp Tissue Research Articles

Pulp exposure management

The maintenance of healthy pulp tissue and the prevention of apical periodontitis form the basis of minimally invasive dentistry. Although, the dental pulp exhibits an array of strategies to protect itself against irritation, the conservative management of the exposed pulp has traditionally been unpredictable. Recent dental biomaterial advances, as well as an evolving understanding of molecular biology and regenerative medicine have led to the development of new treatment strategies for the exposed pulp. Although calcium-silicate cements now represent the gold standard capping material, but stimulate repair non-specifically and have some practical limitations.

Vascularity and Angiogenic Signaling in the Dentine-Pulp Complex of Immature and Mature Permanent Teeth.

ABSTRACTObjective:This study aimed to examine the protein and gene expression of vascular endothelial growth factor (VEGF) and angiopoietins-1 and 2 in tissue from healthy and inflamed dental pulps.Methods:Permanent teeth with pulps diagnosed as healthy or reversible pulpitis were used for immunohistochemistry (IHC) and gene expression experiments. For IHC, a whole pulp tissue was excavated from the pulp chamber, and it was formalin-fixed and processed for routine IHC with angiogenic markers anti-VEGF, anti-Ang1, and anti-Ang2. Staining was visualized with diaminobenzidine (DAB), and examined using light microscopy. The distribution of markers in healthy and inflamed pulps was qualitatively and quantitatively analyzed. Real-time quantitative polymerase chain reaction (RT qPCR) was used to ascertain the gene expression levels of ANGPT1, ANGPT2, and TEK in the presence of inflammation. Statistical analysis was performed using the Mann–Whitney test with the statistical significance level set at 0.05.Results:There was increased protein and mRNA expression of VEGF and Ang-1 markers in inflamed pulp samples as compared with that in the healthy pulp tissue. IHC demonstrated intense expression of the VEGF protein on endothelial cells (EC) and some non-ECs, and there was significantly more staining on ECs associated with inflamed tissue (P<0.001). Ang-1 and Ang-2 were significantly expressed on ECs and non-ECs (P<0.05). RT qPCR did not show significant differences in gene expression between healthy and inflamed samples although similar trends were observed to IHC.Conclusion:The presence of Ang-1, Ang-2, VEGF, and TEK gene in healthy and mildly inflamed pulp tissue associated with reversible pulpitis indicates that these angiogenic factors may participate in physiological and pathological angiogenesis and healing. The inflammatory process may regulate Ang-1/Ang2/Tie2 signaling; and together with VEGF, these growth factors have an important role in modulating pulp angiogenesis.

Inflammation-induced overexpression of microRNA-223-3p regulates odontoblastic differentiation of human dental pulp stem cells by targeting SMAD3.

To profile miRNA expression between inflamed and healthy human dental pulp tissues and to investigate how the upregulation of miR-223-3p in the inflamed pulp tissue regulates odontoblast differentiation and regeneration. Microarray analysis was used to identify differences in miRNA expression patterns between healthy and inflamed pulp tissue. The results were validated using quantitative real-time PCR. To determine the effect of miR-223-3p on odontoblast differentiation, miR-223-3p was overexpressed in human dental pulp stem cells (DPSCs), which were cultured in mineralizing induction medium (to induce odontoblast differentiation). To identify the target genes of miR-223-3p, an SABiosciences Human Osteogenesis PCR Array, combined with bioinformatics, was used. Furthermore, a dual-luciferase reporter assay and a small interfering RNA (siRNA) experiment were used to confirm the relationship between miR-223-3p and its target gene. Statistical analysis was performed using the Student's t-test or one-way analysis of variance (anova); P<0.05 was considered statistically significant. Seventy-nine miRNAs were significantly differentially expressed (fold change >2.0; P<0.05) between the two tissues. In particular, miR-223-3p was markedly upregulated in inflamed dental pulp. Overexpression of miR-223-3p in DPSCs significantly increased the protein levels of dentine sialophosphoprotein (DSPP) and dentine matrix protein 1 (DMP-1) (P<0.05). However, the SMAD family member 3 (SMAD3) protein level was significantly lower than in control DPSCs (P<0.05). Bioinformatics and the dual-luciferase assay reporter assay indicated that Smad3 was a potential target of miR-223-3p. Knockdown of Smad3 in DPSCs subjected to mineralization induction resulted in detection of DSPP and DMP-1 earlier than in control DPSCs, and it increased the protein level of alkaline phosphatase (ALP), thereby promoting odontoblast differentiation. miR-223-3p is implicated in the regulation of odontoblast differentiation, which may be involved in the process of pulpitis repair.

Effects of Er:YAG and Diode Laser Irradiation on Dental Pulp Cells and Tissues.

Vital pulp therapy (VPT) is to preserve the nerve and maintain healthy dental pulp tissue. Laser irradiation (LI) is beneficial for VPT. Understanding how LI affects dental pulp cells and tissues is necessary to elucidate the mechanism of reparative dentin and dentin regeneration. Here, we show how Er:YAG-LI and diode-LI modulated cell proliferation, apoptosis, gene expression, protease activation, and mineralization induction in dental pulp cells and tissues using cell culture, immunohistochemical, genetic, and protein analysis techniques. Both LIs promoted proliferation in porcine dental pulp-derived cell lines (PPU-7), although the cell growth rate between the LIs was different. In addition to proliferation, both LIs also caused apoptosis; however, the apoptotic index for Er:YAG-LI was higher than that for diode-LI. The mRNA level of odontoblastic gene markers—two dentin sialophosphoprotein splicing variants and matrix metalloprotease (MMP)20 were enhanced by diode-LI, whereas MMP2 was increased by Er:YAG-LI. Both LIs enhanced alkaline phosphatase activity, suggesting that they may help induce PPU-7 differentiation into odontoblast-like cells. In terms of mineralization induction, the LIs were not significantly different, although their cell reactivity was likely different. Both LIs activated four MMPs in porcine dental pulp tissues. We helped elucidate how reparative dentin is formed during laser treatments.

Levels of oxidative stress biomarkers and bone resorption regulators in apical periodontitis lesions infected by Epstein-Barr virus.

To investigate whether apical periodontitis lesions infected by Epstein-Barr virus (EBV) exhibit higher levels of oxidative stress biomarkers [8-hydroxydeoxyguanosine (8-OHdG) and oxidized glutathione (GSSG)] and bone resorption regulators [receptor activator of nuclear factor (NF-κB) ligand (RANKL) and osteoprotegerin (OPG)] compared to EBV-negative periapical lesions and healthy pulp tissues. The experimental group consisted of 30 EBV-positive and 30 EBV-negative periapical lesions collected in conjunction with apicoectomy. The pulp tissues of 20 impacted third molars were used as healthy controls. The qualitative and quantitative analysis of EBV was performed by nested and real-time polymerase chain reaction (PCR), respectively. The levels of RANKL and OPG were analysed by reverse transcriptase real-time PCR. The levels of 8-OHdG and GSSG were determined by enzyme-linked immunosorbent assay (ELISA). Mann-Whitney U-test and Spearman's correlation were used for statistical analysis. The levels of RANKL, OPG, 8-OHdG and GSSG were significantly higher in apical periodontitis lesions compared to healthy pulp controls (P=0.001, P<0.001, P<0.001 and P<0.05, respectively). RANKL and OPG mRNA expression was significantly higher in EBV-positive compared to EBV-negative periapical lesions (P<0.05). There was no significant correlation between EBV copy numbers and levels of RANKL, OPG, 8OH-dG and GSSG in apical periodontitis. Levels of bone resorption regulators and oxidative stress biomarkers were increased in apical periodontitis compared to healthy pulp tissues. EBV-positive periapical lesions exhibited higher levels of RANKL and OPG compared to EBV-negative periapical lesions. EBV may contribute to progression of apical periodontitis via enhanced production of bone resorption regulators.

Two-stage technique in third molar autotransplantation: case report

ABSTRACT Tooth autotransplantation is an option for treating patients presenting early tooth loss. The teeth most commonly removed are the first molars, and their absence could lead to several oral health problems in patients. This transplant technique consists of the transposition and repositioning of a tooth from one area to another, in the same patient. Dental implants have high success rates, but tooth autotransplantation is less complex and less expensive, because the patient’s own tooth is used. In the context of dental rehabilitation, tooth transplantation is focused on re-establishing masticatory function and esthetics. Success rates are variable, but in the majority of cases they exceed 80%. This article aims to report the case of a patient who underwent autotransplantation of the maxillary left third molar into the maxillary right first molar position. The surgical procedure was performed on two stages. After a 3-year clinical and radiographic follow-up period, a satisfactory result was achieved with the transplanted tooth presenting a healthy pulp and periodontal tissues, reestablishing the patient’s function and esthetics.

The roles of autophagy and hypoxia in human inflammatory periapical lesions.

To determine the expressions of hypoxia-related [hypoxia-inducible transcription factors (HIF)-1α, BCL2/adenovirus E1B 19kDa protein-interacting protein 3 (BNIP3) and phospho-adenosine monophosphate activated protein kinase (pAMPK)] and autophagy-related [microtubule-associated protein 1 light chain 3 (LC3), beclin-1 (BECN-1), autophagy-related gene (Atg)5-12, and p62] proteins in human inflammatory periapical lesions. Fifteen samples of radicular cysts (RCs) and 21 periapical granulomas (PGs), combined with 17 healthy dental pulp tissues, were examined. Enzyme-linked immunosorbent assay (ELISA) was used to detect interleukin (IL)-1β cytokine; immunohistochemical (IHC) and Western blot (WB) analyses were employed to examine autophagy-related and hypoxia-related proteins. Transmission electron microscopy (TEM) was used to explore the ultrastructural morphology of autophagy in periapical lesions. Nonparametric Kruskal-Wallis tests and Mann-Whitney U-tests were used for statistical analyses. ELISA revealed a significantly higher (P< 0.001) IL-1β expression in periapical lesions than in normal pulp tissue. Immunoscores of IHC expressions of pAMPK, HIF-1α, BNIP3, BECN-1 and Atg5-12 proteins in periapical lesions were significantly higher (P<0.001) (except BECN-1) than those in normal pulp tissue. The results of IHC studies were largely compatible with those of WB analyses, where significantly higher (P<0.05) expressions of hypoxia-related and autophagy-related proteins (except BECN-1, p62 and LC3II in WB analyses) in periapical lesions were noted as compared to normal pulp tissue. Upon TEM, ultrastructural double-membrane autophagosomes and autolysosomes were observed in PGs and RCs. Autophagy associated with hypoxia may play a potential causative role in the development and maintenance of inflamed periapical lesions.

Detection and Assessment of Interleukin 6 in Irreversible Pulp Inflamation

The study aimed to assess the number, localization and distribution of interleukin 6 (IL-6) positive cells in healthy pulp, acute and chronic pulpitis. The study group included 48 patients aged between 18-72, treated in University of Medicine and Pharmacy Grigore T. Popa Iasi, Romania. The pulpectomy was performed on 42 patients diagnosed with acute and chronic pulpitis. The other 6 patients, without signs of dental caries or periodontal disease, were submitted to extractions of teeth for orthodontic purposes, with pulpectomy performed before extraction. The pulp samples were examined with optic microscope. The detection and assessment of IL-6 were performed using immunohistochemical technique. Data were statistically analysed using non-parametric tests. According to morphopathological criteria, 42.85% were classified as acute pulpitis and 57.14% as chronic pulpitis. The pulp samples in control group were not associated with IL-6 positive cells. The analysis of all samples with acute and chronic pulpitis identified 73.80% samples with IL-6 and 26.20% associated with the absence of IL-6. The highest frequency of IL-6 positive cells was recorded in rich-cell zone of crown dental pulp. The systemic distribution of IL-6 positive cells was mostly diffused without well-defined orientation. IL-6 release in acute and chronic pulpitis is significantly higher comparing with healthy pulp tissue.

Biological Markers for Pulpal Inflammation: A Systematic Review.

Background and ObjectivePulpitis is mainly caused by an opportunistic infection of the pulp space with commensal oral microorganisms. Depending on the state of inflammation, different treatment regimes are currently advocated. Predictable vital pulp therapy depends on accurate determination of the pulpal status that will allow repair to occur. The role of several players of the host response in pulpitis is well documented: cytokines, proteases, inflammatory mediators, growth factors, antimicrobial peptides and others contribute to pulpal defense mechanisms; these factors may serve as biomarkers that indicate the status of the pulp. Therefore, the aim of this systematic review was to evaluate the presence of biomarkers in pulpitis.MethodsThe electronic databases of MEDLINE, EMBASE, Scopus and other sources were searched for English and non-English articles published through February 2015. Two independent reviewers extracted information regarding study design, tissue or analyte used, outcome measures, results and conclusions for each article. The quality of the included studies was assessed using a modification of the Newcastle-Ottawa-Scale.Results and ConclusionsFrom the initial 847 publications evaluated, a total of 57 articles were included in this review. In general, irreversible pulpitis was associated with different expression of various biomarkers compared to normal controls. These biomarkers were significantly expressed not only in pulp tissue, but also in gingival crevicular fluid that can be collected non-invasively, and in dentin fluid that can be analyzed without extirpating the entire pulpal tissue. Such data may then be used to accurately differentiate diseased from healthy pulp tissue. The interplay of pulpal biomarkers and their potential use for a more accurate and biologically based diagnostic tool in endodontics is envisaged.

LECZENIE BIOLOGICZNE MIAZGI ZĘBÓW STAŁYCH

The vitality of dental pulp is essential for long-term tooth survival. The aim of vital pulp therapy is to preserve vital, healthy pulp tissue. This therapy's foundation is the elimination of bacteria from the dentin-pulp complex. The treatment option depends on the cause and extent of mineralised tooth tissue destruction. The outcome of such treatment is determined by accurate assessment of the pulp's status and the dentist's ability to predict the success of the therapy. The aim of this review is to facilitate the dentist in making a proper decision referring to vital pulp therapy in permanent teeth, and to provide an overview of new approaches in such treatment.

Expression of KLF5 in odontoblastic differentiation of dental pulp cells during invitro odontoblastic induction and invivo dental repair.

To identify whether Krüppel-like factor 5 (KLF5) was involved in odontoblastic differentiation during reparative dentine formation. Human Dental pulp cells (DPCs) were isolated from healthy human dental pulp tissue and induced for odontoblastic differentiation. Alizarin Red staining, alkaline phosphatase (ALPase) activity, quantitative real-time PCR and Western Blot were performed to evaluate invitro odontoblastic differentiation. The expression profile of KLF5 during the invitro odontoblastic differentiation was determined by quantitative real-time PCR and Western Blot. Knock-down of KLF5 by lentivirus-mediated shRNA was performed to determine the function of KLF5 in odontoblastic differentiation. After direct pulp capping with MTA, the maxillary first molar segments dissected from male Wistar rats were prepared forhistology analysis and immunohistochemistry staining. Odontoblastic differentiation was confirmed by significantly increased alkaline phosphatase (ALP; P=0.004) activity and upregulated odontoblastic differentiation-related genes including dentine sialophosphoprotein (DSPP; P=0.004) and dentine matrix protein-1 (DMP-1; P=<0.001). The expression of KLF5 was significantly upregulated during odontoblastic differentiation of invitro cultured DPCs (P=0.0002). KLF5 knock-down impaired odontoblastic differentiation. After direct pulp capping, dentine bridge-like calcified tissues were formed under the perforation sites. KLF5 was expressed in odontoblast-like cells and DPCs beneath the perforation sites during reparative dentine formation. KLF5 might be involved in the process of odontoblastic differentiation during reparative dentine formation.

Catalase activity in healthy and inflamed pulp tissues of permanent teeth in young people.

To evaluate catalase (CAT, EC 1.11.1.6) activity in healthy and inflamed dental pulp of young patient's teeth and to investigate if an active defense system oxidizing agents is present as a response to bacterial invasion. Twenty young patients between 15 and 25 ages, who were diagnosed to be healthy, were the source of the pulp tissue. The situation of the dental pulps was evaluated using clinical and radiographic assessments. The patients were divided two groups from healthy, and inflamed pulp tissues were obtained; each participant provided one pulp tissue specimens. The specimens were collected during endodontic treatment or by longitudinally grooving and splitting the teeth (if extracted). Catalase activity was determined through spectrophotometric methods and an independent sample t-test assessed the significance of differences between the groups. There was statistically a difference between healthy pulp tissue and inflamed pulp tissue (P < 0.005, independent sample t-test). The catalase activity of healthy group was significantly lower than inflamed pulp groups. The present study has shown that a significant increase in catalase activity is determined in inflamed dental pulps, which is due to pulpitis in comparison to healthy dental pulp.

Dental tissue engineering: Future of regenerative dentistry

Dental caries, periodontitis, tooth loss, and bone resorption are considered prevalent health problems that have a direct effect on the quality of life. Unlike other tissues in the body, dental tissues are unique in their development, function, and even in their maintenance throughout life. Tissue engineering is a novel and exciting field that aims to recreate functionally healthy tissues and organs to replace diseased, dying, or dead tissues. To accomplish pulpal regeneration after tooth injury is not easy because the infected pulp requires either root canal therapy or tooth extraction. Currently, an ideal form of therapy might consist of regenerative approaches in which diseased or necrotic pulp tissues are removed and replaced with healthy pulp tissue to revitalize teeth. This article describes various components of tissue engineering, its applications, challenges, and future directions that can be integrated into clinical dental therapies to restore and regenerate oral tissues which will allow regenerative dentistry to become a reality in near future.

Human Cytomegalovirus and Epstein-Barr Virus Genotypes in Apical Periodontitis Lesions

IntroductionDifferent genotypes of human cytomegalovirus (HCMV) and Epstein-Barr virus (EBV) possess specific pathogenic abilities because of various interactions with the host's immune system and differences in cell tropism. The aim of this study was to determine the distribution of HCMV and EBV genotypes in apical periodontitis lesions in relation to their clinical and histopathologic features. MethodsOne hundred samples of apical periodontitis lesions and 25 control samples (healthy pulp tissue) were collected. The presence of HCMV glycoprotein B (gB) and EBV nuclear antigen-2 genotypes was analyzed by nested polymerase chain reaction and restriction fragment length polymorphisms analysis. ResultsEBV and HCMV were detected in apical periodontitis lesions at significantly higher frequencies than in healthy pulp controls (P = .020 and P = .020, respectively). HCMV gB type II was significantly more frequent compared with gB type I in the examined groups (P = .036). No HCMV gB type III or IV products were found. In both periapical lesions and controls, EBV-1 occurred more often compared with EBV-2 (P = .001). Dual EBV and HCMV coinfection was more frequently detected in large-size periapical lesions (P = .038). ConclusionsBoth HCMV and EBV are associated with inflammatory processes of periapical bone destruction. HCMV gB type II and EBV-1 are the most prevalent genotypes in apical periodontitis lesions.

The Effects of Smoking on the Osmotic Pressure of Human Dental Pulp Tissue

Objective: We aimed to investigate the effect of smoking on the osmotic pressure (OP) of human dental pulp tissue. Materials and Methods: Sixty male dental patients (smokers and nonsmokers) scheduled for root canal treatment for prosthodontics were included in the study. Fifteen patients (1 premolar tooth/patient) were allocated to each of the following groups according to their smoking habits, i.e. group 1: ≤10 cigarettes/day, group 2: 11-20 cigarettes/day, group 3: >20 cigarettes/day and group 4: nonsmoking controls. Apical pulp tissues were removed via coronal access. Pulp tissue supernatants were obtained to measure the pulpal OP by means of a semimicro digital osmometer. One-way analysis of variance and the post hoc Duncan test were used to analyze the differences in OP between groups. Regression analysis was used to determine the relationship between the number of cigarettes smoked daily and the pulpal OP. Results: The mean (± SD) OP value decreased as cigarette consumption increased: group 4 (268.00 ± 10.09 mosm/kg) > group 1 (259.20 ± 7.16 mosm/kg) > group 2 (248.90 ± 2.23 mosm/kg) > group 3 (239.90 ± 7.40 mosm/kg). The OP differed significantly between groups (p < 0.01), and a significant negative correlation was found between cigarette consumption and pulpal OP (r = -0.809, p < 0.01). Conclusion: In this study, the OP decreased as the number of cigarettes smoked increased. In clinical examination, there may be misdiagnosis of pulpal conditions in smokers (even in healthy pulp tissue) due to the effect of altered OP on pulpal tissue reactions.

A review on vital pulp therapy in primary teeth.

Maintaining deciduous teeth in function until their natural exfoliation is absolutely necessary. Vital pulp therapy (VPT) is a way of saving deciduous teeth. The most important factors in success of VPT are the early diagnosis of pulp and periradicular status, preservation of the pulp vitality and proper vascularization of the pulp. Development of new biomaterials with suitable biocompatibility and seal has changed the attitudes towards preserving the reversible pulp in cariously exposed teeth. Before exposure and irreversible involvement of the pulp, indirect pulp capping (IPC) is the treatment of choice, but after the spread of inflammation within the pulp chamber and establishment of irreversible pulpitis, removal of inflamed pulp tissue is recommended. In this review, new concepts in preservation of the healthy pulp tissue in deciduous teeth and induction of the reparative dentin formation with new biomaterials instead of devitalization and the consequent destruction of vital tissues are discussed.

Catechins inhibit vascular endothelial growth factor production and cyclooxygenase-2 expression in human dental pulp cells.

To investigate the effect of catechins on vascular endothelial growth factor (VEGF) production and cyclooxygenase-2 (COX-2) expression in human dental pulp cells (HDPC) stimulated with bacteria-derived factors or pro-inflammatory cytokines. Morphologically fibroblastic cells established from explant cultures of healthy human dental pulp tissues were used as HDPC. HDPC pre-treated with catechins, epigallocatechin-3-gallate (EGCG) or epicatechin gallate (ECG), were exposed to lipopolysaccharide (LPS), peptidoglycan (PG), interlukin-1β (IL-1β) or tumour necrosis factor-α (TNF-α). VEGF production was examined by enzyme-linked immunosorbent assay, and COX-2 expression was assessed by immunoblot. EGCG and ECG significantly reduced LPS- or PG-mediated VEGF production in the HDPC in a dose-dependent manner. EGCG also prevented IL-1β-mediated VEGF production. Although TNF-α did not enhance VEGF production in the dental pulp cells, treatment of 20μgmL(-1) of EGCG decreased the level of VEGF. In addition, the catechins attenuated COX-2 expression induced by LPS and IL-1β. The up-regulated VEGF and COX-2 expressions in the HDPC stimulated with these bacteria-derived factors or IL-1β were diminished by the treatment of EGCG and ECG. These findings suggest that the catechins may be beneficial as an anti-inflammatory tool of the treatment for pulpal inflammation.

Modulatory Roles of Interferon-γ through Indoleamine 2, 3-dioxygenase Induction in Innate Immune Response of Dental Pulp Cells

IntroductionMarked infiltration of inflammatory cells such as activated T cells producing interferon-γ (IFN-γ) is observed in severe pulpitis. However, the roles of IFN-γ in the innate immune response of dental pulp have not been reported. Indoleamine 2, 3-dioxygenase (IDO) is a regulator of immune responses, and the IDO expression is induced by IFN-γ in many cells whose expression in dental pulp is unknown. The purpose of this study was to determine the role of IFN-γ in the immune response through microbial pattern recognition receptors (PRRs) such as Toll-like receptors or nucleotide-binding oligomerization domain–like receptors on the production of proinflammatory cytokines such as CXCL10 and interleukin (IL)-6 and the expression of IDO in cultured human dental pulp cells (HDPCs). MethodsHDPCs were established from explant cultures of healthy pulp tissues. CXCL10 and IL-6 production was determined using enzyme-linked immunosorbent assay. Confirmation of IDO localization in dental pulp tissues was examined using immunohistochemistry. IDO expression in HDPCs was analyzed by immunoblot. ResultsIFN-γ significantly up-regulated CXCL10 and IL-6 production in the HDPCs stimulated with ligands for PRRs in a concentration-dependent manner. The expression of IDO was detected in inflamed pulp tissue. In addition, IFN-γ in combination with the PRR ligands enhanced IDO expression in HDPCs compared with IFN-γ alone. Moreover, CXCL10 production in IFN-γ–stimulated HDPCs was inhibited by an IDO inhibitor. ConclusionsThis study showed the synergistic effects by IFN-γ on cytokine production and IDO expression in HDPCs, suggesting that IFN-γ may modulate the innate immune response of dental pulp.

An overview of Regenerative Pulp Therapy in Children

A remarkable shift in paradigm is seen with the treatment of pulp therapy procedures from conventional to regenerative ones since 10-15 years in the field of pediatric endodontics. Though conventional treatment techniques provide excellent success for many conditions, an ideal form of therapy might consist of regenerative approaches in which diseased or necrotic pulp tissues are removed and replaced with healthy pulp tissue. Regenerative pulp procedure is the creation and delivery of tissues to replace diseased, missing, and traumatized pulp. This review provides an overview on the biology of dental pulp tissue and regenerative pulp procedures like stem cells therapy, scaffolds, injectable delivery systems, pulp implantation, gene therapy, revascularization and tissue engineering including their goals and describe possible techniques that will allow this to become a reality.

Regenerative endodontics: a road less travelled.

Although traditional approaches like root canal therapy and apexification procedures have been successful in treating diseased or infected root canals, but these modalities fail to re-establish healthy pulp tissue in treated teeth. Regeneration-based approaches aims to offer high levels of success by replacing diseased or necrotic pulp tissues with healthy pulp tissue to revitalize teeth. The applications of regenerative approaches in dental clinics have potential to dramatically improve patients' quality of life. This review article offers a detailed overview of present regenerative endodontic approaches aiming to revitalize teeth and also outlines the problems to be dealt before this emerging field contributes to clinical treatment protocols. It conjointly covers the basic trilogy elements of tissue engineering.