Regenerative Endodontics: Saving Teeth with Stem Cells

Stem cells play a demanding  role in development and in tissue regeneration. The dental pulp contains a small sub-population of stem cells that are involved in the response of the pulp to caries progression.  Odontoblasts replaced by stem cells that have undergone cell death as a consequence of the cariogenic challenge. Stem cells also secrete factors that have the potential to enhance pulp vascularization and provide the oxygen and nutrients required for the dentinogenic response that is typically observed in teeth with deep caries. Angiogenic factors, contribute to the demise of the pulp by enhancing vascular permeability and interstitial pressure required for dentin regeneration. Recent studies focused on the biology of dental pulp stem cells revealed that the multipotency and angiogenic capacity of these cells could be exploited therapeutically in dental pulp tissue engineering.

                                

The regenerative potential of adult stem cells is directed toward achieving the following:

·         Regeneration of damaged coronal dentin and pulp

·         Periodontal regeneration

·         Repair and replacement of bone in craniofacial defects

·         Whole tooth regeneration.

Stem cells in endodontic therapy

v  Stem cells in the dental pulp: The fraction of multipotent stem cells in the dental pulp is small and the location of these cells is not clearly known. SHED having higher proliferative rate than DPSC due to the presence of large amount of alkaline phosphatase activity and osteocalcin production.

v  Stem cells and caries-induced dentinogenesis: The dental pulp is a highly vascularized and innervated connective tissue responsible for maintaining the tooth vitality and able to respond to injuries. The odontoblasts, ecto-mesenchymal derived cells, are the first cells to respond to the injury caused by bacterial invasion during caries progression. A dentin matrix secreted by primary odontoblast that mineralizes as reactionary dentin in response to shallow caries.

v  Stem cells and pulp angiogenesis: Vascular endothelial growth factor (VEGF) is a potent inducer of endothelial cell differentiation and survival, and it is the most effective angiogenic factor. VEGF also plays a critical role on the control of vascular permeability during physiological and pathological events.

Application of stem cells in regenerative Endodontics:

Ø  Implantation

Ø  Pulp revascularization

Ø  Whole tooth regeneration

Stem cells are most important for the physiology of the dental pulp and for the response of this tissue to injury. These cells may become the primary strategy for the revitalization of necrotic immature permanent teeth. Such discoveries have the potential to fundamentally change the paradigms of conservative vital pulp and root canal therapy, and perhaps allow for the treatment in the future of conditions that are presently untreatable in Dentistry.