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Tissue Engineering
REGENERATIVE
ENDODONTICS
Table 1: 4
RECENT PROGRESS ON
DENTAL STEM CELL
RESEARCH
To date, four types of human dental stem
cells have been isolated and characterized:
Stem cell biology has become an important a) Dental pulp stem cells (DPSCs), b) Stem
field for the understanding of tissue cells from exfoliated deciduous teeth
regeneration, although much knowledge in (SHED), c) Stem cells from apical papilla
this area has been from the in vitro studies. (SCAP), and d) Periodontal ligament stem
In general, stem cells are defined by having cells (PDLSCs). Among them, all except
two major properties: SHED are from permanent teeth. DPSCs
1. They are capable of self-renewal and SHED are from the pulp and SCAP is
2. When they divide, some daughter from the pulp precursor tissue, apical
cells give rise to cells that eventually papilla. These ex vivo expanded cells can
become differentiated cells. differentiate into odontoblast-like cells and
produce dentin-like tissue in both in vitro space with triple antibiotic paste or
and in vivo study systems. 38 calcium hydroxide and increased
number of clinical sessions are other
When grown in cultures and induced under drawbacks.
specific conditions, DPSCs and SHED can 3. Poor root development: in some
differentiate into neuronal and adipogenic studies, the outcome of regenerative
cells in addition to dentinogenic cells.39,40 endodontic treatments of necrotic
SCAP together with PDLSCs are able to immature teeth was lower than ideal,
form a root-like structure when seeded onto including absence of increase in root
the hydroxyapatite-based scaffold and length, absence of increase in root
implanted in pig jaws. These dental stem wall thickness, or lack of formation
cells may potentially be utilized for dental of tooth apex. Formation of hard-
tissue regeneration, i.e., pulp/dentin and tissue barrier inside the canal
periodontal ligament. 41-43 between the coronal MTA plug and
The indentification of these dental stem cells the root apex is another reported
provided us a better understanding of the unfavorable outcome.
biology of pulp and periodontal ligament 4. Root canal calcification/obliteration:
tissues and their regenerative potential after in a case series study by Chen et al,
tissue damage. For example, the observation complete root canal
of severely infected pulp in immature teeth calcification/obliteration happened in
capable of undergoing complete root 4 of 20 cases within an average
maturation after proper disinfection follow-up time of 16 months.
procedures may be explained by the 5. Insufficient bleeding: some authors
possibility that SCAP somehow survive have reported failure to induce
from infection.44,45 bleeding. A recent study revealed
that mesenchymal stem cells are
delivered into root canal space after
DRAWBACKS OF bleeding induction in human teeth, a
REGENERATIVE ENDODONTIC phenomenon that did not happen in
TREATMENTS: the absence of blood clot inside the
disinfected root canal space. In
addition, it is assumed that the blood
The most common drawbacks observed are: clot formed inside the root canal
space after disinfection contains
1. Discoloration: due to use of
platelet-derived growth factors that
minocycline in the triple antibiotic
serves as a protein-rich scaffold.
paste, when minocycline comes in
contact with coronal dentinal walls
during treatment procedure.
2. Treatment period: the required time
for disinfection of the root canal