Dental Pulpal Tissue Regeneration, Pulpal Vitality Testing, and Healing of Apical Lesions Following Stem Cell Transplant: A Systematic Review and Meta-Analysis

Abstract

To analyze data obtained from animal and human studies using stem cells. Material and Methods: Medical Literature Analysis and Retrieval System Online (MEDLINE), PubMed, Cochrane Library, Embase, Information Sciences Institute (ISI), as well as Google Scholar were utilized and searched as available electronic databases to perform a systematic literature review of articles published between 2010 and 2019. The Endnote X9 for Windows was also employed to manage electronic titles and abstracts of the selected studies. Searches were conducted using keywords of "pulpal OR pulpal tissue OR pulpal vitality", "regeneration", "apical healing", "stem cells OR progenitor cells", and "mediated pulpal tissue". Consequently, 189 titles and abstracts endowed with potential relevance were discovered based on searches into manual and electronic sources. Ultimately, a total of six articles met the inclusion criteria in the present systematic review and meta-analysis. Results: Out of the six articles identified and selected, five studies were categorized as animal experiments and one article was nominated as a human clinical trial. The greatest bias risks were accordingly observed in the majority of animal examinations, but articles related to humans revealed decreased risks of bias, while the human clinical trial showed some concerns. Conclusion: Promising parameters testing functional pulp regeneration could be represented through stem cell transplants.

Regenerative Endodontic Procedures: An Umbrella Review

“…Overall, twenty SRs without meta-analysis [ 4 , 5 , 6 , 7 , 8 , 9 , 12 , 13 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ] and nine SRs with meta-analysis were included [ 10 , 11 , 14 , 15 , 34 , 35 , 36 , 37 , 38 ] ( Table 1 ). Multiple sub-topics were investigated, such as REP protocols and outcomes [ 4 , 5 , 7 , 9 , 11 , 12 , 13 , 14 , 15 , 22 , 27 , 29 , 36 ], solely REP protocols [ 30 , 37 ], solely outcomes [ 6 , 8 , 10 , 23 , 28 , 38 ], and stem cells on REP [ 24 , 25 , ...…”

“…Six SRs failed to report a defined timeframe [ 6 , 9 , 14 , 26 , 28 , 31 ]. Seven SRs did not report language restrictions [ 11 , 22 , 23 , 31 , 33 , 35 , 38 ], twelve applied a language restriction as an inclusion criterion [ 8 , 10 , 12 , 13 , 14 , 15 , 24 , 26 , 28 , 29 , 32 , 36 , 37 ], and the remaining had no language restriction [ 4 , 5 , 6 , 7 , 9 , 25 , 27 , 30 , 34 ].…”

“…None of the included SRs fully satisfied the AMSTAR2 Criteria ( Table 2 ). Overall, two were rated as “high quality” [ 15 , 37 ], fourteen as “moderate quality” [ 5 , 7 , 9 , 10 , 11 , 13 , 25 , 27 , 28 , 29 , 31 , 34 , 35 , 36 ], three as “low quality” [ 6 , 8 , 12 ], and ten were assessed as “critically low quality” [ 4 , 14 , 22 , 23 , 24 , 26 , 30 , 32 , 33 , 38 ]. Major concerns regarding methodological quality were found on the: (a) lack of information regarding the type of included studies; (b) the literature search strategy; (c) the absence of a list of excluded studies with justification; and (d) declaration of funding sources.…”

“…Of the twenty-nine SRs analyzed, eight focused on histological assessment and the role of stem cells in REP [ 24 , 25 , 26 , 31 , 32 , 33 , 34 , 35 ], two of them with a meta-analysis performed [ 34 , 35 ].…”

“…Regarding the role of stem cells, five SRs [ 25 , 26 , 33 , 34 , 35 ] included animal teeth, mostly dog teeth, in their analysis, and only one focused solely on human teeth, specifically, the impacted 3rd molar [ 31 ].…”