Analysis of Pulpal Reactions to Restorative Procedures, Materials, Pulp Capping, and Future Therapies

Abstract

Every year, despite the effectiveness of preventive dentistry and dental health care, 290 million fillings are placed each year in the United States; two-thirds of these involve the replacement of failed restorations. Improvements in the success of restorative treatments may be possible if caries management strategies, selection of restorative materials, and their proper use to avoid post-operative complications were investigated from a biological perspective. Consequently, this review will examine pulp injury and healing reactions to different restorative variables. The application of tissue engineering approaches to restorative dentistry will require the transplantation, replacement, or regeneration of cells, and/or stimulation of mineralized tissue formation. This might solve major dental problems, by remineralizing caries lesions, vaccinating against caries and oral diseases, and restoring injured or replacing lost teeth. However, until these therapies can be introduced clinically, the avoidance of post-operative complications with conventional therapies requires attention to numerous aspects of treatment highlighted in this review.

The thickness of odontoblast-like cell layer after induced by propolis extract and calcium hydroxide

“…Progenitor cells of new odontoblast-like cells assumed as cells from the subodontoblast layer or pulp fibroblasts. 17 In the de-differentiation process, the odontoblast cell is not turned young and pluripotent, but still unipotent and just divide from the cell with the same structure and function with the related cell. There are two mechanisms of reparative dentinogenesis.…”

The role of transforming growth factor beta in tertiary dentinogenesis

“…37 During reactionary dentinogenesis (Figure 1), solubilized TGF-βs may be able to diffuse to the odontoblasts and pulpal cells localized beneath the damaged region and signal the up-regulation of these cells' secretory activity. 27 This upregulation of surviving odontoblasts will lead to focal secretion of new matrices at the pulp-dentin interface. 2 Quite a few studies have demonstrated that TGF-β stimulates the synthesis of extracellular matrices and also initiates odontoblast cytodifferentiation in vitro 38 and in vivo.…”

“…Consequently, these primary cells must be replaced by a new generation of odontoblast-like cells. 27 Therefore, the formation of reparative dentin is a complex sequence of biological process, which is dependent on multiple factors, including the presence of responsive progenitor cells as well as the appropriate inductive molecular signals for induction of proliferation, migration, and differentiation of the new generation of odontoblast-like cells. The derivation of the progenitor cells for these odontoblast-like cells remains unclear although they may be variable.…”

Casting the runes

“…This is still a matter of controversy and a few reports still consider that the pulp reaction to adhesive systems is generally minimal (Murray et al 2002, Murray et al 2003. Improvements of resin-containing materials and bonding agents and techniques have reduced the significance of shrinkage and gaps at the interface, which may be less than 1µm (Hashimoto et al 2004).…”