Biomimetic Microenvironments for Regenerative Endodontics

Abstract

Regenerative endodontics has been proposed to replace damaged and underdeveloped tooth structures with normal pulp-dentin tissue by providing a natural extracellular matrix (ECM) mimicking environment; stem cells, signaling molecules, and scaffolds. In addition, clinical success of the regenerative endodontic treatments can be evidenced by absence of signs and symptoms; no bony pathology, a disinfected pulp, and the maturation of root dentin in length and thickness. In spite of the various approaches of regenerative endodontics, there are several major challenges that remain to be improved: a) the endodontic root canal is a strong harbor of the endodontic bacterial biofilm and the fundamental etiologic factors of recurrent endodontic diseases, (b) tooth discolorations are caused by antibiotics and filling materials, (c) cervical root fractures are caused by endodontic medicaments, (d) pulp tissue is not vascularized nor innervated, and (e) the dentin matrix is not developed with adequate root thickness and length. Generally, current clinical protocols and recent studies have shown a limited success of the pulp-dentin tissue regeneration. Throughout the various approaches, the construction of biomimetic microenvironments of pulp-dentin tissue is a key concept of the tissue engineering based regenerative endodontics. The biomimetic microenvironments are composed of a synthetic nano-scaled polymeric fiber structure that mimics native pulp ECM and functions as a scaffold of the pulp-dentin tissue complex. They will provide a framework of the pulp ECM, can deliver selective bioactive molecules, and may recruit pluripotent stem cells from the vicinity of the pulp apex. The polymeric nanofibers are produced by methods of self-assembly, electrospinning, and phase separation. In order to be applied to biomedical use, the polymeric nanofibers require biocompatibility, stability, and biodegradability. Therefore, this review focuses on the development and application of the biomimetic microenvironments of pulp-dentin tissue among the current regenerative endodontics.

What is the best long-term treatment modality for immature permanent teeth with pulp necrosis and apical periodontitis?

“…J of endod, Vol 40; Issue 3; p 333–8 Too small study size ( n = 13). Too short follow-up (18 months) Kaushik et al ( 2016 ) Biomimetic microenvironments for regenerative endodontics. Biomaterials research; Vol 20; Issue 0; p 14 Not an intervention study Kumar et al ( 2014 ) Management of 2 teeth diagnosed with dens invaginatus with regenerative endodontics and apexification in the same patient: a case report and review.…”

Effects of concentrated growth factor on proliferation, migration, and differentiation of human dental pulp stem cells in vitro

“…Biomimetic scaffold is another key element of tissue engineering, which mimics the ECM of normal pulp. 8 Platelet concentrates are attractive autologous scaffolds suitable for regenerative medicine as its fiber architecture and rich growth factors. 9,10 Concentrated growth factor (CGF) is the third generation of autologous plasma extract prepared by a special centrifugal program.…”

Local Drug Delivery Systems for Vital Pulp Therapy: A New Hope

“…Haugen et al claim that nanofibers can be considered for pulp tissue engineering and regenerative endodontics due to their potential use for dental tissues [ 56 ]. Related studies have reported that fibers can act biomimetically to create microenvironments and behave as an appropriate scaffold for the pulp-dentine complex, mimicking the native pulp and function [ 57 ]. Fibers and nanofibrous constructs can be regarded as an alternative approach for intracanal disinfection [ 58 ], since they appear to operate/serve as a drug delivery vehicle for a number of antibiotics, revealing analogous antibacterial effects to antibiotic pastes, however, with minimum concentration of the drugs used [ 59 ].…”