Pulp Vascularization during Tooth Development, Regeneration, and Therapy

Abstract

The pulp is a highly vascularized tissue situated in an inextensible environment surrounded by rigid dentin walls, with the apical foramina being the only access. The pulp vascular system is not only responsible for nutrient supply and waste removal but also contributes actively to the pulp inflammatory response and subsequent regeneration. This review discusses the underlying mechanisms of pulp vascularization during tooth development, regeneration, and therapeutic procedures, such as tissue engineering and tooth transplantation. Whereas the pulp vascular system is established by vasculogenesis during embryonic development, sprouting angiogenesis is the predominant process during regeneration and therapeutic processes. Hypoxia can be considered a common driving force. Dental pulp cells under hypoxic stress release proangiogenic factors, with vascular endothelial growth factor being one of the most potent. The benefit of exogenous vascular endothelial growth factor application in tissue engineering has been well demonstrated. Interestingly, dental pulp stem cells have an important role in pulp revascularization. Indeed, recent studies show that dental pulp stem cell secretome possesses angiogenic potential that actively contributes to the angiogenic process by guiding endothelial cells and even by differentiating themselves into the endothelial lineage. Although considerable insight has been obtained in the processes underlying pulp vascularization, many questions remain relating to the signaling pathways, timing, and influence of various stress conditions.

External cervical resorption‐part 1: histopathology, distribution and presentation

“…(e) Transaxial view of tooth 36 with ECR, note the reparative nature of the ECR.] External cervical resorption-part 1 Patel et algranulation tissue accompanying ECR(Mavridou et al 2016a, Rombouts et al 2017.…”

Understanding external cervical resorption patterns in endodontically treated teeth

“…Hypoxia is a driving force of angiogenesis and could play a role in the continuous development of highly vascularized granulation tissue accompanying ECR (Rombouts et al . ).…”

“…Hypoxia is believed to play a vital role in the evolution mechanism of ECR in both endodontically and teeth with vital pulps. Hypoxia is a driving force of angiogenesis and could play a role in the continuous development of highly vascularized granulation tissue accompanying ECR (Rombouts et al 2016).…”

Successful pulp revascularization of an autotransplantated mature premolar with fragile fracture apicoectomy and plasma rich in growth factors: a 3‐year follow‐up

“…Autotransplanted teeth respond to hypoxia by releasing many signals from the pulp and the bloodstream, such as VEGF, PDGF and bFGF, that guide the cells in the pulp healing process, which, in turn, initiates vascular neoformation and a connection between the healing site and the pre‐existing pulp tissue vessels. This process finally leads to the apposition of tertiary dentine as a repair mechanism (Caviedes‐Bucheli et al , Rombouts et al ).…”

“…Indeed, revascularization has often been observed when enlarging the apical foramen by apicoectomy in teeth with closed apices (Skoglund et al 1978, Skoglund & Tronstad 1981. Paganelli & Lanfranchi (2014) described the fragile fracture to harvest a greater amount of dental pulp stem cells (DPSCs), which is essential for pulp revascularization (Rombouts et al 2017). In addition, platelet-rich plasma (PRP) has recently shown promising results in autotransplanted teeth (Gonzalez-Ocasio & Stevens 2017).…”