Roles of Dental Mesenchymal Stem Cells in the Management of Immature Necrotic Permanent Teeth

Abstract

Dental caries and trauma always lead to pulp necrosis and subsequent root development arrest of young permanent teeth. The traditional treatment, apexification, with the absence of further root formation, results in abnormal root morphology and compromises long-term prognosis. Regeneration endodontics procedures (REPs) have been developed and considered as an alternative strategy for management of immature permanent teeth with pulpal necrosis, including cell-free and cell-based REPs. Cell-free REPs, including revascularization and cell homing with molecules recruiting endogenous mesenchymal stem cells (MSCs), have been widely applied in clinical treatment, showing optimistic periapical lesion healing and continued root development. However, the regenerated pulp–dentin complex is still absent in these cases. Dental MSCs, as one of the essentials of tissue engineering, are vital seed cells in regenerative medicine. Dental MSC–based REPs have presented promising potential with pulp–dentin regeneration in large animal studies and clinical trials via cell transplantation. In the present review, we summarize current understanding of the biological basis of clinical treatments for immature necrotic permanent teeth and the roles of dental MSCs during this process and update the progress of MSC-based REPs in the administration of immature necrotic permanent teeth.

The Understanding of Vital Pulp Therapy in Permanent Teeth: A New Perspective

“…For the indication of pulpotomy, the size of the pulp exposure, the time, and the location of pulp exposure, whether it is irreversible pulp inflammation and even periapical periodontitis, are not necessarily related [39][40][41][42][43][44][45][46]. It is suggested that the status and repairing ability of the pulp have more important significance in the prognosis of pulpotomy [47].…”

EVL Promotes Osteo-/Odontogenic Differentiation of Dental Pulp Stem Cells via Activating JNK Signaling Pathway

“…Current approaches for treating immature permanent teeth with pulpal necrosis do not reliably achieve continued root development and restore functional competence of the pulp tissue [ 58 , 59 ]. Recently, stem cell-based techniques have shown immense potential for regeneration of the dentin-pulp complex [ 6 , 7 , 60 ]. Within this context, the ability of EVL to enhance the osteo-/odontogenic commitment in hDPSCs may prove rewarding in the promotion of root development and reinforcement of dentinal walls by deposition of hard tissue.…”

Dental Stem Cells SV40, a new cell line developed in vitro from human stem cells of the apical papilla

“…Many adult stem cells have been studied for tissue regeneration, and among them, SCAPs are of interest because they can induce root development even after apical periodontitis has occurred (Chrepa et al, 2017; Lin et al, 2018). Given their anatomical location, SCAPs are believed to be the principal source of stem cells during regenerative endodontic therapy (Cui et al, 2021; Lovelace et al, 2011). In the disease and during regenerative endodontic therapy, SCAPs face conditions of necrosis, infection and periapical inflammation, are exposed to different substances (irrigants and intracanal medications) that can affect their viability, and must be tested in vitro before clinical use (Althumairy et al, 2014; Ruparel et al, 2012; Trevino et al, 2011).…”