Survival of the Apical Papilla and Its Resident Stem Cells in a Case of Advanced Pulpal Necrosis and Apical Periodontitis

Chrepa, Vanessa; Pitcher, Brandon; Henry, Michael; Diogenes, Aníbal

doi:10.1016/j.joen.2016.09.024

Cited by 99 publications

(68 citation statements)

References 27 publications

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“…, Chrepa et al . ), long‐term exposure to pro‐inflammatory cytokines such as TNF‐α and IL‐1β can inhibit the osteogenic/dentinogenic differentiation of stem cells from the apical papilla (Liu et al . ).…”

Section: Discussionmentioning

confidence: 99%

Regenerative endodontics: a comprehensive review

et al. 2018

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The European Society of Endodontology and the American Association for Endodontists have released position statements and clinical considerations for regenerative endodontics. There is increasing literature on this field since the initial reports of Iwaya et al. (Dental Traumatology, 17, 2001, 185) and Banchs & Trope (Journal of Endodontics, 30, 2004, 196). Endogenous stem cells from an induced periapical bleeding and scaffolds using blood clot, platelet rich plasma or platelet-rich fibrin have been utilized in regenerative endodontics. This approach has been described as a 'paradigm shift' and considered the first treatment option for immature teeth with pulp necrosis. There are three treatment outcomes of regenerative endodontics; (i) resolution of clinical signs and symptoms; (ii) further root maturation; and (iii) return of neurogenesis. It is known that results are variable for these objectives, and true regeneration of the pulp/dentine complex is not achieved. Repair derived primarily from the periodontal and osseous tissues has been shown histologically. It is hoped that with the concept of tissue engineering, namely stem cells, scaffolds and signalling molecules, that true pulp regeneration is an achievable goal. This review discusses current knowledge as well as future directions for regenerative endodontics. Patient-centred outcomes such as tooth discolouration and possibly more appointments with the potential for adverse effects needs to be discussed with patients and parents. Based on the classification of Cvek (Endodontics and Dental Traumatology, 8, 1992, 45), it is proposed that regenerative endodontics should be considered for teeth with incomplete root formation although teeth with near or complete root formation may be more suited for conventional endodontic therapy or MTA barrier techniques. However, much is still not known about clinical and biological aspects of regenerative endodontics.

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Section: Discussionmentioning

confidence: 99%

Regenerative endodontics: a comprehensive review

et al. 2018

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“…Recently, it has been reported that the human apical papilla was moderately inflamed with the SCAPs retaining their vitality and properties and had increased osteogenic and angiogenesis potential under the inflammatory condition (Chrepa et al . ). It is believed that continued root formation is associated with SCAPs.…”

Section: Introductionmentioning

confidence: 97%

The potential application of concentrated growth factor in regenerative endodontics

Hong

Cai

et al. 2018

Int Endodontic J

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Aim To investigate the potential application of concentrated growth factor (CGF) to promote pulp regeneration within immature teeth. Methodology Concentrated growth factor clots produced from peripheral blood samples were investigated histologically by haematoxylin–eosin (HE) staining and evaluated morphologically by scanning electron microscope (SEM). The cytokines were extracted from the CGF, and representative cytokines were quantified by enzyme‐linked immunosorbent assay (ELISA). The biological effects of the CGF on human stem cells from the apical papilla (SCAPs) were then investigated and quantified, including cell proliferation, cell migration, mineralized nodule formation, and the gene expression of alkaline phosphatase (ALP), dentine sialophosphoprotein (DSPP) and dentine matrix protein (DMP)‐1. The results were analysed statistically using one‐way analysis of variance (anova). Results Concentrated growth factor had a complex three‐dimensional structure with a high density of platelets and nucleated cells. Representative growth factors including PDGF‐BB, IGF‐1, TGF‐β1, bFGF and VEGF were detected. The growth rate and migratory cell numbers of the CGF groups were significantly greater than those in the control groups (P < 0.05). The mineralization areas in the CGF groups were significantly larger than those in the control groups (P < 0.05). The expression levels of ALP, DSPP and DMP‐1 were significantly up‐regulated after induction by CGF (P < 0.05). Conclusions Concentrated growth factor promoted the proliferation, migration and differentiation of SCAPs and could be a promising biomaterial applied in regenerative endodontics.

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“…After pulp necrosis, the recruitment of SCAPs or SCs migrating from the blood system becomes more important and more complex than recruitment of DSPCs due to a loss of pulpal blood supply [58]. During apical periodontitis, SCAPs retain vitality and stemness, and can undergo osteogenic and angiogenic differentiation under the influence of GFs [59]. Chemotactic GFs including SDF-1, TGF-β1, platelet-derived growth factor (PDGF), G-CSF, and bFGF stimulate migration of SCAPs, while a combining GCSF and TGF-β1 significantly enhanced mineralization responses [48].…”

Section: Reviewmentioning

confidence: 99%

“…In order to better understand the clinical interaction of GFs, it is sensible to analyze this in a sequential fashion while highlighting the best current therapeutic strategy to optimize GF release during revitalization. Preoperatively, there is unlikely to be significant release of reparative GFs in the necrotic/infected canal; however, SCAP populations have been shown to be resilient to infection and inflammatory processes ready to be utilized after effective infection control [59]. After endodontic access, a combination of minimal instrumentation, disinfection with chlorhexidine, and a final rinse with 17% EDTA will stimulate the release of GFs (e.g., TGFβ−1, VEGF) and other mobilization factors from dentin, which will promote SC chemotaxis from the apical papilla and beyond.…”

Section: Reviewmentioning

confidence: 99%

Growth Factors and Cell Homing in Dental Tissue Regeneration

Duncan

Kobayashi

Shimizu

2018

Curr Oral Health Rep

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Purpose of Review To summarize current views on the role and therapeutic potential of growth factors (GFs) within endodontic cell homing. Recent Findings Cell homing/revitalization techniques aim to regenerate dentin and pulp using endogenous cells. Clinically, revitalization has successfully created new vital tissue in necrotic permanent teeth with an open apex; however, there is no evidence of new odontoblasts, pulp tissue, or predictable extension in root length. Although the response is reparative rather than regenerative, exciting opportunities to improve these biologically-based strategies remain by (1) efficiently sequestering dentin-matrix-components (DMCs) using irrigants and dental materials (2) designing next-generation GF-releasing scaffold materials and (3) utilizing other sources of GF such as cells and plasma-rich plasma and plasma-rich fibrin. Summary GFs can promote reparative-dentinogenesis and pulp-like tissue formation. The future development and clinical approval of GF-functionalized-scaffolds is a priority; however, current focus should be to harness DMCs and target the interaction of stem cells and GFs.

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Survival of the Apical Papilla and Its Resident Stem Cells in a Case of Advanced Pulpal Necrosis and Apical Periodontitis

Cited by 99 publications

References 27 publications

Regenerative endodontics: a comprehensive review

Regenerative endodontics: a comprehensive review

The potential application of concentrated growth factor in regenerative endodontics

Growth Factors and Cell Homing in Dental Tissue Regeneration

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