Pulp Regeneration: Current Approaches and Future Challenges.
Pulp Regeneration: Current Approaches and Future Challenges.
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纸浆再生：当前的方法和未来的挑战。
DOI：
10.3389/fphys.2016.00058
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发表时间：
2016
影响因子：
4
通讯作者：
Chen Z
中科院分区：
文献类型：
--
作者：
Yang J;Yuan G;Chen Z
再生牙髓学的目的是用再生的牙髓样组织取代发炎/坏死的牙髓组织，以恢复牙齿的活力，提高生活质量。牙髓血运重建的病例报告显示了成功的临床和影像学结果，表明通过细胞归巢策略进行牙髓再生的可能临床应用。从临床的角度来看，功能性牙髓样组织的再生应具有血管化、神经再支配和牙本质沉积的特征，其再生速率与正常牙髓相似。有效的根管消毒和合适的根尖孔大小是牙髓再生的两个必要前提。通过细胞归巢策略进行牙髓再生已经取得了进展。本文就牙髓再生的前提条件和细胞归巢策略进行了综述。根管消毒除传统的机械预备和冲洗外，抗生素、EndoVac根尖负压系统辅助冲洗、超声波和激光照射等也被广泛应用于根管消毒。此外，髓样组织可以形成根尖孔小于1 mm，但需要更多的研究来确定适当的大小。此外，包括基质细胞衍生因子（SDF-1α）、碱性成纤维细胞生长因子（bFGF）、血小板衍生生长因子（PDGF）、干细胞因子（SCF）和粒细胞集落刺激因子（G-CSF）的信号分子用于通过细胞归巢策略实现牙髓样组织形成。牙髓再生细胞来源的研究可能为信号分子的选择提供一些线索。主动募集内源性细胞进入根管以再生牙髓样组织是一个新的概念，可能为当前牙髓再生生物学疗法的近期临床转化提供前所未有的机会。
Regenerative endodontics aims to replace inflamed/necrotic pulp tissues with regenerated pulp-like tissues to revitalize teeth and improve life quality. Pulp revascularization case reports, which showed successful clinical and radiographic outcomes, indicated the possible clinical application of pulp regeneration via cell homing strategy. From a clinical point of view, functional pulp-like tissues should be regenerated with the characterization of vascularization, re-innervation, and dentin deposition with a regulated rate similar to that of normal pulp. Efficient root canal disinfection and proper size of the apical foramen are the two requisite preconditions for pulp regeneration. Progress has been made on pulp regeneration via cell homing strategies. This review focused on the requisite preconditions and cell homing strategies for pulp regeneration. In addition to the traditionally used mechanical preparation and irrigation, antibiotics, irrigation assisted with EndoVac apical negative-pressure system, and ultrasonic and laser irradiation are now being used in root canal disinfection. In addition, pulp-like tissues could be formed with the apical foramen less than 1 mm, although more studies are needed to determine the appropriate size. Moreover, signaling molecules including stromal cell derived factor (SDF-1α), basic Fibroblast Growth Factor (bFGF), Platelet Derived Growth Factor (PDGF), stem cell factor (SCF), and Granulocyte Colony-Stimulating Factor (G-CSF) were used to achieve pulp-like tissue formation via a cell homing strategy. Studies on the cell sources of pulp regeneration might give some indications on the signaling molecular selection. The active recruitment of endogenous cells into root canals to regenerate pulp-like tissues is a novel concept that may offer an unprecedented opportunity for the near-term clinical translation of current biology-based therapies for dental pulp regeneration.