Pulp/Dentin Regeneration: It Should Be Complicated.
Pulp/Dentin Regeneration: It Should Be Complicated.
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DOI：
10.1016/j.joen.2020.06.020
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发表时间：
2020-09
影响因子：
4.2
通讯作者：
Azim AA
中科院分区：
文献类型：
--
作者：
Huang GT;Liu J;Zhu X;Yu Z;Li D;Chen CA;Azim AA
干细胞介导的再生牙髓学已进入人体临床试验阶段;然而，仍存在许多问题，阻碍了这种技术广泛应用于临床实践。这些问题并不简单，而且很复杂。他们应该是因为纸浆再生是处理一个小的死胡同空间。更重要的是，当需要再生时，该空间通常会受到严重感染。牙髓再生的真正标准应该是除了产生一些纤维结缔组织和无定形矿物存款之外的一切。到目前为止，我们仍然远远没有达到标准-完全血管化和神经支配的牙髓再生与新形成的管状牙本质在所有类型的牙齿。因此，我们需要回到实验室，使用已建立的动物模型或创建新的动物模型来解决这些问题。本文将解决几个关键问题，包括通过增强新血管形成来实现磨牙小根管牙髓再生的可能性，以及根管壁是否可以生成有组织的管状牙本质。来自我们的半原位牙齿碎片小鼠模型的数据表明，由于血液供应有限，在小管中使用牙髓干细胞（DPSC）进行完全牙髓再生一直不一致。这种不一致性在我们的原位小型猪模型中是相似的，尽管在某些情况下，DPSC移植后可以在整个根管空间形成血管化的牙髓样组织。此外，在原位牙髓再生中没有观察到管状牙本质，尽管DPSC在羟基磷灰石/磷酸三钙介导的小鼠异位牙髓/牙本质形成模型中具有产生一些管状牙本质样结构的能力。本文讨论了为解决这些再生问题而进行测试的潜在策略。
Stem cell-mediated regenerative endodontics has reached the human clinical trial phase; however, many issues still exist preventing such technology to be a widely used clinical practice. These issues are not straightforward and are complicated. And they should be because pulp regeneration is dealing with a small dead-end space. More so, when regeneration is needed, the space is often heavily infected. The true standard of pulp regeneration should be everything except generation of some fibrous connective tissue and amorphous mineral deposit. As of now, we are still far short of reaching the standard – complete vascularized and innervated pulp regeneration with newly formed tubular dentin in all types of teeth. Thus, we need to go back to the bench and use established animal models or create new animal models to tackle those issues. This paper will address several key issues including the possibility of pulp regeneration in small canals of molar teeth by enhancing the neovascularization, and whether the organized tubular dentin can be generated on the canal walls. Data from our semi-orthotopic tooth fragment mouse model have shown that complete pulp regeneration using dental pulp stem cells (DPSCs) in small canal has been inconsistent due to limited blood supply. This inconsistency is similar in our orthotopic miniature swine model, although in some cases vascularized pulp-like tissue can be formed throughout the canal space after DPSC transplantation. Furthermore, no tubular dentin was observed in the orthotopic pulp regeneration, despite DPSCs have the capacity to generate some tubular dentin-like structure in the hydroxyapatite/tricalcium phosphate-mediated ectopic pulp/dentin formation model in mice. Potential strategies to be tested to address these regeneration issues are discussed herein.
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影响因子：
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作者：
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