Present and future of tissue engineering scaffolds for dentin-pulp complex regeneration.
Present and future of tissue engineering scaffolds for dentin-pulp complex regeneration.
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DOI：
10.1002/term.2769
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发表时间：
2019-01
影响因子：
3.3
通讯作者：
Aparicio C
中科院分区：
文献类型：
--
作者：
Moussa DG;Aparicio C
全球超过三分之二的人口患有蛀牙，这导致了不同程度的损伤严重的蛀牙。治疗蛀牙的临床干预措施从简单的冠状充填到侵入性根管治疗。牙髓盖盖术是临床上唯一可用于维持深部病变牙髓活力的方法，但不可逆的牙髓炎症和再感染是这种治疗的常见结果。当受影响的牙髓无法修复时，牙医必须进行牙髓治疗，使牙齿失去活力和易碎。正在进行的研究策略未能克服现有髓盖材料的局限性，从而实现损伤组织的健康和渐进再生。保持牙髓活力对牙齿的内稳态和耐久性至关重要，因此，迫切需要临床干预措施，使牙本质-牙髓复合体再生，每年拯救数百万牙齿。鉴定和开发适合牙本质-牙髓支架的生物材料是优化这些杂交牙组织再生临床方法的必要条件。同样，深入了解微环境、生长因子和祖细胞之间的相互作用将为设计最合适的支架提供基础。在这篇综述中，我们首先介绍了挽救患病牙齿活力的长期临床牙科问题，目前临床治疗和干预措施在修复受损组织方面的局限性，以及需要新的策略来充分激活牙齿。然后，我们全面报道了天然衍生和人工合成聚合物、陶瓷和复合支架等主要材料的特点及其在牙本质-牙髓复合物再生策略中的应用。最后，我们提出了一系列创新的智能高分子生物材料，具有克服牙本质-牙髓复合体再生挑战的潜力。
More than two thirds of the global population suffers from tooth decay, which results in cavities with various levels of lesion severity. Clinical interventions to treat tooth decay range from simple coronal fillings to invasive root canal treatment. Pulp capping is the only available clinical option to maintain the pulp vitality in deep lesions, but irreversible pulp inflammation and reinfection are frequent outcomes for this treatment. When affected pulp involvement is beyond repair, the dentist has to perform endodontic therapy leaving the tooth non-vital and brittle. On-going research strategies have failed to overcome the limitations of existing pulp capping materials so that healthy and progressive regeneration of the injured tissues is attained. Preserving pulp vitality is crucial for tooth homeostasis and durability, and thus, there is a critical need for clinical interventions that enable regeneration of the dentin-pulp complex to rescue millions of teeth annually. The identification and development of appropriate biomaterials for dentin-pulp scaffolds are necessary to optimize clinical approaches to regenerate these hybrid dental tissues. Likewise, a deep understanding of the interactions between the micro-environment, growth factors, and progenitor cells will provide design basis for the most fitting scaffolds for this purpose. In this review, we first introduce the long-lasting clinical dental problem of rescuing diseased tooth vitality, the limitations of current clinical therapies and interventions to restore the damaged tissues, and the need for new strategies to fully revitalize the tooth. Then, we comprehensively report on the characteristics of the main materials of naturally-derived and synthetically-engineered polymers, ceramics, and composite scaffolds as well as their use in dentin-pulp complex regeneration strategies. Finally, we present a series of innovative smart polymeric biomaterials with potential to overcome dentin-pulp complex regeneration challenges.
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