Pulp Development, Repair, and Regeneration: Challenges of the Transition from Traditional Dentistry to Biologically Based Therapies
Pulp Development, Repair, and Regeneration: Challenges of the Transition from Traditional Dentistry to Biologically Based Therapies
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DOI：
10.1016/j.joen.2014.01.018
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发表时间：
2014-04-01
影响因子：
4.2
通讯作者：
Smith, Anthony J.
中科院分区：
文献类型：
--
作者：
Schmalz, Gottfried;Smith, Anthony J.
用惰性材料（修复）替代患病牙齿/牙髓组织的传统概念正受到牙髓生物学最新进展的挑战，这些进展导致了旨在产生新的重要组织的再生策略。在充分控制感染和形成血凝块后，可以观察到牙髓腔内新组织的形成。然而，真成牙细胞的分化仍然是更加推测的，而且这种方法很大程度上局限于具有开放尖端的未成熟牙齿。采用组织工程概念，使用基质、合适的（干细胞）和信号分子来指导组织事件，可能会提供一种更系统的方法。有了这些工具，在实验动物身上已经产生了类似纸浆的结构。然而，牙髓再生的临床转化仍然面临许多挑战（例如，细胞来源[常驻干细胞与非常驻干细胞，后者与无细胞方法相关]，成牙髓细胞分化的机制，牙髓环境，感染和炎症的作用，牙本质预处理以释放牙本质中的化石信号分子，以及提供合适的基质）。从一种“正常”形式到另一种“正常”形式的过渡是一个过程，它不仅基于科学的进步，而且基于在日常实践中实现对既定治疗概念的改变。然而，很明显，最近在牙髓生物学方面取得的重大成就为牙髓再生的临床转化提供了一个令人兴奋的平台。
The traditional concept of replacing diseased tooth/pulp tissues by inert materials (restoration) is being challenged by recent advances in pulp biology leading to regenerative strategies aiming at the generation of new vital tissue. New tissue formation in the pulp chamber can be observed after adequate infection control and the formation of a blood clot. However, differentiation of true odontoblasts is still more speculative, and the approach is largely limited to immature teeth with open apices. A more systematic approach may be provided by the adoption of the tissue engineering concepts of using matrices, suitable (stem) cells, and signaling molecules to direct tissue events. With these tools, pulp-like constructs have already been generated in experimental animals. However, a number of challenges still remain for clinical translation of pulp regeneration (eg, the cell source [resident vs nonresident stem cells, the latter associated with cell-free approaches], mechanisms of odontoblast differentiation, the pulp environment, the role of infection and inflammation, dentin pretreatment to release fossilized signaling molecules from dentin, and the provision of suitable matrices). Transition as a process, defined by moving from one form of "normal'' to another, is based not only on the progress of science but also on achieving change to established treatment concepts in daily practice. However, it is clear that the significant recent achievements in pulp biology are providing an exciting platform from which clinical translation of dental pulp regeneration can advance.