Regenerative endodontics: barriers and strategies for clinical translation.
Regenerative endodontics: barriers and strategies for clinical translation.
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DOI：
10.1016/j.cden.2012.05.005
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发表时间：
2012-07
影响因子：
--
通讯作者：
Zhou X
中科院分区：
文献类型：
--
作者：
Mao JJ;Kim SG;Zhou J;Ye L;Cho S;Suzuki T;Fu SY;Yang R;Zhou X
尽管付出了巨大的热情和努力，再生牙髓学在临床转化方面遇到了巨大的挑战。美国牙科协会（ADA）最近采用了未成熟恒牙诱发牙髓出血的方法，这是再生牙髓学的重要一步。然而，大多数牙髓疾病没有再生疗法。对其他器官系统正在开发的细胞疗法和组织工程策略的简单概括尚未导致再生牙髓学的临床转化。牙髓干细胞似乎是牙髓再生的优先选择。然而，需要牙髓再生的患者可能无法获得牙髓干细胞。即使牙髓干细胞可以自体或同种异体获得，也必须解决许多科学、监管和商业化障碍，除非这些问题得到解决，否则牙髓干细胞移植仍将是一项科学活动，而不是临床现实。最近的工作使用新型生物材料支架和生长因子来协调宿主内源细胞的归巢，这代表了与传统细胞移植方法的背离，并可能加速临床转化。鉴于牙髓和牙本质的功能和规模，再生牙髓学有望成为再生牙科医学的早期生物解决方案之一。
Despite a great deal of enthusiasm and effort, regenerative endodontics has encountered substantial challenges towards clinical translation. Recent adoption by the American Dental Association (ADA) of evoked pulp bleeding in immature permanent teeth is an important step for regenerative endodontics. However, there is no regenerative therapy for the majority of endodontic diseases. Simple recapitulation of cell therapy and tissue engineering strategies that are under development for other organ systems has not led to clinical translation in regeneration endodontics. Dental pulp stem cells may appear to be a priori choice for dental pulp regeneration. However, dental pulp stem cells may not be available in a patient who is in need of pulp regeneration. Even if dental pulp stem cells are available autologously or perhaps allogeneically, one must address a multitude of scientific, regulatory and commercialization barriers, and unless these issues are resolved, transplantation of dental pulp stem cells will remain a scientific exercise, rather than a clinical reality. Recent work using novel biomaterial scaffolds and growth factors that orchestrate the homing of host endogenous cells represents a departure from traditional cell transplantation approaches and may accelerate clinical translation. Given the functions and scale of dental pulp and dentin, regenerative endodontics is poised to become one of the early biological solutions in regenerative dental medicine.