This document discusses regenerative endodontics and stem cell therapy. It describes how stem cells can be used to regenerate and replace damaged oral tissues. Two main types of stem cells are discussed: mature stem cells obtained from adult tissues and early stem cells obtained from embryos. The document outlines various techniques being explored for regenerative endodontics, including revascularization using blood clotting, stem cell therapy, scaffold implantation, and gene delivery. Growth factors that could stimulate stem cell proliferation and differentiation are also mentioned.
STEM CELLS IN HUMAN EXFOLIATED DECIDUOUS TEETH(SHED)Upama Sishan
- Recent studies have shown that stem cells from human exfoliated deciduous teeth (SHED) can develop into more types of body tissue than other stem cell sources.
- SHED are a promising source of stem cells because they can be easily collected from discarded baby teeth, have a high proliferation rate, and may be useful for treating a variety of conditions through cell therapy and tissue regeneration.
- It is advantageous for parents to bank their child's SHED now while they are young and healthy to provide a guaranteed stem cell donor source for any future medical needs.
Cultured skin substitutes prepared from cultured skin cells and biopolymers can reduce the need for donor skin grafts and have been shown to effectively treat excised burns, burn scars, and congenital skin lesions. Cultured skin substitutes generate skin phenotypes in the lab and restore tissue function and systemic homeostasis when implanted. Healed skin from cultured skin substitutes is smooth, soft and strong, though pigmentation may be irregular. Cultured skin substitutes close 67 times the area of donor skin compared to less than 4 times for split-thickness skin grafts, and result in similar qualitative outcomes.
This document discusses potential regenerative endodontic technologies including root canal revascularization using blood clotting, postnatal stem cell therapy, pulp implantation, scaffold implantation, injectable scaffold delivery, 3D cell printing, and gene delivery. It provides examples of each technique, such as using intracanal irrigants and antibiotics to induce revascularization in necrotic teeth. The goal is to regenerate pulp-like tissue and repair damaged dentin. Autologous postnatal stem cells are promising due to fewer disadvantages than other stem cell sources.
Dental stem cells were discovered in 2000 and have since been studied extensively. They are found in dental pulp and other dental tissues. Dental stem cells can differentiate into several cell types including bone, connective tissue, muscle and neural cells. Research is exploring their potential to regenerate dental and craniofacial tissues through procedures like regenerative endodontics and periodontal regeneration. Dental stem cells may also help treat other conditions like heart disease, diabetes and neurological disorders. Further research is still needed but dental stem cells show promise for advancing regenerative dentistry and medicine.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Stem cells in Dentistry | by Dr Alaa Al-saidiDenTeach
Dental pulp stem cells are derived from the dental pulp within teeth. They are multipotent stem cells that can differentiate into several cell types. Dental pulp stem cells are a promising source for regenerative dentistry and tissue engineering due to their accessibility and differentiation potential. They have applications in pulp regeneration, alveolar bone regeneration, and treatment of craniofacial defects. However, there are also challenges to their clinical use including low survival rates, contamination risks, and high costs.
Dental and orofacial mesenchymal stem cells in craniofacialAamir Godil
This document discusses dental and orofacial mesenchymal stem cells and their potential applications in craniofacial regeneration from the perspective of prosthodontists. It provides an overview of stem cell sources in dentistry, including dental tissue-derived stem cells like dental pulp stem cells, stem cells from exfoliated deciduous teeth, periodontal ligament stem cells, and gingival mesenchymal stem cells. It also discusses the use of hydrogels, particularly alginate hydrogel, as scaffolds for tissue engineering and encapsulating dental stem cells. Recent studies encapsulating dental stem cells in alginate hydrogels show promise for regenerating tissues like cartilage, tendon, and muscle.
STEM CELLS IN HUMAN EXFOLIATED DECIDUOUS TEETH(SHED)Upama Sishan
- Recent studies have shown that stem cells from human exfoliated deciduous teeth (SHED) can develop into more types of body tissue than other stem cell sources.
- SHED are a promising source of stem cells because they can be easily collected from discarded baby teeth, have a high proliferation rate, and may be useful for treating a variety of conditions through cell therapy and tissue regeneration.
- It is advantageous for parents to bank their child's SHED now while they are young and healthy to provide a guaranteed stem cell donor source for any future medical needs.
Cultured skin substitutes prepared from cultured skin cells and biopolymers can reduce the need for donor skin grafts and have been shown to effectively treat excised burns, burn scars, and congenital skin lesions. Cultured skin substitutes generate skin phenotypes in the lab and restore tissue function and systemic homeostasis when implanted. Healed skin from cultured skin substitutes is smooth, soft and strong, though pigmentation may be irregular. Cultured skin substitutes close 67 times the area of donor skin compared to less than 4 times for split-thickness skin grafts, and result in similar qualitative outcomes.
This document discusses potential regenerative endodontic technologies including root canal revascularization using blood clotting, postnatal stem cell therapy, pulp implantation, scaffold implantation, injectable scaffold delivery, 3D cell printing, and gene delivery. It provides examples of each technique, such as using intracanal irrigants and antibiotics to induce revascularization in necrotic teeth. The goal is to regenerate pulp-like tissue and repair damaged dentin. Autologous postnatal stem cells are promising due to fewer disadvantages than other stem cell sources.
Dental stem cells were discovered in 2000 and have since been studied extensively. They are found in dental pulp and other dental tissues. Dental stem cells can differentiate into several cell types including bone, connective tissue, muscle and neural cells. Research is exploring their potential to regenerate dental and craniofacial tissues through procedures like regenerative endodontics and periodontal regeneration. Dental stem cells may also help treat other conditions like heart disease, diabetes and neurological disorders. Further research is still needed but dental stem cells show promise for advancing regenerative dentistry and medicine.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Stem cells in Dentistry | by Dr Alaa Al-saidiDenTeach
Dental pulp stem cells are derived from the dental pulp within teeth. They are multipotent stem cells that can differentiate into several cell types. Dental pulp stem cells are a promising source for regenerative dentistry and tissue engineering due to their accessibility and differentiation potential. They have applications in pulp regeneration, alveolar bone regeneration, and treatment of craniofacial defects. However, there are also challenges to their clinical use including low survival rates, contamination risks, and high costs.
Dental and orofacial mesenchymal stem cells in craniofacialAamir Godil
This document discusses dental and orofacial mesenchymal stem cells and their potential applications in craniofacial regeneration from the perspective of prosthodontists. It provides an overview of stem cell sources in dentistry, including dental tissue-derived stem cells like dental pulp stem cells, stem cells from exfoliated deciduous teeth, periodontal ligament stem cells, and gingival mesenchymal stem cells. It also discusses the use of hydrogels, particularly alginate hydrogel, as scaffolds for tissue engineering and encapsulating dental stem cells. Recent studies encapsulating dental stem cells in alginate hydrogels show promise for regenerating tissues like cartilage, tendon, and muscle.
This document discusses advances in stem cell therapy using dental stem cells. It summarizes that dental stem cells, such as dental pulp stem cells and stem cells from exfoliated deciduous teeth, have been shown to be a better source of mesenchymal stem cells than bone marrow. These dental stem cells can be isolated from accessible dental tissues, have high proliferative ability, and can differentiate into various cell types. Cryopreserved dental pulp tissues from exfoliated deciduous teeth are a feasible source of stem cells that maintain stem cell properties and have shown therapeutic potential for regenerative medicine applications and treating conditions like immune disorders.
Stem cells have potential applications in dentistry for tissue regeneration. There are several types of stem cells, including embryonic, adult, and induced pluripotent stem cells. Dental tissues contain stem cells that are advantageous for use due to high plasticity and ability to be cryopreserved. Current approaches to stem cell therapy include using stem cells from sources like bone marrow or dental pulp to regenerate bone or develop cell sheets. Research aims to regenerate whole teeth by transplanting bioengineered tooth units constructed from epithelial and mesenchymal stem cells into defects. These techniques could help with problems like root regeneration and prosthodontic treatments.
Denise Resen will give an informative speech on dental stem cells. She will discuss what dental stem cells are, the benefits they provide, how they are harvested and stored, and when this new technology will be available. Dental stem cells are unspecified cells harvested from extracted teeth that can be stored for future use in treating diseases and regenerating tissues. They are an accessible stem cell source and pose fewer ethical issues than other sources. Current technology allows for their storage in dental offices using collection kits.
Baby teeth revealed as source of stem cellsVrunda Shah
Stem cells can be derived from baby teeth and have potential medical applications. Researchers at NIH discovered that stem cells extracted from the pulp of baby teeth, called deciduous or milk teeth, can differentiate into various cell types like neural cells, bone cells, and fat cells. These stem cells may be useful for treating conditions like spinal cord injuries, Parkinson's, and other diseases. Extracting and storing stem cells from baby teeth is non-controversial compared to embryonic stem cells and could provide an easily accessible stem cell source for future medical needs.
This document discusses regenerative endodontics and the potential for dental pulp stem cells to regenerate damaged dentin and pulp tissues. It describes how dental pulp stem cells can proliferate and differentiate into odontoblasts and other cell types, potentially regenerating the dentin-pulp complex. Studies with dental pulp stem cells in scaffolds and with growth factors have shown new dentin formation in animal models, raising the possibility of clinical treatments to repair teeth and prevent tooth loss. The document reviews the key components needed for regenerative endodontics, including appropriate stem cells, scaffolds, and growth factors.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
1) Regenerative endodontics uses principles of tissue engineering to regenerate damaged pulp and root structures in immature permanent teeth with pulpal necrosis. It aims to restore pulpal function and allow root development to continue.
2) Case studies show that regenerative endodontic procedures can result in healing of apical periodontitis, ongoing root development, and increased root wall thickness.
3) Future regenerative procedures may utilize customized scaffolds combined with autologous stem cells and growth factors to better mimic the original pulp and dentin structures.
Human Dental Pulp Stem Cells Cryopreservation
This study evaluated the effect of two cryopreservation methods on the viability and phenotype of human dental pulp stem cells (DPSCs). DPSCs were isolated from teeth extracted from patients, cryopreserved using two different methods, and then analyzed for viability and phenotype markers after 24 hours and 7 days. The results showed that both cryopreservation methods maintained high viability of DPSCs short-term, though one method resulted in slightly higher viability. Both methods also maintained the stem cell phenotype after cryopreservation. However, longer-term studies are still needed to fully evaluate the effects of cryopreservation methods on DPSCs.
Tissue Engineering in restorative dentistryLama K Banna
Stem cells have potential applications in regenerative dentistry. Dental stem cells can be isolated from sources like dental pulp, extracted teeth, and apical papilla. These stem cells may be used along with growth factors and scaffolds to regenerate tissues like dental pulp, dentin, cementum, and periodontal ligament. However, challenges remain such as a lack of available dental epithelial stem cells and scaling up the engineering of tooth structures. Further research is needed to address these obstacles and develop clinically feasible stem cell therapies for replacing lost tooth structures.
This document discusses tissue engineering techniques in endodontics, specifically root canal revascularization. It begins by defining regenerative endodontics and its goal of regenerating damaged dental tissues. The key elements of tissue engineering are then explained: stem cells, growth factors, and scaffolds. Various techniques are described, including revascularization via blood clotting, postnatal stem cell therapy, scaffold and pulp implantation. The document outlines the objectives and components of regenerative endodontic treatment, including a case selection and disinfection protocol for revascularization. In under 3 sentences, this document discusses regenerative endodontic techniques for tissue engineering and regenerating damaged dental tissues, outlining the key elements and various approaches, including a protocol for revascularization
Tooth bioengineering and the next generation of dentistryAmir Rajaey
Tooth bioengineering and the next generation of dentistry.
As a result of numerous rapid and exciting developments in tissue engineering technology, scientists are able to regenerate a fully functional tooth in animal models, from a bioengineered tooth germ. Advances in technology, together with our understanding of the mechanisms of tooth development and studies dealing with dentally derived stem cells, have led to significant progress in the field of tooth regeneration
Stem cells found in dental tissues such as dental pulp, dental pulp of deciduous teeth, apical papilla, and dental follicle can differentiate into odontoblast cells and have potential applications in dental tissue regeneration and repair. There are several types of dental stem cells that can potentially be used to regenerate dental tissues and whole teeth. Delivery of growth factors has shown potential to induce homing of endogenous stem cells to regenerate dental pulp-like tissue in root canals of extracted human teeth implanted in mice without cell transplantation. Further research is still needed but dental stem cells show promise for applications in dental tissue engineering and whole tooth regeneration.
This document provides an overview of regenerative endodontics. It defines regenerative endodontics as the creation and delivery of tissues to replace diseased, missing, and traumatized pulp. The document discusses the history and technologies of regenerative endodontics, including the use of stem cells, growth factors, and scaffolds. The key goals of regenerative endodontics are outlined as regenerating pulp-dentin complex tissue and revitalizing teeth through pulp regeneration.
Dr. David Steenblock has been specializing in regenerative medicine for over 40 years. This power point discusses how stem cells can regenerate the body and help you heal. To learn more about stem cell treatments, call 1-800-300-1063.
"Tissue Engineering": Competition Experience ReportFatima A
A brief report regarding our poster presentation, given to faculty and peers at a professional development conference in the college after the IADSR event.
A detailed description of regenerative endodontics with illustrated journals right from its history,, needs, till its future advancements and challenges...
V Bobic OrthoBiologics - CKC Nuffield Seminars - 071017Vladimir Bobic
The document discusses developments in orthopaedics moving from traditional surgical techniques towards biological approaches using regenerative medicine and stem cell technologies. It summarizes various surgical options for cartilage repair like microfracture, OATS, and ACI. Recent research suggests stem cells and concentrating bone marrow can improve healing of cartilage defects compared to microfracture alone. The subchondral bone unit is an important new area of focus, and combining osteochondral grafts with bone marrow may provide integrated repair. While stem cell therapies are promising, further research is still needed to demonstrate benefits over placebo. Overall, the field is shifting from mechanical to more biological approaches focused on tissue regeneration.
This document provides an overview of regenerative endodontics and tissue engineering. It discusses definitions of key terms like regeneration, repair, and the regenerative triad of stem cells, growth factors, and scaffolds. The history and objectives of regenerative endodontics are described. Regenerative endodontic procedures aim to physiologically replace damaged tooth structures using principles of tissue engineering. This involves stimulating regeneration of the pulp-dentin complex using the building blocks of stem cells, signaling molecules, and matrices.
Mix powders together in 1:1:1 ratio.
Add small amount of carrier (MP) and mix to a thick paste consistency.
Add remaining carrier and mix thoroughly.
Store in sealed container at room temperature.
Use within 1 month.
6/1/2017 39
Placement of intracanal medicament
Antibiotic paste is placed into the canal with a hand plugger or
lentulo spiral to the full working length.
Excess paste is removed from the canal orifice with a small
paper point.
Temporary restoration is placed.
Medicament is left in place for 1-
This document discusses stem cells and their role in operative dentistry and endodontics. It defines tissue engineering as using stem cells, growth factors, and scaffolds to develop biological substitutes. Regenerative endodontics aims to physiologically replace damaged tooth structures. Stem cells are undifferentiated cells that can self-renew and differentiate. Dental stem cells like dental pulp stem cells, stem cells from exfoliated deciduous teeth, stem cells from the apical papilla, and periodontal ligament stem cells show potential for regenerative applications like periodontal regeneration, bone regeneration, and salivary gland regeneration. Challenges to further development include controlling tooth size, root formation, and eruption for bio-tooth
This document discusses advances in stem cell therapy using dental stem cells. It summarizes that dental stem cells, such as dental pulp stem cells and stem cells from exfoliated deciduous teeth, have been shown to be a better source of mesenchymal stem cells than bone marrow. These dental stem cells can be isolated from accessible dental tissues, have high proliferative ability, and can differentiate into various cell types. Cryopreserved dental pulp tissues from exfoliated deciduous teeth are a feasible source of stem cells that maintain stem cell properties and have shown therapeutic potential for regenerative medicine applications and treating conditions like immune disorders.
Stem cells have potential applications in dentistry for tissue regeneration. There are several types of stem cells, including embryonic, adult, and induced pluripotent stem cells. Dental tissues contain stem cells that are advantageous for use due to high plasticity and ability to be cryopreserved. Current approaches to stem cell therapy include using stem cells from sources like bone marrow or dental pulp to regenerate bone or develop cell sheets. Research aims to regenerate whole teeth by transplanting bioengineered tooth units constructed from epithelial and mesenchymal stem cells into defects. These techniques could help with problems like root regeneration and prosthodontic treatments.
Denise Resen will give an informative speech on dental stem cells. She will discuss what dental stem cells are, the benefits they provide, how they are harvested and stored, and when this new technology will be available. Dental stem cells are unspecified cells harvested from extracted teeth that can be stored for future use in treating diseases and regenerating tissues. They are an accessible stem cell source and pose fewer ethical issues than other sources. Current technology allows for their storage in dental offices using collection kits.
Baby teeth revealed as source of stem cellsVrunda Shah
Stem cells can be derived from baby teeth and have potential medical applications. Researchers at NIH discovered that stem cells extracted from the pulp of baby teeth, called deciduous or milk teeth, can differentiate into various cell types like neural cells, bone cells, and fat cells. These stem cells may be useful for treating conditions like spinal cord injuries, Parkinson's, and other diseases. Extracting and storing stem cells from baby teeth is non-controversial compared to embryonic stem cells and could provide an easily accessible stem cell source for future medical needs.
This document discusses regenerative endodontics and the potential for dental pulp stem cells to regenerate damaged dentin and pulp tissues. It describes how dental pulp stem cells can proliferate and differentiate into odontoblasts and other cell types, potentially regenerating the dentin-pulp complex. Studies with dental pulp stem cells in scaffolds and with growth factors have shown new dentin formation in animal models, raising the possibility of clinical treatments to repair teeth and prevent tooth loss. The document reviews the key components needed for regenerative endodontics, including appropriate stem cells, scaffolds, and growth factors.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
1) Regenerative endodontics uses principles of tissue engineering to regenerate damaged pulp and root structures in immature permanent teeth with pulpal necrosis. It aims to restore pulpal function and allow root development to continue.
2) Case studies show that regenerative endodontic procedures can result in healing of apical periodontitis, ongoing root development, and increased root wall thickness.
3) Future regenerative procedures may utilize customized scaffolds combined with autologous stem cells and growth factors to better mimic the original pulp and dentin structures.
Human Dental Pulp Stem Cells Cryopreservation
This study evaluated the effect of two cryopreservation methods on the viability and phenotype of human dental pulp stem cells (DPSCs). DPSCs were isolated from teeth extracted from patients, cryopreserved using two different methods, and then analyzed for viability and phenotype markers after 24 hours and 7 days. The results showed that both cryopreservation methods maintained high viability of DPSCs short-term, though one method resulted in slightly higher viability. Both methods also maintained the stem cell phenotype after cryopreservation. However, longer-term studies are still needed to fully evaluate the effects of cryopreservation methods on DPSCs.
Tissue Engineering in restorative dentistryLama K Banna
Stem cells have potential applications in regenerative dentistry. Dental stem cells can be isolated from sources like dental pulp, extracted teeth, and apical papilla. These stem cells may be used along with growth factors and scaffolds to regenerate tissues like dental pulp, dentin, cementum, and periodontal ligament. However, challenges remain such as a lack of available dental epithelial stem cells and scaling up the engineering of tooth structures. Further research is needed to address these obstacles and develop clinically feasible stem cell therapies for replacing lost tooth structures.
This document discusses tissue engineering techniques in endodontics, specifically root canal revascularization. It begins by defining regenerative endodontics and its goal of regenerating damaged dental tissues. The key elements of tissue engineering are then explained: stem cells, growth factors, and scaffolds. Various techniques are described, including revascularization via blood clotting, postnatal stem cell therapy, scaffold and pulp implantation. The document outlines the objectives and components of regenerative endodontic treatment, including a case selection and disinfection protocol for revascularization. In under 3 sentences, this document discusses regenerative endodontic techniques for tissue engineering and regenerating damaged dental tissues, outlining the key elements and various approaches, including a protocol for revascularization
Tooth bioengineering and the next generation of dentistryAmir Rajaey
Tooth bioengineering and the next generation of dentistry.
As a result of numerous rapid and exciting developments in tissue engineering technology, scientists are able to regenerate a fully functional tooth in animal models, from a bioengineered tooth germ. Advances in technology, together with our understanding of the mechanisms of tooth development and studies dealing with dentally derived stem cells, have led to significant progress in the field of tooth regeneration
Stem cells found in dental tissues such as dental pulp, dental pulp of deciduous teeth, apical papilla, and dental follicle can differentiate into odontoblast cells and have potential applications in dental tissue regeneration and repair. There are several types of dental stem cells that can potentially be used to regenerate dental tissues and whole teeth. Delivery of growth factors has shown potential to induce homing of endogenous stem cells to regenerate dental pulp-like tissue in root canals of extracted human teeth implanted in mice without cell transplantation. Further research is still needed but dental stem cells show promise for applications in dental tissue engineering and whole tooth regeneration.
This document provides an overview of regenerative endodontics. It defines regenerative endodontics as the creation and delivery of tissues to replace diseased, missing, and traumatized pulp. The document discusses the history and technologies of regenerative endodontics, including the use of stem cells, growth factors, and scaffolds. The key goals of regenerative endodontics are outlined as regenerating pulp-dentin complex tissue and revitalizing teeth through pulp regeneration.
Dr. David Steenblock has been specializing in regenerative medicine for over 40 years. This power point discusses how stem cells can regenerate the body and help you heal. To learn more about stem cell treatments, call 1-800-300-1063.
"Tissue Engineering": Competition Experience ReportFatima A
A brief report regarding our poster presentation, given to faculty and peers at a professional development conference in the college after the IADSR event.
A detailed description of regenerative endodontics with illustrated journals right from its history,, needs, till its future advancements and challenges...
V Bobic OrthoBiologics - CKC Nuffield Seminars - 071017Vladimir Bobic
The document discusses developments in orthopaedics moving from traditional surgical techniques towards biological approaches using regenerative medicine and stem cell technologies. It summarizes various surgical options for cartilage repair like microfracture, OATS, and ACI. Recent research suggests stem cells and concentrating bone marrow can improve healing of cartilage defects compared to microfracture alone. The subchondral bone unit is an important new area of focus, and combining osteochondral grafts with bone marrow may provide integrated repair. While stem cell therapies are promising, further research is still needed to demonstrate benefits over placebo. Overall, the field is shifting from mechanical to more biological approaches focused on tissue regeneration.
This document provides an overview of regenerative endodontics and tissue engineering. It discusses definitions of key terms like regeneration, repair, and the regenerative triad of stem cells, growth factors, and scaffolds. The history and objectives of regenerative endodontics are described. Regenerative endodontic procedures aim to physiologically replace damaged tooth structures using principles of tissue engineering. This involves stimulating regeneration of the pulp-dentin complex using the building blocks of stem cells, signaling molecules, and matrices.
Mix powders together in 1:1:1 ratio.
Add small amount of carrier (MP) and mix to a thick paste consistency.
Add remaining carrier and mix thoroughly.
Store in sealed container at room temperature.
Use within 1 month.
6/1/2017 39
Placement of intracanal medicament
Antibiotic paste is placed into the canal with a hand plugger or
lentulo spiral to the full working length.
Excess paste is removed from the canal orifice with a small
paper point.
Temporary restoration is placed.
Medicament is left in place for 1-
This document discusses stem cells and their role in operative dentistry and endodontics. It defines tissue engineering as using stem cells, growth factors, and scaffolds to develop biological substitutes. Regenerative endodontics aims to physiologically replace damaged tooth structures. Stem cells are undifferentiated cells that can self-renew and differentiate. Dental stem cells like dental pulp stem cells, stem cells from exfoliated deciduous teeth, stem cells from the apical papilla, and periodontal ligament stem cells show potential for regenerative applications like periodontal regeneration, bone regeneration, and salivary gland regeneration. Challenges to further development include controlling tooth size, root formation, and eruption for bio-tooth
Dedifferentiation is a term used to suggest that differentiated epithelial cells revert to a previous developmental stage before their subsequent differentiation into an alternative cell fate. Hereby we discuss about the phenomenon and their impact in medical applications.
Denise Resen will give an informative speech on dental stem cells. She will discuss what dental stem cells are, the benefits they provide, how they are harvested and stored, and when this new technology will be available. Dental stem cells are unspecified cells harvested from extracted teeth that can be stored for future use in treating diseases and regenerating tissues. They are an ethically preferable alternative to other stem cell sources and can now be collected and cryopreserved using kits available through dental offices.
International Journal of Pharmaceutical Science Invention (IJPSI)inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online
"Exploring Regenerative Endodontics: A Paradigm Shift in Root Canal Therapy" aims to delve into the groundbreaking approach of regenerative endodontics, which has revolutionized traditional root canal treatments. This presentation serves as a comprehensive guide for dental professionals, researchers, and students who are keen on understanding the shift towards biologically-based procedures designed to replace damaged tooth structures, including dentin and root structures, as well as cells of the pulp-dentin complex.
Key Points Covered:
Introduction to Traditional Endodontics: A brief overview of conventional root canal treatments, setting the stage for the limitations that regenerative endodontics aims to address.
Fundamentals of Regenerative Endodontics: Understand what regenerative endodontics is, its aims, and the principles guiding this new approach.
Materials and Techniques: Discover the novel materials and technologies used in regenerative endodontics including scaffolds, growth factors, and stem cells.
Clinical Applications and Benefits: Discuss various case studies and clinical trials that demonstrate the effectiveness and benefits of regenerative procedures.
Challenges and Future Prospects: A balanced view on the hurdles facing regenerative endodontics and what the future holds.
This presentation is essential viewing for anyone interested in the future of dental science and how regenerative approaches can offer effective and more natural alternatives to traditional endodontic treatments."
Feel free to modify this description to better suit your specific needs and focus points.
Artículos Científicos - Células Madre Dentales - BioEDEN MexicoBioEDEN Mexico
The document summarizes several scientific articles about the therapeutic potential of dental stem cells. It discusses how dental stem cells from teeth, both primary and permanent, can be extracted and multiplied in vitro to generate trillions of cells for therapeutic use. These stem cells are multipotent and can differentiate into various cell types like nerve cells, adipocytes, osteoblasts, chondrocytes, myocytes and odontoblasts. Due to their accessibility and high proliferation rates, dental stem cells are good candidates for tissue engineering and regenerative treatments. The document provides summaries of specific articles about using dental stem cells for conditions like skin regeneration, bone and craniofacial structure regeneration, cardiac regeneration, neurological problems, corneal regeneration and others
Articulos cientificos celulas madre dentales nuevoBioEDEN Mexico
The document discusses the potential therapeutic uses of stem cells derived from dental tissues. It provides an overview of several scientific articles on this topic, which found that dental stem cells can differentiate into various cell types, including nerve cells, adipocytes, osteoblasts, chondrocytes, myocytes and odontoblasts. The stem cells may be useful for dental tissue regeneration, bone and craniofacial structure regeneration, cardiac regeneration, neurological problems, corneal regeneration, skin regeneration, diabetes treatment, and hepatic regeneration among other applications. The document provides links to read full articles on stem cells from dental tissues and their potential to treat various medical conditions.
This document describes a retrospective study conducted at a tertiary care center that analyzed data on cases of osteomyelitis from 2006 to 2016. The study found that the number of female patients was equal to male patients, and most patients were between 30-45 years old. Unlike typical presentations where the mandible is more commonly affected, this study found that the maxilla was more commonly involved than the mandible. The posterior region of the maxilla was more frequently affected than the anterior region. The study aims to help optimize local treatment protocols by assessing epidemiological data from this specific tertiary care center.
Stem-cell therapy in medicine–how far we came and what we can expect?Apollo Hospitals
The name ‘stem-cell’ is making the news in recent times both for good and not. The current articles tries to give a snap shot of the scientific and clinical picture of stem-cells in medicine as of today and discuss what it have to offer in the to the mankind. The article discusses the characters and types of stem-cells, their current indication in therapeutics (both established and upcoming), as well as their use in research. It also gives a brief overview of the current laws guiding its use in clinical practice and the various cultural beliefs associated with the use of same.
Regenerative endodontics aims to regenerate damaged pulp and root structures through biologically-based procedures. Historically, studies in the 1960s-70s showed blood clots could induce tissue formation in root canals. Current methods include placing stem cells on scaffolds with growth factors in the root canal to regenerate the pulp-dentin complex. Triple antibiotic paste, calcium hydroxide, and MTA are used as antimicrobial medicaments. The protocol involves inducing bleeding into the root canal to form a blood clot which triggers regeneration. The goal is periradicular health and evidence of vital regenerated tissue through radiographic and clinical measures.
This study extracted mesenchymal stem cells from dental pulp tissue from a freshly extracted deciduous tooth. The cells were cultured and showed active growth over 35 days. Chromosome analysis of 25 and 100 cells at 20 and 35 days found no abnormalities. This establishes a method for extracting and culturing stem cells from deciduous teeth, a biological waste, for potential therapeutic applications. Further research with more samples and passage cultures is needed to validate producing these stem cells at larger scales.
Tissue Engineering: A New Era in DentistryFatima A
Tissue engineering uses stem cells, scaffolds, and growth factors to regenerate dental and oral tissues as an alternative to implants. Stem cells are isolated from dental tissues and seeded onto a scaffold to provide a structure for new tissue to grow. Growth factors stimulate cell growth and differentiation. The developing tissue is grown in a bioreactor, which supports cell growth, before implantation. Tissue engineering could help address limitations of dental materials and implants by regenerating lost tissues rather than replacing them. Ethical issues around cell sources and who receives treatments require consideration. Researchers believe tissue engineering may one day enable completely engineered replacement teeth.
This document summarizes a review article on regenerative endodontics using the cell homing technique. It provides an overview of the cell homing technique, which involves regeneration through chemotaxis of endogenous stem cells to the injury site. The document then reviews 9 clinical trials on regenerative endodontics using cell homing. The results show promise for immature teeth but are contradictory for mature teeth. Regenerative endodontics aims to regenerate damaged pulp tissues to preserve tooth vitality and sensitivity while avoiding necrosis.
This document provides an overview of regenerative endodontics, which aims to regenerate dental tissues through biologically-based procedures using stem cells, growth factors, and scaffolds. Key elements for pulp regeneration include reliable stem cell sources, such as dental pulp stem cells, growth factors to stimulate cell proliferation and differentiation, and appropriate scaffolds. Potential regenerative therapies include revascularization, stem cell therapy, scaffold implantation, and gene delivery. Measuring clinical outcomes and further applications are areas of future focus to develop regenerative endodontic therapies.
This document provides an overview of regenerative endodontics, which aims to regenerate dental tissues through biological procedures. The key elements required are stem cells, growth factors, and scaffolds. Stem cells that may be suitable include dental pulp stem cells, stem cells from exfoliated deciduous teeth, and stem cells of the apical papilla. Regenerative endodontic procedures seek to regenerate pulp-like tissues and stimulate further root development, offering improved outcomes over current treatments. Additional research is needed to develop these techniques for clinical use in regenerating damaged dental tissues.
This study evaluated the clinical outcomes and properties of periodontal ligament progenitor cells (PDLPs) for the treatment of periodontitis. Three patients with intrabony periodontal defects were treated by transplantation of autologous PDLPs cultured on a bone graft material. Clinical measurements over 32-72 months showed reduced probing depths and clinical attachment gains, indicating potential therapeutic benefits. In vitro analysis found that PDLPs showed characteristics similar to periodontal ligament stem cells (PDLSCs), including proliferation, mesenchymal surface marker expression, and multipotent differentiation, but lacked expression of the tendon marker scleraxis. This provides preliminary evidence that PDLP transplantation may be an effective and safe approach for periodontitis
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Are you looking for a long-lasting solution to your missing tooth?
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3. Each year approx $400 billion is spent treating Americans suffering some type of
tissues loss.
This includes
20000 organ transplants,
5,00000 joint replacement, and
millions of dental and oral craniofacial procedures, ranging from tooth
restorations to major reconstruction of facial soft and mineralized tissues.
INTRODUCTION
08/04/14 3YES YES WHY
4. I. The regeneration or replacement of oral tissues affected by inherited
disorders, trauma, and neoplastic or infectious diseases is expected to solve
many dental problems with in next 25 years.
II. As well as ability to stimulate endodontic regeneration
III. Replace diseased tissue
IV. Vaccinations against virus
V. Genetically altered diseased pathogens to help eradicate caries and
periodontitis
VI. Patient demand for tissue engineering therapy.
NEED FOR DEMAND
08/04/14 4YES YES WHY
5. Regenerative endodontic procedures can be defined as biologically based
procedures designed to replace damaged structures, including dentin and root
structures, as well as cells of the pulp-dentin complex.
Definition of tissue engineering
LANGER & VACANTI stated that it was “ an interdisciplinary field that
applies the principle of engineering and life sciences towards the
development of biological substitutes that restore, maintain, or improve
tissue function.”
Langer & vacanti tissue engineering, science 1993:260.920-6
08/04/14 5YES YES WHY
6. The objectives of regenerative endodontic procedure, are to
Regenerate pulp like tissue, ideally. The pulp -dentin complex
Regenerate damaged coronal dentin, such as following a caries exposure
Regenerate resorbed root, cervical or apical dentin.
OBJECTIVE
08/04/14 6YES YES WHY
7. The counterargument to the development of regenerative endodontic
procedures is In terms of esthetics. there is a potential risk that endodontic filling
materials and sealers may discolor the tooth crown.
van der Burgt TP. Plasschaert AJ .Tooth discoloration induced be
dental materials. Oral Surg Oral Med Oral Pathol 1995b,
666-9
In addition, an in vitro studies of endodontically treated human teeth found the
long-terns intracanal placement of calcium hydroxide may reduce the fracture
resistance of root dentin.
Doyon GE. Dumsha T, von Fraunhofer jA. Fracture resistance of human root dentin
exposed to intracanal calcium hydroxide J Endod 2005.31-895-708/04/14 7YES YES WHY
8. A retrospective study of tooth survival times following root canal filling
versus tooth restoration found that although root canal therapy
prolonged tooth survival, the removal of pulp in a compromised tooth
may still lead to tooth loss in comparison with teeth with normal tissues
Caplan DJ, cai J, yin G, While BA Root canal filled versus non-root canal
filled teeth, a retrospective comparison of survival times
J Public Health Dent 2005;65; 9o-6
08/04/14 8YES YES WHY
11. What Is a Stem Cell?
• Unspecialized cells
• Give rise to more than 250
specialized cells in the body
• Serve as the body’s repair system
– Renew itself
– Replenish other cells
08/04/14 11YES YES WHY
12. A stem cell is commonly defined as a cell that has the ability to continuously
divide and produce progeny cells that differentiate (develop) into various other
types of cells or tissues
The plasticity of the stem cell defines its ability to produce cells of different tissues
08/04/14 12YES YES WHY
13. What Are the Sources of
Mature Stem Cells?
Mature Body Tissues
08/04/14 13YES YES WHY
14. What Is a Treatment Example?
08/04/14 14YES YES WHY
15. Umbilical Cord & Placenta SC Research
• Isolated immediately following
birth
• Wharton’s Jelly showing promise
as a source
• More flexibility = some pluripotent
characteristics
• Research is limited but growing
08/04/14 15YES YES WHY
16. What Are the Sources of Early Stem Cells?
Somatic Cell Nuclear Transfer (SCNT)
08/04/14 16YES YES WHY
17. Where Are Early Stem Cells Found?
5 days of
development
Who did it first?
In 1998,
U. Wisconsin
research team
isolates stem cells
from
IVF-blastocysts
08/04/14 17YES YES WHY
18. How Big Is a Blastocyst?
08/04/14 18YES YES WHY
19. What Are the Characteristics?
Early stem cells are
pluripotent
Retain the special ability to
develop into nearly any
cell type
08/04/14 19YES YES WHY
21. In Summary: Two Major Types of SC
Mature Stem Cells Early Stem Cells
Adult (includes umbilical cord &
placenta)
Embryonic; blastocystic
Cells obtained from specific mature
body tissues, umbilical cord, placenta
Cells obtained from inner cell mass of
a blastocyst
Multipotent —
Give rise to multiple but limited cell
types
Pluripotent —
Flexible, give rise to
any cell type in the body
08/04/14 21YES YES WHY
22. Both Kinds of SCR are Needed
Mature Stem Cells Early Stem Cells
First isolated in 1960s First isolated in 1998
50+ years of research 9+ years of research
Federal Funding =
>$2.7 Billion (FY02-06)
Federal Funding =
$132 Million (FY02-06)
Results: 50+ human therapies Results: Only in animal trials; No
human trials
08/04/14 22YES YES WHY
24. However, the sourcing of embryonic stem cells is controversial and is
surrounded by ethical and legal issues, which reduces the attractiveness
of these cells for developing new therapies.
This explains why many researchers are now focusing attention on developing
stem cell therapies using postnatal stem cells donated by the patients
themselves or their close relatives.
08/04/14 24YES YES WHY
25. The application of postnatal stem cell therapy was launched in 1968,
when the first allogenic bone marrow transplant was successfully used in
the treatment of severe combined immunodeficiency
Kenny AB, Hitzig WH. Bone marrow transplantation for severe
combined immunodeficiency disease. Reported from 1968 to 1977.
Eur J Pediatr 1979;131:155–77.
08/04/14 25YES YES WHY
26. Since the 1970s, bone marrow transplants have been used
to successfully treat leukemia, lymphoma, various anemias, and genetic
Disorders
Postnatal stem cells have been sourced from umbilical cord blood, umbilical
cord, bone marrow, peripheral blood, body fat, and almost all body tissues
including the pulp tissue of teeth
Tsukamoto Y, Fukutani S, Shin-Ike T, et al. Mineralized
nodule formation by cultures of human dental pulp-derived
fibroblasts. Arch Oral Biol 1992;37:1045–55.
08/04/14 26YES YES WHY
27. One of the first stem cell researchers was Dr. John Enders, who received the
1954 Nobel Prize in medicine for growing polio virus in human embryonic
kidney cells
In 1998, Dr. James Thomson, isolated cells from the inner cell mass of the
early embryo and developed the first human embryonic stem cell lines
In 1998, Dr. John Gearhart derived human embryonic germ cells from cells in
fetal gonadal tissue (primordial germ cells)
08/04/14 27YES YES WHY
28. There is increased interest in autogenous postnatal stem cells as an
alternative source for clinical applications, because these cells are readily
available and have no immunogenicity issues, even though they may have
reduced plasticity.
Stem cells are often categorized by their source: The most practical
clinical application of a stem cell therapy would be to use a patient’s own
donor cells.
Autologous stem cells are obtained from the same individual to whom they
will be implanted.
08/04/14 28YES YES WHY
29. Stem cells could be taken from the
bone marrow
peripheral blood
fat removed by liposuction
the periodontal ligament
oral mucosa, or skin.
An example of an autologous cell bank is one that stores umbilical cord
stem cells
It may be possible to use neuronal stem cells from adipose fat as part of
regenerative medicine instead of bone marrow cells, possibly providing a
less painful and less threatening alternative collection method.
Seo BM, Miura M, Sonoyama W,
Coppe C, Stanyon R, Shi S. Recovery
of stem cells from cryopreserved
periodontal ligament. J Dent Res
2005;84:907–12.
08/04/14 29YES YES WHY
30. concern applies to very ill or elderly persons.
One potential disadvantage of harvesting cells from patients is that surgical
operations might lead to postoperative sequelae, such as donor site infection
To accomplish endodontic regeneration, the most promising cells are
autologous postnatal stem cells, because these appear to have the fewest
disadvantages that would prevent them from being used clinically
Nakashima M, Iohara K, Ishikawa M, et al. Stimulation of reparative dentin
formation by ex vivo gene therapy using dental pulp stem cells
electrotransfected with growth/differentiation factor 11 (Gdf11). Hum Gene
Ther 2004;15:1045–53.08/04/14 30YES YES WHY
31. Allogenic cells originate from a donor of the same species
Examples of donor allogenic cells include blood cells used for a
Blood transfusion
Bone marrow cells used for a bone marrow transplant
Donated egg cells used for in vitro transplantation
However, the most serious disadvantages of using preexisting cell lines from
donors to treat patients are the risks of immune rejection and pathogen
transmission
08/04/14 31YES YES WHY
32. The use of donated allogenic cells, such as dermal fibroblasts from human
foreskin, has been demonstrated to be immunologically safe and thus a
viable choice for tissue engineering of skin for burn victims
The FDA has approved several companies producing skin for burn victims
using donated dermal fibroblasts
The same technology may be applied to replace pulp tissues after root canal
therapy, but it has not yet been evaluated and published.
Slifkin M, Doron S, Snydman DR. Viral prophylaxis in organ
transplant patients. Drugs 2004;64:2763–92.
08/04/14 32YES YES WHY
33. Xenogenic cells are those isolated from individuals of another species.
Pig tooth pulp cells have been transplanted into mice, and these have formed
tooth crown structures (60, 61).
This suggests it is feasible to accomplish the reverse therapy, eventually using
donated animal pulp stem cells to create tooth tissues in humans.
However, many problems remain, such as the high potential for immune rejection
and pathogen transmission from the donor animal to the human recipient
Duailibi MT, Duailibi SE, Young CS, Bartlett JD, Vacanti JP, Yelick
PC. Bioengineered teeth from cultured rat tooth bud cells. J Dent
Res 2004;83:523– 8.
08/04/14 33YES YES WHY
35. The dental pulp contains a population of stem cells, called pulp stem cells or, in
the case of immature teeth, stem cells from human exfoliated deciduous teeth
Sometimes pulp stem cells are called odontoblastoid cells, because these cells
appear to synthesize and secrete dentin matrix like the odontoblast cells they
Replace
After severe pulp damage or mechanical or caries exposure, the odontoblasts
are often irreversibly injured beneath the wound site
08/04/14 35YES YES WHY
36. Odontoblasts are postmitotic terminally differentiated cells, and cannot
proliferate to replace subjacent irreversibly injured odontoblasts
It was proposed that the cells within the subodontoblast cell–rich layer or
zone of Hohl adjacent to the odontoblasts differentiate into odontoblastoids.
However, the purpose of these cells appears to be limited to an odontoblast-
supporting role, as the survival of these cells was linked to the survival of the
odontoblasts and no proliferative or regenerative activity was observed
08/04/14 36YES YES WHY
37. The use of tritiated thymidine to study cellular division in the pulp by
autoradiography after damage revealed a peak in fibroblast activity close to
the exposure site about 4 days after successful pulp capping of monkey
teeth
Labeling of specific cells among the fibroblasts and perivascular cells
shifted from low to high over time if the exposure was limited to the
odontoblastic layer and the cell-free zone
whereas labeling changed from high to low if the exposure was deep into
the pulpal tissue.
08/04/14 37YES YES WHY
38. This provided support for the theory that the progenitor stem cells for the
odontoblastoid cells are resident undifferentiated mesenchymal cells.
One of the most significant obstacles to overcome in creating replacement
pulp tissue for use in regenerative endodontics is to obtain progenitor pulp
cells that will continually divide and produce cells or pulp tissues that can be
implanted into root canal systems.
Possibilities are the development of an autogenous human pulp stem cell
line that is disease- and pathogen-free, and/or the development of a tissue
biopsy transplantation technique using cells from the oral mucosa, as
examples.
08/04/14 38YES YES WHY
39. Stem cells can be identified and isolated from mixed cell populations by four
commonly used techniques:
(a)staining the cells with specific antibody markers and using a flow cytometer,
in a process called fluorescent antibody cell sorting (FACS);
(b) Immunomagnetic bead selection;
(c) immunohistochemical staining; and
(d) Physiological and histological criteria, including phenotype (appearance),
(chemotaxis, proliferation, differentiation, and mineralizing activity.)
Stem Cell Identification
08/04/14 39YES YES WHY
40. Growth factors are proteins that bind to receptors on the cell and induce
cellular proliferation and/or differentiation
Many growth factors are quite versatile, stimulating cellular division in
numerous cell types, while others are more cell specific
For example, fibroblast growth factor (FGF) was found in a cow brain extract
by Gospadarowicz and colleagues (85) and tested in a bioassay which caused
fibroblasts to proliferate.
Growth Factors
08/04/14 40YES YES WHY
41. Currently, a variety of growth factors have been identified, with specific
functions that can be used as part of stem cell and tissue engineering
therapies
Many growth factors can be used to control stem cell activity, such as by
increasing the rate of proliferation,
inducing differentiation of the cells into another tissue type,
or stimulating stem cells to synthesize and secrete mineralized matrix
08/04/14 41YES YES WHY
45. An Overview of Potential Technologies for regenerative
Endodontics
These techniques are
Root canal revascularization via blood clotting,
Postnatal stem cell therapy,
Pulp implantation,
Scaffold implantation,
Injectable scaffold delivery,
Three-dimensional cell printing,
Gene delivery.
08/04/14 45YES YES WHY
46. Root canal revascularization via blood clotting
Several case reports have documented revascularization of necrotic root canal
systems by disinfection followed by establishing bleeding into the canal system
via overinstrumentation
An important aspect of these cases is the use of intracanal irrigants (NaOCl
and chlorhexdine) with placement of antibiotics (e.g. a mixture of ciprofloxacin,
metronidazole, and minocycline paste) for several weeks.
Banchs F, Trope M. Revascularization of immature permanent teeth with apical
periodontitis: new treatment protocol? J Endod 2004;30:196 –200.
08/04/14 46YES YES WHY
47. This particular combination of antibiotics effectively disinfects root canal
Systems and increases revascularization of avulsed and
necrotic teeth suggesting that this is a critical step in revascularization.
For example, tetracycline enhances the growth of host cells
on dentin, not by an antimicrobial action, but via exposure of embedded
collagen fibers or growth factors
it has been noted that reimplantation of avulsed teeth with an apical opening
of approximately 1.1 mm demonstrate a greater likelihood of
revascularization
08/04/14 47YES YES WHY
48. This finding suggests that revascularization of necrotic pulps with fully
formed (closed) apices might require instrumentation of the tooth apex to
approximately 1 to 2mm in apical diameter to allow systemic bleeding into
root canal systems.
The revascularization method assumes that the root canal space has been
disinfected and that the formation of a blood clot yields a matrix (e.g., fibrin)
that traps cells capable of initiating new tissue formation.
It is not clear that the regenerated tissue’s phenotype resembles dental pulp;
08/04/14 48YES YES WHY
49. however, case reports published to date do demonstrate continued root
formation and the restoration of a positive response to thermal pulp testing
Banchs F, Trope M. Revascularization of immature permanent teeth with apical
periodontitis: new treatment protocol? J Endod 2004;30:196 –200.
several advantages to a revascularization approach.
First, this approach is technically simple and can be completed using currently
available instruments and medicaments without expensive biotechnology.
Second, the regeneration of tissue in root canal systems by a patient’s own blood
cells avoids the possibility of immune rejection and pathogen transmission from
replacing the pulp with a tissue engineered construct.
08/04/14 49YES YES WHY
50. However, several concerns need to be addressed in prospective research. First,
the case reports of a blood clot having the capacity to regenerate pulp tissue are
exciting, but caution is required, because the source of the regenerated tissue
has not been identified.
Animal studies and more clinical studies are required to investigate the potential
of this technique before it can be recommended for general use in patients.
Generally, tissue engineering does not rely on blood clot formation, because the
concentration and composition of cells trapped in the fibrin clot is unpredictable.
08/04/14 50YES YES WHY
51. On the other hand, some aspects of this approach may be useful; plasma-
derived fibrin clots are being used for development as scaffolds in several
studies
Second, enlargement of the apical foramen is necessary to promote
vascularizaton and to maintain initial cell viability via nutrient diffusion.
Related to this point, cells must have an available supply of oxygen;
Llames SG, Del Rio M, Larcher F, et al. Human plasma as a dermal
scaffold for the generation of a completely autologous bioengineered skin.
Transplantation 2004;77:350 –5.
08/04/14 51YES YES WHY
53. The simplest method to administer cells of appropriate regenerative
potential is to inject postnatal stem cells into disinfected root canal
systems after the apex is opened.
Postnatal stem cells can be derived from multiple tissues,
including skin,
buccal mucosa,
fat, and bone
A major research obstacle is identification of a postnatal stem cell source
capable of differentiating into the diverse cell population found in adult pulp
(e.g., fibroblasts, endothelial cells, odontoblasts).
Postnatal Stem Cell Therapy
08/04/14 53YES YES WHY
54. Technical obstacles include the development of methods for harvesting
and any necessary ex vivo methods required to purify and/or expand cell
numbers sufficiently for regenerative endodontic applications.
One possible approach would be to use dental pulp stem cells derived from
autologous (patient’s own) cells that have been taken from a buccal mucosal
biopsy, or umbilical cord stem cells that have been cryogenically stored after
birth;
08/04/14 54YES YES WHY
55. several advantages to an approach using postnatal stem cells.
First, autogenous stem cells are relatively easy to harvest and to deliver by
syringe, and the cells have the potential to induce new pulp regeneration.
Second, this approach is already used in regenerative medical applications,
including bone marrow replacement, and a recent review has described
several potential endodontic applications
Nakashima M, Akamine A. The application of tissue engineering to
regeneration of pulp and dentin in endodontics. J Endod
2005;31:711– 8.08/04/14 55YES YES WHY
56. However, there are several disadvantages to a delivery method of
injecting cells.
First, the cells may have low survival rates.
Second, the cells might migrate to different locations within the body
possibly leading to aberrant patterns of mineralization.
A solution for this latter issue may be to apply the cells together with a
fibrin clot or other scaffold material.
08/04/14 56YES YES WHY
57. In general, scaffolds, cells, and bioactive signaling molecules are needed
to induce stem cell differentiation into a dental tissue type
Therefore, the probability of producing new functioning pulp tissue by
injecting only stem cells into the pulp chamber, without a scaffold or
signaling molecules, may be very low.
Instead, pulp regeneration must consider all three elements (cells, growth
factors, and scaffold) to maximize potential for success.
Nakashima M. Bone morphogenetic proteins in dentin
regeneration for potential use in endodontic therapy. Cytokine
Growth Factor Rev 2005;16:369 –76.
08/04/14 57YES YES WHY
59. The majority of in vitro cell cultures grow as a single monolayer attached to the
base of culture flasks.
However, some stem cells do not survive unless they are grown on top of a
layer of feeder cells
In all of these cases, the stem cells are grown in two dimensions.
In theory, to take two-dimensional cell cultures and make them three-
dimensional, the pulp cells can be grown on biodegradable membrane filters.
Pulp Implantation
08/04/14 59YES YES WHY
60. Many filters will be required to be rolled together to form a three dimensional
pulp tissue, which can be implanted into disinfected root canal systems.
The advantages of this delivery system are that the cells are relatively easy to
grow on filters in the laboratory.
Moreover, aggregated sheets of cells are more stable than dissociated cells
administered potential problems associated with the implantation of sheets of
cultured pulp tissue is that specialized procedures may be required to ensure
that the cells properly adhere to root canal walls.
08/04/14 60YES YES WHY
61. Sheets of cells lack vascularity, so only the apical portion of the canal
systems would receive these cellular constructs, with coronal canal systems
filled with scaffolds capable of supporting cellular proliferation
Because the filters are very thin layers of cells, they are extremely fragile,
and this could make them difficult to place in root canal systems without
breakage.
The cultured pulp tissue is grown in sheets in vitro on biodegradable
polymer nanofibers or on sheets of extracellular matrix proteins such as
collagen I or fibronectin
Fukuda J, Khademhosseini A, Yeh J, Engl G, Cheng J, Farokhzad OC,
Langer R. Micropatterned cell co-cultures using layer-by-layer deposition of
extracellular matrix components. Biomaterials 2006;27:1479–86
08/04/14 61YES YES WHY
62. The advantage of having the cells aggregated together is that it localizes the
postnatal stem cells in the root canal system.
The disadvantage of this technique is that implantation of sheets of cells may
be technically difficult. The sheets are very thin and fragile, so research
is needed to develop reliable implantation techniques.
The sheets of cells also lack vascularity,
Cells located more than 200 µm from the maximum oxygen diffusion distance
from a capillary blood supply are at risk of anoxia and necrosis
08/04/14 62YES YES WHY
64. To create a more practical endodontic tissue engineering therapy, pulp stem
cells must be organized into a three-dimensional structure that can support
cell organization and vascularization.
This can be accomplished using a porous polymer scaffold seeded with pulp
stem cells
A scaffold should contain growth factors to aid stem cell proliferation and
differentiation, leading to improved and faster tissue development
Nakashima M. Tissue engineering in endodontics. Aust Endod J
2005;31:111–3.
SCAFFOLD IMPLANTATION
08/04/14 64YES YES WHY
65. The scaffold may also contain nutrients promoting cell survival and growth and
possibly antibiotics to prevent any bacterial in-growth in the canal systems.
The engineering of nanoscaffolds may be useful in the delivery of
pharmaceutical drugs to specific tissues
In pulp-exposed teeth, dentin chips have been found to stimulate reparative
dentin bridge formation
Dentin chips may provide a matrix for pulp stem cell attachment and also be a
reservoir of growth factors
Kitasako Y, Shibata S, Pereira PN, Tagami J. Short-term dentin
bridging of mechanically- exposed pulps capped with adhesive
resin systems. Oper Dent 2000; 25:155– 62.08/04/14 65YES YES WHY
66. To achieve the goal of pulp tissue reconstruction, scaffolds must meet
some specific requirements.
Biodegradability is essential, since scaffolds need to be absorbed by the
surrounding tissues without the necessity of surgical removal
A high porosity and an adequate pore size are necessary to facilitate cell
seeding and diffusion throughout the whole structure of both cells and
nutrients
The rate at which degradation occurs has to coincide as much as possible
with the rate of tissue formation; this means that while cells are fabricating
their own natural matrix structure around themselves.
08/04/14 66YES YES WHY
67. Most of the scaffold materials used in tissue engineering have had a long history
of use in medicine as bioresorbable sutures and as meshes used in wound
dressings
The types of scaffold materials available are natural or synthetic, biodegradable
or permanent.
The synthetic materials include
polylactic acid (PLA),
polyglycolic acid (PGA), and
polycaprolactone (PCL)
which are all common polyester materials that degrade within the human body
08/04/14 67YES YES WHY
68. The principal drawbacks are related to the difficulties of obtaining high porosity
and regular pore size.
This has led researchers to concentrate efforts to engineer scaffolds at the
nanostructural level to modify cellular interactions with the scaffold
Scaffolds may also be constructed from natural materials
Several proteic materials, such as
collagen or fibrin,
Polysaccharidic materials, like chitosan or glycosaminoglycans (GAGs),
have not been well studied.
However, early results are promising in terms of supporting cell survival and
function
08/04/14 68YES YES WHY
70. Rigid tissue engineered scaffold structures provide excellent support
for cells used in bone and other body areas
In root canal systems a tissue engineered pulp is not required to provide
structural support of the tooth.
This will allow tissue engineered pulp tissue to be administered in a soft three-
dimensional scaffold matrix, such as a polymer hydrogel.
Hydrogels are injectable scaffolds that can be delivered by syringe (155, 156).
INJECTABLE SCAFFOLD DELIVERY
Trojani C, Weiss P, Michiels JF, et al. Three-dimensional culture and differentiation of
human osteogenic cells in an injectable hydroxypropylmethylcellulose hydrogel.
Biomaterials 2005;26:5509 –17.
08/04/14 70YES YES WHY
71. Hydrogels have the potential to be noninvasive and easy to deliver into root
canal systems.
In theory, the hydrogel may promote pulp regeneration by providing a
substrate for cell proliferation and differentiation into an organized tissue
structure
Past problems with hydrogels included limited control over tissue formation
and development, but advances in formulation have dramatically improved
their ability to support cell survival
Desgrandchamps F. Biomaterials in functional reconstruction. Curr Opin
Urol 2000;10:201– 6.
08/04/14 71YES YES WHY
72. Despite these advances, hydrogels at are at an early stage of research, and
this type of delivery system, although promising, has yet to be proven to be
functional in vivo.
To make hydrogels more practical, research is focusing on making them
photopolymerizable to form rigid structures once they are implanted into the
tissue site
08/04/14 72YES YES WHY
73. In theory, an ink-jet-like device is used to dispense layers of cells suspended
in a hydrogel to recreate the structure of the tooth pulp tissue.
The three-dimensional cell printing technique can be used to precisely
position cells (162), and this method has the potential to create tissue
constructs that mimic the natural tooth pulp tissue structure.
The ideal positioning of cells in a tissue engineering construct would include
placing odontoblastoid cells around the periphery to maintain and repair
dentin, with fibroblasts in the pulp core supporting a network of vascular and
nerve cells.
Three-Dimensional Cell Printing
08/04/14 73YES YES WHY
74. Theoretically, the disadvantage of
using the three-dimensional cell printing technique is that careful orientation
of the pulp tissue construct according to its apical and coronal asymmetry
would be required during placement into cleaned and shaped root canal
systems.
However, early research has yet to show that three-dimensional cell printing
can create functional tissue in vivo
08/04/14 74YES YES WHY
75. The year 2003 marked a major milestone in the realm of genetics and
molecular biology.
That year marked the 50th anniversary of the discovery of the double-helical
structure of DNA by Watson and Crick.
On April 14, 2003, 20 sequencing centers in five different countries
declared the human genome project complete.
This milestone will make possible new medical treatments involving gene
therapy (164).
08/04/14 75YES YES WHY
76. All human cells contain a 1-m strand of DNA containing 3 billion base
pairs, with the sole exception of nonnucleated cells, such as red blood
cells.
The DNA contains genetic sequences (genes) that control cell activity and
function; one of the most well known genes is p53
New techniques involving viral or nonviral vectors can deliver genes for
growth factors, morphogens, transcription factors, and extracellular
matrix molecules into target cell populations, such as the salivary gland
08/04/14 76YES YES WHY
77. Viral vectors are modified to avoid the possibility of causing disease, but still
retain the capacity for infection. Several viruses have been genetically
modified to deliver genes, including
retroviruses,
adenovirus,
adenoassociated virus,
herpes simplex virus, and
Lentivirus
Nonviral gene delivery systems include plasmids, peptides,
gene guns, DNA-ligand complexes,
electroporation, sonoporation, and cationic liposomes
08/04/14 77YES YES WHY
78. a literature search indicates there has been little or no research in this field,
except for the work of Rutherford
He transfected ferret pulps with cDNA-transfected mouse BMP-7 that failed
to produce a reparative response
The FDA did approve research into gene therapy involving terminally ill
humans, but approval was withdrawn in 2003 after a 9-year-old boy
receiving gene therapy was found to have developed tumors in different
parts of his body
Stolberg SG. Trials are halted on gene therapy: child in experiment
falls ill: new setback for research. NY Times 2002;A1, A25.
08/04/14 78YES YES WHY
80. A Call to Action: Research Priorities for Developing
Regenerative Endodontic Techniques
Improved Methods to Disinfect and Shape Root Canal Systems
The majority of the available evidence suggests that necrotic and infected
tooth pulp does not heal.
Therefore, in the foreseeable future, it will be necessary to disinfect the
root canal systems and remove infected hard and soft tissues before
using regenerative endodontic treatments.
08/04/14 80YES YES WHY
81. However, because of bacterial interactions, nutrient availability and low oxygen
potentials in root canal systems, the numbers of bacterial species present in
endodontic infections are restricted
These selective conditions lead to the predominance of facultative and strictly
anaerobic microorganisms that survive and multiply, causing infections that
stimulate local bone resorption
Disinfection is one of the main objectives of root canal preparation.
Thorough disinfection removes microorganisms, permits better adaptation of
filling materials, and enhances the action of the intracanal medicaments.
08/04/14 81YES YES WHY
82. The choice of an irrigant is of great importance, because the irrigant acts as a
lubricant during instrumentation, flushes debris and microorganisms out of the
canal, and reacts with pulp, necrotic tissues, and microorganisms and their
subproducts.
Sodium hypochlorite has been extensively used for several decades for this
purpose Its excellent properties of tissue dissolution and antimicrobial
Activity
even though it has several undesirable characteristics, such as tissue toxicity
at high concentrations and so forth
08/04/14 82YES YES WHY
83. Moreover, sodium hypochlorite does not totally clean the surfaces of the
root canal systems (180).
Chlorhexidine gluconate has been studied for its various properties,
antimicrobial activity and biocompatibility with the objective of evaluating it
as an alternative to sodium hypochlorite
Regenerative endodontics would benefit from a new generation of
irrigants that are as effective as current irrigants, but are nonhazardous
to patient tissues.
One such irrigation solution under development is based on a plant extract
08/04/14 83YES YES WHY
84. The presence of a smear layer on root canal walls may inhibit the
adherence of implanted pulp stem cells, potentially causing the regenerative
endodontic treatment to fail
Chemical chelating agents are used to remove the smear layer from root canal
walls, most commonly a 17% solution of ethylenediaminetetraacetic
acid (EDTA) that is applied as a final flush
MTAD is an aqueous solution of 3% doxycycline, 4.25% citric acid, and 0.5%
polysorbate 80 detergent .
This biocompatible intracanal irrigant is commercially available as a two-part set
that is mixed on demand
Smear Layer Removal
08/04/14 84YES YES WHY
85. The success of regenerative endodontic therapy is dependent on the ability of
researchers to create a technique that will allow clinicians to create a functional
pulp tissue within cleaned and shaped root canal systems.
The source of pulp tissue may be from root canal revascularization, which involves
enlarging the tooth apex to approximately 1 to 2 mm to allow bleeding into root
canals and generation of vital tissue that appears capable of forming hard tissue
under certain conditions;
Engineering a Functional Pulp Tissue
08/04/14 85YES YES WHY
86. stem cell therapy, involving the delivery of autologous or allogenic stem
cells into root canals; or pulp implantation, involving the surgical implantation
of synthetic pulp tissue grown in the laboratory.
Each of these techniques to regenerate pulp tissue will have advantages and
limitations that still have to be defined through basic science and clinical
Research.
08/04/14 86YES YES WHY
87. Delivery of regenerative endodontic procedures
A promising cellular source for regenerative endodontic procedures is
autogenous stem cells from oral mucosa.
The oral mucosa cells are readily accessible as a source of oral cells, which
avoids the problem of patients being required to store umbilical cord blood or
third molars immediately after extraction.
08/04/14 87YES YES WHY
88. The oral mucosa cells may be maintained using in vitro cell culture with
antibiotics to remove infection
The cells may then be seeded in the apical 1 to 3 mm of a tissue engineering
scaffold with the remaining coronal 15 mm containing an acellular scaffold that
supports cell growth and vascularization.
This tissue construct may involve
an injectable slurry of [hydrogelcellsX (growth factors, etc)] or
[hydrogel X (growth factors, etc.)],
then this twolayer method would be fairly easy to accomplish.
08/04/14 88YES YES WHY
89. Both these delivery methods reduce the need for an autogenous pulp stem
cell population that will not be readily available to endodontists, because the
teeth requiring treatment are presumably infected and necrotic.
This proposed delivery method would help avoid the potential for immune
and infection issues surrounding the use of an allogenic pulp stem cell line.
08/04/14 89YES YES WHY
90. Measuring Appropriate Clinical Outcomes
Once a tissue engineered pulp has been implanted, it is not ethical
to remove functioning tissues to conduct a histological analysis.
Therefore, it will not be possible to histologically investigate mineralizing
odontoblastoid cell functioning or nerve innervation.
Clinicians will have to rely on the noninvasive tests in use today, such as
laser Doppler blood flowmetry in teeth
pulp testing involving heat, cold, and electricity
lack of signs or symptoms.
Magnetic resonance
08/04/14 90YES YES WHY
91. Imaging (MRI) has shown the potential to distinguish between vital and
nonvital tooth pulps
The ideal clinical outcome is a nonsymptomatic tooth that never needs
retreatment,
but nonsubjective vitality assessment methods are essential to validate that
regenerative endodontic techniques are truly effective.
08/04/14 91YES YES WHY
92. Summary of the barriers to be addressed to permit the introduction
of regenerative endodontics
Disinfection and shaping of root canals in a fashion to permit regenerative
endodontics.
Chemomechanical debridement — cleaning and shaping root Canals
Irrigants — 6% sodium hypochlorite and 2% chlorhexidine gluconate and
alternatives
Medicaments — Calcium hydroxide, triple antibiotics, MTAD, and alternatives
08/04/14 92YES YES WHY
93. Creation of replacement pulp-dentin tissues
Pulp revascularization by apex instrumentation
Stem cells; allogenic, autologous, xenogenic, umbilical cord sources
Growth factors; BMP-2, -4, -7; TGF-B1,-B2,-B3 among others
Gene therapy; identification of mineralizing genes
Tissue engineering; cell culture, scaffolds, hydrogels
Delivery of replacement pulp-dentin tissues
08/04/14 93YES YES WHY
94. Surgical implantation methods
Injection site
Dental restorative materials
Improve the quality of sealing between restorative materials and dentin
Ensure long-term sealing to prevent recurrent pulpitis
Measuring appropriate clinical outcomes
Vascular blood flow
Mineralizing odontoblastoid cells
Intact afferent innervations
Lack of signs or symptoms
08/04/14 94YES YES WHY
95. The clinical success rates of endodontic treatments can exceed 90%
However, many teeth are not given the opportunity to be saved by endodontic
treatment and instead are extracted, with subsequent placement of an artificial
prosthesis, such as an implant.
Regenerative endodontic methods have the potential for regenerating both
pulp and dentin tissues and therefore may offer an alternative method to
save teeth that may have compromised structural integrity.
Conclusions
08/04/14 95YES YES WHY
96. Several developmental issues have been described to accomplish
endodontic regeneration.
Each one of the regenerative techniques has advantages and disadvantages,
and some of the techniques are hypothetical, or at an early stage of
development.
The available case reports of pulp revascularization were generally reported on
young patients (with high stem cell populations) and teeth with open apices.
However, for regenerative endodontic procedures to be widely available and
predictable, endodontists will have to depend on tissue engineering therapies
to regenerate pulp dentin tissue.
08/04/14 96YES YES WHY
97. The proposed therapies involving stem cells, growth factors, and tissue
engineering all require pulp re-vascularization, in itself an enormous challenge.
One of the most challenging aspects of developing a regenerative endodontic
therapy is to understand how the various component procedures can be
optimized and integrated to produce the outcome of a regenerated pulp-dentin
complex.
The future development of regenerative endodontic procedures
will require a comprehensive research program directed at each
of these components and their application to our patients.
08/04/14 97YES YES WHY
98. The authors believe that regenerative endodontics is an inevitable
therapy, and they call for action from scientists, funding agencies, and
the endodontic
profession to pool resources to hasten its development. The unleashed
potential of regenerative endodontics may benefit millions of patients
each year.
08/04/14 98YES YES WHY