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LETTER TO EDITOR Table of Contents   
Year : 2009  |  Volume : 20  |  Issue : 4  |  Page : 517-518
Regenerative endodontics: A paradigm shift in dental practice


Department of Conservative Dentistry and Endodontics, K.D. Dental College and Hospital, Mathura - 281 006, Uttar Pradesh, India

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Date of Web Publication29-Jan-2010
 

How to cite this article:
Hans MK, Shetty S. Regenerative endodontics: A paradigm shift in dental practice. Indian J Dent Res 2009;20:517-8

How to cite this URL:
Hans MK, Shetty S. Regenerative endodontics: A paradigm shift in dental practice. Indian J Dent Res [serial online] 2009 [cited 2019 Nov 13];20:517-8. Available from: http://www.ijdr.in/text.asp?2009/20/4/517/59433
Sir,

Regenerative endodontic procedures can be defined as biological procedures designed to replace damaged structures, including dentin and root structures, as well as cells of the pulp-dentin complex. Dr. B.W. Hermann was the first clinician to carry out regenerative endodontic procedures, when he applied Ca(OH) 2 in a case report of vital pulp amputation. [1] Subsequent regenerative dental procedures include the development of guided tissue or bone regeneration (GTR, GBR) procedures and distraction osteogenesis; [2] the application of platelet rich plasma (PRP) for bone augmentation, [3] emdogain for periodontal tissue regeneration, [4] recombinant human bone morphogenic protein (rhBMP) for bone augmentation; [5] and preclinical trials on the use of fibroblast growth factor 2 (FGF2) for periodontal tissue regeneration. [6]

Stem cell biology has become an area of importance to understand tissue regeneration, although much knowledge in this area has been from the in vitro studies. In general, stem cells are defined by having two major properties: (1) they are capable of self-renewal and (2) when they divide, some daughter cells give rise to cells that eventually differentiate. To date, four types of human dental stem cells have been isolated and characterized: (i) dental pulp stem cells (DPSCs), [7] (ii) stem cells from exfoliated deciduous teeth (SHED), [8] (iii) stem cells from apical papilla (SCAP), [9],[10] and (iv) periodontal ligament stem cells (PDLSCs). [11] Among them, all except SHED are from permanent teeth. These dental stem cells are considered mesenchymal stem cells (MSCs) and possess different levels of capacities to become specific tissue forming cells. DPSCs and SHED are from the pulp; SCAP is from the pulp precursor tissue, apical papilla. These ex vivo expanded cells can differentiate into odontoblast-like cells and produce dentin-like tissue in both in vitro and in vivo study systems. When grown in cultures and induced under specific conditions, DPSCs and SHED can differentiate into neuronal and adipogenic cells in addition to dentinogenic cells. [8],[12]

The modern concept of medicine emphasizes on prevention and reversal of diseases. Only when these attempts fail we take on the unfavorable approaches, i.e., surgical intervention and restoration with artificial prostheses. Utilization of stem cells to regenerate the lost tissues may, thereby, reverse tissues to their normal state. Regenerative endodontics deals with the healing of impaired dental tissues including dentin, pulp, cementum and periodontal tissues. The endodontic community is highly motivated in the promotion of tissue regeneration research and practice. [13] Several major areas of research might have application in the development of regenerative endodontic techniques. These techniques are (a) root canal revascularization via blood clotting, (b) postnatal stem cell therapy, (c) pulp implantation, (d) scaffold implantation, (e) injectable scaffold delivery, (f) three-dimensional cell printing, and (g) gene delivery. [13]

Although the challenges of introducing endodontic tissue engineering therapies are substantial, the potential benefits to patients and the profession are groundbreaking.

 
   References Top

1.Hermann BW. On the reaction of the dental pulp to vital amputation and calxyl capping. Dtsch Zahnarztl Z 1952;7:1446-7.   Back to cited text no. 1  [PUBMED]    
2.Block MS, Cervini D, Chang A, Gottsegen GB. Anterior maxillary advancement using tooth-supported distraction osteogenesis. J Oral Maxillofac Surg 1995;53:561-5.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]  
3.Kassolis JD, Rosen PS, Reynolds MA. Alveolar ridge and sinus augmentation utilizing platelet-rich plasma in combination with freeze-dried bone allograft: Case series. J Periodontol 2000;71:1654-61.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]  
4.Heijl L, Heden G, Svärdström G, Ostgren A. Enamel matrix derivative (EMDOGAIN) in the treatment of intrabony periodontal defects. J Clin Periodontol 1997;24:705-14.  Back to cited text no. 4      
5.Fujimura K, Bessho K, Kusumoto K, Ogawa Y, Iizuka T. Experimental studies on bone inducing activity of composites of atelopeptide type I collagen as a carrier for ectopic osteoinduction by rhBMP-2. Biochem Biophys Res Commun 1995;208:316-22.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]  
6.Takayama S, Murakami S, Shimabukuro Y, Kitamura M, Okada H. Periodontal regeneration by FGF-2 (bFGF) in primate models. J Dent Res 2001;80:2075-9.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]  
7.Gronthos S, Mankani M, Brahim J, Robey PG, Shi S. Postnatal human dental pulp stem cells (DPSCs) in vitro and in vivo. Proc Natl Acad Sci U S A 2000;97:13625-30.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]  
8.Miura M, Gronthos S, Zhao M, Lu B, Fisher LW, Robey PG, et al. SHED: stem cells from human exfoliated deciduous teeth. Proc Natl Acad Sci U S A 2003;100:5807-12.  Back to cited text no. 8  [PUBMED]  [FULLTEXT]  
9.Sonoyama W, Liu Y, Fang D, Yamaza T, Seo BM, Zhang C, et al. Mesenchymal stem cell-mediated functional tooth regeneration in Swine. PLoS One 2006;1:e79.  Back to cited text no. 9  [PUBMED]  [FULLTEXT]  
10.Sonoyama W, Liu Y, Yamaza T, Tuan RS, Wang S, Shi S, et al. Characterization of the apical papilla and its residing stem cells from human immature permanent teeth: A pilot study. J Endod 2008;34:166-71.  Back to cited text no. 10      
11.Seo BM, Miura M, Gronthos S, Bartold PM, Batouli S, Brahim J, et al. Investigation of multipotent postnatal stem cells from human periodontal ligament. Lancet 2004;364:149-55.  Back to cited text no. 11  [PUBMED]  [FULLTEXT]  
12.Gronthos S, Brahim J, Li W, Fisher LW, Cherman N, Boyde A, et al. Stem cell properties of human dental pulp stem cells. J Dent Res 2002;81:531-5.   Back to cited text no. 12  [PUBMED]  [FULLTEXT]  
13.Murray PE, Garcia-Godoy F, Hargreaves KM. Regenerative endodontics: A review of current status and a call for action. J Endod 2007;33:377-90.  Back to cited text no. 13  [PUBMED]  [FULLTEXT]  

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Correspondence Address:
Manoj Kumar Hans
Department of Conservative Dentistry and Endodontics, K.D. Dental College and Hospital, Mathura - 281 006, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.59433

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This article has been cited by
1 Mesenchymal stem cells derived from dental tissues
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2 Mesenchymal stem cells derived from dental tissues
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