Dental Pulp Cell Biology: Stem Cells and Regenerative Endodontics By Candace DeVeaux DDS
Transcript
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By Candace DeVeaux DDS
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Objectives Identify the cells found in the dental pulp and
their function Understand what a stem cell is, its function, and
location Understand the stem cells role in regeneration of
teeth-pulp
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Cell types found in the dental pulp Odontoblasts Fibroblasts
Axons Endothelial Cells Schwann Cells Immune Cells Smooth Muscle
Stem Cells
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Cell types found in the dental pulp Odontoblasts Specialized
cells that deposit dentin lining the outer portion of the pulp
Fibroblasts The most abundant cells of the cell rich zone Coronal
pulp (abundant) Pulp proper Form a network within the extracellular
matrix components and produce a range of extracellular matrix
components ie. Collagen
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Cell types found in the dental pulp Axons Plexus of Raschkow
Schwann Cells Plexus of Raschkow
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Cell types found in the dental pulp Immune Cells Lymphocytes B
Cells T Cells Macrophages Dendritic Cells Endothelial cells Various
epithelial and mesenchymal Cells Jontell 1998 Smooth Muscle
Pericytes and myofibroblasts have been identified in mineralized
human pulp culture. (Alliot-Licht 2001)
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STEM CELLS Different Types of Stem Cells Embryonic Stem Cells
Adult/Tissue Specific Stem Cells Induced Stem Cells WHAT ARE STEM
CELLS? A CELL WHOSE DAUGHTER CELLS MAY DIFFERENTIATE INTO OTHER
CELL TYPES Stedmans Medical Dictionary defines it as a Pre-cursor
Cell
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STEM CELL USE IN REGENERATIVE ENDODONTICS What is Regenerative
Endodontics? An alternative treatment approach to conventional
Endodontic Therapy Goal- Restore Pulpal Function and complete root
development Revascularization vs. Regeneration
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Clinical Considerations 1. Young patient 2. Necrotic pulp and
immature apex 3. Minimal or no instrumentation of the dentinal
walls 4. Placement of an intracanal medicament 5. Creation of a
blood clot or protein scaffold in canal 6. Effective coronal
seal
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STEM CELLS WHAT IS TISSUE ENGINEERING? INTEGRATION OF
BIOLOGICAL AND ENGINEERING PRINCIPLES, to develop substitutes to
restore normal function. KEY ELEMENTS
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STEM CELLS What type are found in the tooth? 1) Dental Pulp
Stem Cells 2) Stem Cells from human- exfoliated deciduous teeth 3)
Periodontal Ligament Stem Cells 4) Dental Follicle Progenitor Stem
Cells 5) Stem Cells from apical papilla
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How the Stem Cells are identified Stem cell markers Genes and
their protein products used by scientists to isolate and identify
stem cells Various markers for Odontoblasts ALP DMP1/DMP2 DPP DSP
DSPP Enamelysin Example:
Figure. Dentin secretion and odontoblast activity are related
to gene and cascade pathway regulation. Simon S et al. ADR
2011;23:340-345 Copyright by International & American
Associations for Dental Research
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So What Regenerates? Histologically? Pulp-like tissue
Cementum-like tissue Bone-like tissue How ? Growth Factors -
Proteins that binds to the cell and act as signals to induce
intracellular proliferation and/or differentiation.
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Growth Factors Examples found in the pulp: 1.Bone morphogenic
protein 2.TGF- 3.FGF
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Goal of Regenerative endodontics Tooth is asymptomatic and
functional Radiographic evaluation: 6-12 months * Resolution of
periapical radiolucency * May see increased dentinal wall thickness
12-24 months * Increased dentinal wall thickness * Increased root
length
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Clinical Procedures
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REFERENCES Hargreaves, KM, Giesler T, Henry M., et al.
Regeneration potential of the young permanent tooth: what does the
future hold? J Endod 2008; 34:S51-6 Smith AJ, Scheven BA, Takahashi
Y, et al. Dentine as a bioactive extracellular matrix. Arch Oral
Biol 2012; 57:109-21 Sun HH, Jin T, Yu Q, et al. Biological
approaches toward dental pulp regeneration by tissue engineering.
J. Tissue Eng. Regen. Med 2011; 5 e1-16. Regeneration of tooth pulp
and dentin : trends and advances Sarang Sharma1, Vimal Sikri2, Neel
Kamal Sharma3, Vivek M. Sharma4 Sedgley CM, Botero TM. Dental stem
sells and their sources. Dent Clin North Am 2012;56:549-61 Bohl,
KS, Shon J. Rutherford B. et al. Role of Synthetic Extracellular in
development of engineered pulp. J. Biometer Sci. Polym Ed. 1998;9:
749-64