Fawzy El-Sayed Karim M, Jakusz Kimberley, Jochens Arne, Dörfer Christof, Schwendicke Falk
1 Clinic for Conservative Dentistry and Periodontology, Christian-Albrechts-Universität Kiel , Kiel, Germany .
2 Oral Medicine and Periodontology Department, Faculty of Oral and Dental Medicine, Cairo University , Giza, Egypt .
Tissue Eng Part B Rev. 2015 Oct;21(5):451-60. doi: 10.1089/ten.TEB.2014.0675. Epub 2015 Jul 8.
For treating pulpal pathological conditions, pulpal regeneration through transplanted stem/progenitor cells might be an alternative to conventional root canal treatment. A number of animal studies demonstrated beneficial effects of stem/progenitor cell transplantation for pulp-dentin complex regeneration, that is, pulpal tissue, neural, vascular, and dentinal regeneration. We systematically reviewed animal studies investigating stem/progenitor cell-mediated pulp-dentin complex regeneration. Studies quantitatively comparing pulp-dentin complex regeneration after transplantation of stem/progenitor cells versus no stem/progenitor cell transplantation controls in intraoral in vivo teeth animal models were analyzed. The following outcomes were investigated: regenerated pulp area per root canal total area, capillaries per total surface, regenerated dentinal area per total defect area, and nerves per total surface. PubMed and EMBASE were screened for studies published until July 2014. Cross-referencing and hand searching were used to identify further articles. Standardized mean differences (SMD) and 95% confidence intervals (95% CI) were calculated using random-effects meta-analysis. To assess possible bias, SYRCLE's risk of bias tool for animal studies was used. From 1364 screened articles, five studies (representing 64 animals) were included in the quantitative analysis. Risk of bias of all studies was high. Stem/progenitor cell-transplanted pulps showed significantly larger regenerated pulp area per root canal total area (SMD [95% CI]: 2.28 [0.35-4.21]) and regenerated dentin area per root canal total area (SMD: 6.91 [5.39-8.43]) compared with no stem/progenitor cell transplantation controls. Only one study reported on capillaries per or nerves per total surface and found both significantly increased in stem/progenitor cell-transplanted pulps compared with controls. Stem/progenitor cell transplantation seems to enhance pulp-dentin complex regeneration in animal models. Due to limited data quantity and quality, current evidence levels are insufficient for further conclusions.
对于治疗牙髓病理性疾病，通过移植干细胞/祖细胞实现牙髓再生可能是传统根管治疗的一种替代方法。多项动物研究证明了干细胞/祖细胞移植对牙髓-牙本质复合体再生的有益作用，即牙髓组织、神经、血管和牙本质再生。我们系统回顾了调查干细胞/祖细胞介导的牙髓-牙本质复合体再生的动物研究。分析了在口腔内体内牙齿动物模型中对干细胞/祖细胞移植与未进行干细胞/祖细胞移植对照后牙髓-牙本质复合体再生进行定量比较的研究。研究了以下结果：每根管总面积的再生牙髓面积、每总表面积的毛细血管数、每总缺损面积的再生牙本质面积以及每总表面积的神经数。检索了截至2014年7月发表的PubMed和EMBASE数据库中的研究。通过交叉引用和手工检索来识别更多文章。使用随机效应荟萃分析计算标准化均值差（SMD）和95%置信区间（95%CI）。为评估可能的偏倚，使用了SYRCLE的动物研究偏倚风险工具。从1364篇筛选文章中，五项研究（代表64只动物）纳入定量分析。所有研究的偏倚风险都很高。与未进行干细胞/祖细胞移植的对照相比，并干细胞/祖细胞移植的牙髓每根管总面积的再生牙髓面积（SMD[95%CI]：2.28[0.35 - 4.21]）和每根管总面积的再生牙本质面积（SMD：6.91[5.39 - 8.43]）显著更大。只有一项研究报告了每总表面积的毛细血管数或神经数，发现与对照相比，干细胞/祖细胞移植的牙髓中两者均显著增加。干细胞/祖细胞移植似乎能增强动物模型中的牙髓-牙本质复合体再生。由于数据数量和质量有限，目前的证据水平不足以得出进一步结论。
