Sanz José Luis, Forner Leopoldo, Almudéver Alicia, Guerrero-Gironés Julia, Llena Carmen
Dental Pathology and Therapeutics Unit, Department of Stomatology, Universitat de València, 46010 Valencia, Spain.
Special Care and Gerodontology Unit, Department of Stomatology, University of Murcia, 30100 Murcia, Spain.
Materials (Basel). 2020 Feb 21;13(4):974. doi: 10.3390/ma13040974.
Blood clot formation in the apical third of the root canal system has been shown to promote further root development and reinforcement of dentinal walls by the deposition of mineralized tissue, resulting in an advancement from traditional apexification procedures to a regenerative endodontic treatment (RET) for non-vital immature permanent teeth. Silicate-based hydraulic biomaterials, categorized as bioactive endodontic cements, emerged as bright candidates for their use in RET as coronal barriers, sealing the previously induced blood clot scaffold. Human stem cells from the apical papilla (hSCAPs) surviving the infection may induce or at least be partially responsible for the regeneration or repair shown in RET. The aim of this study is to present a qualitative synthesis of available literature consisting of in vitro assays which analyzed the viability and stimulation of hSCAPs induced by silicate-based hydraulic biomaterials. A systematic electronic search was carried out in Medline, Scopus, Embase, Web of Science, Cochrane and SciELO databases, followed by a study selection, data extraction, and quality assessment following the PRISMA protocol. In vitro studies assessing the viability, proliferation, and/or differentiation of hSCAPs as well as their mineralization potential and/or osteogenic, odontogenic, cementogenic and/or angiogenic marker expression in contact with commercially available silicate-based materials were included in the present review. The search identified 73 preliminary references, of which 10 resulted to be eligible for qualitative synthesis. The modal materials studied were ProRoot MTA and Biodentine. Both bioceramic materials showed significant positive results when compared to a control for hSCAP cell viability, migration, and proliferation assays; a significant up-regulation of hSCAP odontogenic/osteogenic marker (ALP, DSPP, BSP, Runx2, OCN, OSX), angiogenic growth factor (VEGFA, FIGF) and pro-inflammatory cytokine (IL-1α, IL-1β, IL-6, TNF-α) expression; and a significant increase in hSCAP mineralized nodule formation assessed by Alizarin Red staining. Commercially available silicate-based materials considered in the present review can potentially induce mineralization and odontogenic/osteogenic differentiation of hSCAPs, thus prompting their use in regenerative endodontic procedures.
研究表明，根管系统根尖三分之一处形成血凝块可促进进一步的牙根发育，并通过矿化组织的沉积强化牙本质壁，从而使非活髓未成熟恒牙的治疗从传统的根尖诱导成形术发展为再生性牙髓治疗（RET）。基于硅酸盐的水硬性生物材料，归类为生物活性牙髓粘固剂，作为冠部屏障用于RET中，封闭先前诱导形成的血凝块支架，成为了备受瞩目的候选材料。来自根尖乳头的人类干细胞（hSCAPs）在感染后存活下来，可能会诱导RET中显示的再生或修复，或者至少对此负有部分责任。本研究的目的是对现有文献进行定性综合分析，这些文献包括体外试验，分析了基于硅酸盐的水硬性生物材料对hSCAPs的活力和刺激作用。在Medline、Scopus、Embase、Web of Science、Cochrane和SciELO数据库中进行了系统的电子检索，随后按照PRISMA方案进行研究选择、数据提取和质量评估。本综述纳入了评估hSCAPs活力、增殖和/或分化以及它们与市售基于硅酸盐的材料接触时的矿化潜力和/或成骨、成牙本质、成牙骨质和/或血管生成标志物表达的体外研究。检索确定了73篇初步参考文献，其中10篇符合定性综合分析的条件。研究的主要材料是ProRoot MTA和Biodentine。与对照组相比，这两种生物陶瓷材料在hSCAP细胞活力、迁移和增殖试验中均显示出显著的阳性结果；hSCAP成牙本质/成骨标志物（碱性磷酸酶、牙本质涎磷蛋白、骨涎蛋白、Runx2、骨钙素、Osterix）、血管生成生长因子（血管内皮生长因子A、成纤维细胞生长因子18）和促炎细胞因子（白细胞介素-1α、白细胞介素-1β、白细胞介素-6、肿瘤坏死因子-α）表达显著上调；通过茜素红染色评估，hSCAP矿化结节形成显著增加。本综述中考虑的市售基于硅酸盐的材料可能会诱导hSCAPs矿化和成牙本质/成骨分化，因此促使它们在再生性牙髓治疗程序中得到应用。
