Asgary Saeed, Eghbal Mohammad Jafar, Shamszadeh Sayna
Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science Tehran, Iran.
Am J Stem Cells. 2024 Jun 15;13(3):110-131. doi: 10.62347/HENE2422. eCollection 2024.
Dentin-pulp regeneration through stem/progenitor cell transplantation represents a promising frontier in regenerative endodontics. This systematic review meticulously evaluates animal studies to investigate the efficacy of stem cell therapy in repairing/regenerating the dentine-pulp complex in mature/immature animal teeth. Employing a comprehensive electronic search of PubMed and Scopus databases up to October 2023, relevant English studies were identified/assessed. Evaluation parameters encompassed radiographic and histological assessments of dentin-pulp complex formation. Outcome measures included pulp-like and dentin-like tissues regeneration, apical healing, dentin thickening, apical closure, and dentinal bridge formation. The risk-of-bias assessment adhered to the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) guidelines. Out of 3250 identified articles, 23 animal experiments were included, categorized into regenerative procedures in mature teeth (n=11), regenerative procedures in immature teeth (n=4), and vital pulp therapy (n=8). Despite the promising potential, the bias in the included studies was high. Notably, Various scaffolds, and growth factors were employed, highlighting the heterogeneity across the studies. Dental pulp stem cells (DPSCs) and bone marrow stem cells, especially specific subfractions, demonstrated notable regenerative potential: hypoxic conditions and extracellular vesicles from preconditioned DPSCs enhanced regeneration, with considerations of cell fate. Donor age impacted regeneration, and challenges persisted in pulpotomy and direct pulp capping. Scaffold and growth factor choices influenced outcomes, underscoring the need for standardized strategies. Despite the promise, clinical viability faces hurdles, necessitating further investigation into adverse effects, optimized scaffolds, and regulatory considerations. This systematic review illuminates the potential of stem cell transplantation for dentin-pulp complex regeneration. The overall evidence quality, influenced by study heterogeneity and biases, underscores the need for cautious interpretation of findings. Future studies should refine methodologies and establish reliable histological parameters for meaningful advancements in dentin-pulp regeneration.
通过干细胞/祖细胞移植实现牙本质-牙髓再生是再生牙髓病学中一个充满前景的前沿领域。本系统评价精心评估动物研究，以探究干细胞疗法在修复/再生成熟/未成熟动物牙齿的牙本质-牙髓复合体方面的疗效。通过对截至2023年10月的PubMed和Scopus数据库进行全面的电子检索，确定并评估了相关的英文研究。评估参数包括对牙本质-牙髓复合体形成的影像学和组织学评估。结果指标包括牙髓样和牙本质样组织再生、根尖愈合、牙本质增厚、根尖闭合和牙本质桥形成。偏倚风险评估遵循实验动物系统评价中心（SYRCLE）指南。在3250篇已识别的文章中，纳入了23项动物实验，分为成熟牙齿的再生程序（n=11）、未成熟牙齿的再生程序（n=4）和活髓治疗（n=8）。尽管潜力巨大，但纳入研究中的偏倚程度较高。值得注意的是，使用了各种支架和生长因子，凸显了各研究之间的异质性。牙髓干细胞（DPSCs）和骨髓干细胞，尤其是特定亚群，显示出显著的再生潜力：低氧条件和预处理DPSCs的细胞外囊泡可增强再生，并考虑细胞命运。供体年龄影响再生，并且在牙髓切断术和直接盖髓方面仍存在挑战。支架和生长因子的选择会影响结果，强调了标准化策略的必要性。尽管前景广阔，但临床可行性面临障碍，需要进一步研究不良反应优化支架和监管方面的考虑因素。本系统评价阐明了干细胞移植用于牙本质-牙髓复合体再生的潜力。受研究异质性和偏倚影响的总体证据质量强调了对研究结果进行谨慎解读的必要性。未来的研究应改进方法，并建立可靠的组织学参数，以推动牙本质-牙髓再生取得有意义的进展。
