Pulp Regeneration

Abstract

Pulp therapies imply indirect or direct pulp capping, vital pulp amputation, and treatment of non-vital teeth. Pulp necrosis therapy implicated pulp regeneration, in the crown and root(s). Dental stem cells isolated from permanent teeth and SHED from exfoliated deciduous teeth was used in order to regenerate the dental pulp. In the apical part of the root, the apical papilla stem cells (SCAP) include the cell-rich zone, and the adjacent apical papilla mesenchyme. The radicular dental pulp contributes to form either the reactionary parietal dentin or the reparative dentin. Stem cells moved laterally from the Höehl sub-odontoblastic border the odontoblasts located externally beneath the pre-dentin and the dentin. Afterwards, the stem cells are sliding of the root toward the crown. Following pulp penetration by cariogenic bacteria and the disinfection of the necrotic pulp the procedure consists in the mechanical enlargement of the root canal. Filling the pulp chamber by a continuous layer of pulp cells, linked by desmosome-like junctions, gap-and tight-junctions produce a hermetic seal of the cavity. A leak-tight filling associated with a biodegradable scaffold supports a permanent biological material closing the gap between the pulp chamber and secondary dentin. Cell-free scaffolds deliver bioactive molecules inducing cell differentiation. Pulp regeneration implicates tissue bioengineered. In the next future, this procedure may constitute a valid substitute to endodontic treatment.