Regenerative endodontics have gained much attention in the past decade because it offers an alternative approach in treating endodontically involved teeth. Instead of filling the canal space with artificial materials, it attempts to fill the canal with vital tissues. Regeneration is to regain the tissue and its function to the original state. In terms of pulp regeneration, a clinical protocol that intends to re-establish pulp/dentin tissues in the canal space has been developed, termed revitalization or revascularization. Histological studies from animal and human teeth receiving revitalization have shown that pulp regeneration is difficult to achieve. In tissue engineering, there are two approaches to regeneration tissues: cell-based and cell-free. The former involves transplanting exogenous cells into the host and the latter does not. Revitalization belongs to the latter approach.
A number of crucial concepts have not been well discussed, noted or understood in the field of regenerative endodontics when dealing with pulp/dentin regeneration: i) critical size defect of dentin and pulp; ii) cell lineage commitment to odontoblasts; iii) regeneration vs repair; and iv) hurdles of cell-based pulp regeneration for clinical applications. This review article will elaborate and analyze at cellular and molecular levels these missing concepts and some of which will explain why the non-cell-based revitalization procedure is difficult to establish pulp/dentin regeneration. Although cell-based approach has been proven to regenerate pulp/dentin, such an approach will face barriers. The key hurdle being the shortage of the current good manufacturing practice (cGMP) facilities which is discussed herein.
Considerable excitement exists for developing dental applications that employ post-natal stem cells and concepts of tissue engineering. Although much remains to be done to advance this field, progress has been made in clinical regenerative endodontic procedures: literally, saving teeth by regenerating a functional pulp-dentin complex. This program will describe the current status of regenerative endodontic procedures, their potential and predictors of healing success. Both clinical and basic studies will be reviewed to provide the practitioner with the latest information on this field with an emphasis on practical steps to apply these procedures in treating selected patients.
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Dr. Kenneth Hargreaves has no relevant commercial relationships.
Dr. George Huang has no relevant commercial relationships.
7703 Floyd Curl Drive
San Antonio, TX 78229-3900
Ken Hargreaves received his DDS from Georgetown University, his PhD in physiology from the Uniformed Services University of the Health Sciences in Bethesda, MD, and his certificate in Endodontics from the University of Minnesota. Ken spent 5 years at the Pain Clinic of the NIDCR and 7 years as an associate professor of Endodontics and Pharmacology at the University of Minnesota. He joined the University of Texas Health Science Center at San Antonio in 1997, as professor and Chair of the Department of Endodontics and is cross-appointed as professor in the Departments of Pharmacology, Physiology and Surgery. He maintains a private practice limited to endodontics and is a Diplomate of the American Board of Endodontists. Ken has received an NIH MERIT Award for research, two IADR Distinguished Scientist Awards and the Louis I. Grossman Award from the AAE. He has published more than 160 articles and, with Harold Goodis and Frank Tay, co-edited the 2nd edition Seltzer and Bender's Dental Pulp, and, with Steve Cohen and Lou Berman, co-edited the 10th edition of Cohen's Pathways of the Pulp. Ken also serves as editor of the Journal of Endodontics.
19 S. Manassas St. Lab Rm 255, office 256
Memphis, Tennessee 38163
Dr. Huang is a board certified endodontist, currently Professor and Director for Stem Cells and Regenerative Therapies, Department of Bioscience Research at UTHSC, College of Dentistry. He is the former Chair/Herbert Schilder Professor in Endodontics, at Boston University, also a former Chair in Endodontics at Columbia University. Dr. Huang has published more than 170 research articles, abstracts, review articles, including papers in Stem Cells, Stem Cells and Development, Stem Cell Research and Therapy, Tissue Engineering, Regenerative Medicine, Infection and Immunity, Human Gene Therapy, Journal of Dental Research, Journal of Endodontics, etc; book chapters in books such as Ingle’s Endodontics, Cohen’s Pathways of the Pulp, Endodontic Microbiology, Principles of Regenerative Medicine, Tissue Engineering and Regenerative Dentistry, Tissue-Specific Stem Cell Niche, Material-Tissue Interfacial Phenomena, etc; and co-edited with Dr. Irma Thesleff and wrote chapters for the text book “Stem cells, craniofacial development and regeneration”, in 2013, published by Wiley-Blackwell. His research has been funded by various sources including NIH and AAE Foundation. His current research interest is in the area of stem cells and regenerative medicine. He is the recipient of the 2015 IADR Distinguished Scientist Award in Pulp Biology and Regeneration.
Original Release Date: September 13, 2014
Review Date: TBD
*Expiration Date: September 13, 2017
*Self-instructional activities are reviewed at least once every three years, or more frequently if indicated by new scientific developments, to ensure that content is current and accurate.
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