Endodontic regeneration: hard shell, soft core
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REVIEW ARTICLE
Endodontic regeneration: hard shell, soft core Matthias Widbiller1 · Gottfried Schmalz1,2 Received: 9 October 2020 / Accepted: 16 November 2020 © The Author(s) 2020
Abstract A loss of organs or the destruction of tissue leaves wounds to which organisms and living things react differently. Their response depends on the extent of damage, the functional impairment and the biological potential of the organism. Some can completely regenerate lost body parts or tissues, whereas others react by forming scars in the sense of a tissue repair. Overall, the regenerative capacities of the human body are limited and only a few tissues are fully restored when injured. Dental tissues may suffer severe damage due to various influences such as caries or trauma; however, dental care aims at preserving unharmed structures and, thus, the functionality of the teeth. The dentin–pulp complex, a vital compound tissue that is enclosed by enamel, holds many important functions and is particularly worth protecting. It reacts physiologically to deleterious impacts with an interplay of regenerative and reparative processes to ensure its functionality and facilitate healing. While there were initially no biological treatment options available for the irreversible destruction of dentin or pulp, many promising approaches for endodontic regeneration based on the principles of tissue engineering have been developed in recent years. This review describes the regenerative and reparative processes of the dentin–pulp complex as well as the morphological criteria of possible healing results. Furthermore, it summarizes the current knowledge on tissue engineering of dentin and pulp, and potential future developments in this thriving field. Keywords Dentin · Pulp · Regeneration · Tissue engineering · Regenerative medicine
Introduction For healthy and vital teeth, the hard dentin shell provides a strong physical framework for the soft pulp core inside. Both tissues, dentin and pulp, have to be understood as a physiological unity. Anatomically and functionally closely interlinked, the dentin–pulp complex counters external impacts and reacts sensitively to all kinds of stimuli, e.g., caries or trauma. At the pulp chamber, odontoblasts are lined up as single-cell layer and extend their processes wide into the dentin tubules (Fig. 1). Adjacent to the odontoblast layer is the pulp connective tissue, which is permeated by blood vessels, lymphatics and nerve fibers. In addition to fibroblasts, the pulp contains mesenchymal stem cells and * Matthias Widbiller [email protected] 1
Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Franz‑Josef‑Strauß‑Allee 11, D‑93053 Regensburg, Germany
Department of Periodontology, University of Bern, Freiburgstrasse 7, Bern CH‑3010, Switzerland
2
tissue-resident immune cells [1, 2]. Via odontoblasts, the pulp tissue is connected to the protective dentin in a zipperlike manner and fulfills several important functions. Besides maintaining the tissue’s metabo
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