PDF(Pubmed)
Abstract：
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.
摘要：
通过干/祖细胞移植进行的牙本质牙髓再生是再生牙髓学有前途的前沿。本系统综述仔细评估了动物研究，以研究干细胞疗法在成熟/未成熟动物牙齿中修复/再生牙本质牙髓复合物的功效。使用截至2023年10月的PubMed和Scopus数据库的全面电子搜索，确定/评估了相关的英语研究。评估参数包括牙本质-牙髓复合物形成的放射学和组织学评估。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，顶端闭合,牙本质桥的形成。偏倚风险评估遵循实验动物实验系统审查中心（SYRCLE）指南。在3250篇文章中，包括23个动物实验，分类为成熟牙齿的再生程序(n=11)，未成熟牙齿的再生过程（n=4），和重要的牙髓疗法（n=8）。尽管潜力巨大，纳入研究的偏倚较高.值得注意的是,各种脚手架，使用了生长因子，突出了整个研究的异质性。牙髓干细胞（DPSC）和骨髓干细胞，尤其是特定的细分，表现出显著的再生潜力：缺氧条件和来自预处理DPSC的细胞外囊泡增强了再生，考虑细胞命运。供体年龄影响再生，在牙髓切除术和直接盖髓方面仍然存在挑战。支架和生长因子的选择影响了结果，强调标准化战略的必要性。尽管承诺,临床生存能力面临障碍，需要进一步调查不利影响，优化的脚手架，和监管方面的考虑。本系统综述阐明了干细胞移植用于牙本质牙髓复合物再生的潜力。整体证据质量,受研究异质性和偏见的影响，强调了对调查结果进行谨慎解释的必要性。未来的研究应完善方法学并建立可靠的组织学参数，以促进牙本质牙髓再生的有意义的进步。
