牙髓炎是牙科诊所的常见病。尽管重要的牙髓治疗和根管治疗可以阻止炎症的进展,它们不允许牙髓牙本质复合物的真正结构再生和功能重建。近年来,随着组织工程和再生医学的发展,基于干细胞的再生牙髓治疗(RET)的研究取得了令人满意的初步结果,显着提高其临床转化前景。作为关键的旁分泌效应之一,外泌体在牙髓-牙本质复合体再生中的作用和功能得到了广泛的关注。由于它们的成本效益优势,来源广泛,良好的生物相容性,和高安全性,外泌体被认为是促进牙髓再生的有前途的治疗工具。因此,在这篇文章中,我们首先关注外泌体的生物学特性,包括它们的生物发生,摄取,隔离,和表征。然后,从细胞增殖的角度来看,迁移,牙本质发生,血管生成,和神经发生,我们的目的是揭示外泌体在再生牙髓中的作用和机制。最后,为说明外泌体应用于牙髓再生的临床策略和影响因素,例如亲代细胞的类型,亲本细胞的培养条件,外泌体浓度,和脚手架材料,试图为探索和促进基于外泌体的再生牙髓手术的治疗策略奠定坚实的基础。
Pulpitis is a common and frequent disease in dental clinics. Although vital pulp therapy and root canal treatment can stop the progression of inflammation, they do not allow for genuine structural regeneration and functional reconstruction of the pulp-dentin complex. In recent years, with the development of tissue engineering and regenerative medicine, research on stem cell-based regenerative endodontic therapy (RET) has achieved satisfactory preliminary results, significantly enhancing its clinical translational prospects. As one of the crucial paracrine effectors, the roles and functions of exosomes in pulp-dentin complex regeneration have gained considerable attention. Due to their advantages of cost-effectiveness, extensive sources, favorable biocompatibility, and high safety, exosomes are considered promising therapeutic tools to promote dental pulp regeneration. Accordingly, in this article, we first focus on the biological properties of exosomes, including their biogenesis, uptake, isolation, and characterization. Then, from the perspectives of cell proliferation, migration, odontogenesis, angiogenesis, and neurogenesis, we aim to reveal the roles and mechanisms of exosomes involved in regenerative endodontics. Lastly, immense efforts are made to illustrate the clinical strategies and influencing factors of exosomes applied in dental pulp regeneration, such as types of parental cells, culture conditions of parent cells, exosome concentrations, and scaffold materials, in an attempt to lay a solid foundation for exploring and facilitating the therapeutic strategy of exosome-based regenerative endodontic procedures.