The effect of amelogenin, growth factors and new nanostructured materials based on calcium silicate cements on pulp regeneration

Abstract

The purpose of treating permanent teeth with exposed pulp, which can be a result of trauma or dental caries progression, is to preserve the vitality and function of the damaged pulp. The therapeutic procedure, along with an adequate indication, most often involves the use of methods of direct pulp capping or vital pulpotomy. Direct pulp capping (DPC) is a therapeutic aplication of drug on exposed dental pulp in order to ensure the closure of the pulp chamber and allow healing process. The treatment includes wound closure with a bioactive material that accelerates healing of the pulp by forming a reparatory dentin or dentin bridge at the site of injury. Recovery of the pulp involves migration of stem/progenitor cells of the pulp to the site of the injury and their proliferation and differentiation into odontoblasts like cells. These cells secrete tertiary dentin matrix with subsequent formation of a reparatory dentin bridge. The success of DPC therapy is often very uncertain and the ideal material does not yet exist. Recent decades have seen a considerable effort by researchers and clinicians in the development of biomaterials which should be characterized not only by biocompatibility, but by bioactivity and bioinductivity. Although MTA still represents the gold standard in DPC today, efforts have been made to overcome the disadvantages of this material (long setting time, difficult handling and application, high market price) along with the introduction of new materials which improved the therapeutic procedure of DPC. Biomimetic regenerative procedures, tissue engineering and nanotechnology provide such possibilities. Biomimetic therapeutic approach and application of amelogenin-enamel proteins in tissue regeneration or the application of new procedures by active regeneration and tissue engineering, can significantly improve the therapeutic results. Emdogain is a newer generation material which consists of enamel proteins and growth factors. For many years it has been successfully used in regenerative therapy of periodontal tissue, but its effect on the pulp tissue is not yet proven. Assumptions have been made about increasing amounts of growth factors at the site of the damaged pulp which can accelerate the healing of pulp wounds and stimulate regeneration...

Osnovni cilj terapije mladih stalnih zuba sa eksponiranom pulpom, koja nastaje kao posledica dentalne traume ili progresije karijesa, je očuvanje vitaliteta i funkcije oštećene pulpe. Terapijski postupak, uz pravilno postavljenu indikaciju, najčešće uključuje primenu metoda direktnog prekrivanja pulpe ili vitalne pulpotomije. Direktno prekrivanje pulpe (DPP) je terapijski postupak aplikacije leka na eksponiranu pulpu zuba sa ciljem da obezbedi zatvaranje pulpne komore i omogući proces zarastanja. Tretman obuhvata zatvaranje rane bioaktivnim materijalom koji pospešuje ozdravljenje pulpe formiranjem reparatornog dentina tj, dentinskog mosta na mestu povrede. Ozdravljenje pulpe podrazumeva migraciju stem/progenitor ćelija pulpe do mesta povrede i njihovu proliferaciju i diferencijaciju u ćelije slične odontoblastima. Ove ćelije sekretuju matriks tercijarnog dentina, sa posledičnim formiranjem reparatornog dentinskog mosta. Kako je uspeh terapije DPP često veoma neizvestan, a idealan materijal za DPP još uvek ne postoji, poslednjih decenija se ulažu veliki napori istraživača i kliničara u razvoj biomaterijala koji bi pored biokompatibilnosti, trebalo da odlikuje i bioaktivnost i bioinduktivnost. Iako danas MTA još uvek predstavlja zlatni standard u DPP, čine se napori kako bi se prevazišli nedostaci ovog materijala (dugo vreme vezivanja, teškoće u rukovanju i aplokaciji, visoka cena na tržištu) i uvođenjem novih materijala unapredila terapijska procedura DPP. Mogućnosti za to svakako postoje u biomimetičkim regenerativnim procedurama, tkivnom inžinjeringu i nanotehnologiji. Biomimetički terapijski pristup i moguća primena amelogenina-gleđnog proteina u tkivnoj regeneraciji, odnosno primena novih koncepata aktivne regeneracije i tkivnog inžinjeringa, može značajno unaprediti terapijske rezultate. Emdogain je materijal novije generacije koji u svom sastavu sadrži gleđne proteine i faktore rasta i kao takav se dugi niz godina uspešno upotrebljava u regenerativnoj terapiji parodoncijuma, ali njegov efekat na pulpno tkivo još uvek nije dokazan. Postoje pretpostavke da se povećanjem količine faktora rasta na mestu oštećenja pulpe može ubrzati zarastanje pulpne rane i stimulisati njena regeneracija...