Webinar Title: Stem Cell, What Does That Mean to Endodontists in their Daily Practice?

Presenter: Dr. George Huang

Date Recorded: July 29, 2017

Duration: 2 hours

CDE Credits: 2.00 CDE credits will be issued by Pure Dental Learning

Details

Description:

Stem cells have been a fascinating cell type for the public and medical professionals because they possess the potential to regenerate tissues and cure diseases. We as dentists and/or endodontists need to have a good background knowledge in this field in order to better correlating such knowledge to our clinical practice as well as to educating the public. Regeneration of pulp was under the radar screen in the field of endodontics due to the lack of understanding of tissue engineering concept and dental stem cells were yet to be isolated before 1990s. As the rapid advancement in the fields of modern tissue engineering and stem cell biology, pulp tissue regeneration has also been rigorously investigated. In fact, beginning from the late 2000s, pulp tissue regeneration with a layer of newly formed osteodentin on the root canal walls has been demonstrated tested in small and large animal models. Using stem cells isolated from pulp tissue, complete pulp regeneration can take place in emptied root canal space. Additionally, clinical trials have been conducted in Japan showing that it is safe to use isolated stem cells for pulp regeneration. Regenerative endodontic protocol has also been proposed and available at the AAE website to give guidance for dentists and endodontists when treating immature teeth with regenerative procedures. In this lecture, we will first review the background of stem cells in general, their research progress and clinical applications. Significant emphasis will be on the dental stem cells, their location in dental tissues and how much we know about them. For example, what happens to these stem cells in the pulp when pulp is irritated and inflamed, or when pulp is exposed? There are also stem cells in the periodontal ligament and even the granuloma at the apxe of infected teeth. How would these stem cells respond to the treatments and what are their roles in the repair and regeneration of the dental tissues after treatment? We will also mention our recent progress on the pulp regeneration research and the challenges. For example, originally pulp regeneration treatment was considered only suited for immature permanent anterior teeth, but now the expectation is to expand to all teeth. For such high goals, we have to overcome new challenges: i) disinfection efficiency, ii) blood supply during regeneration, and iii) quality of the regenerated pulp and dentin. Most teeth that require pulp regeneration are infected to various degrees. Improved disinfection technologies and protocols must be developed. To regenerate pulp in the long and narrow canal of mature teeth, timely formation of vascularity must take place in order to allow inserted stem cells to form tissues. Additionally, the newly formed osteodentin along the canal wall of the regenerated pulp are dissimilar to the original dentin lacking organized dentinal tubules. New strategies must be searched in order to regenerate dentin similar to real dentin not only having organized tubules but also having the same physical strength. To overcome these challenges and to accomplish these goals, in vitro and in vivo study models are needed. Particularly, animal study models for in vivo studies are very important to test new ideas, concepts and technologies.