Periodoncia

Dentin-Pulp complex regeneration: from Lab to clinic
s.r.J. simon1,2,3,4,5*, A. berdal1,2,3,4, P.r. cooper5, P.J. Lumley5, P.L. tomson5, and A.J. smith5
INSERM, UMR S 872, Centre de recherche des Cordeliers, Paris, France; 2Université Pierre et Marie Curie-Paris 6, UMR S 872, Paris, France; 3Université Paris Descartes, UMR S 872, Paris, France; 4Team 5-Molecular Oral Physiopathology, UniversitéParis Diderot, Paris, France; and 5Oral Biology, School of Dentistry, University of Birmingham, Birmingham, B4 6NN, UK; *corresponding author, stephane.simon@ univ-paris-diderot.fr Adv Dent Res 23(3):340-345, 2011
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AbstrAct
Dentistry is entering an exciting era in which many of the advances in biotechnology offer opportunities for exploitation in novel and more effective therapies. Pulphealing is complex and dependent on the extent of injury, among many other factors. Many of the molecular and cellular processes involved in these healing events recapitulate developmental processes. The regulation of odontoblast activity is clearly central to pulp healing, and an understanding of the mechanisms involved in these processes is necessary to enable laboratory studies to be translated toclinic application. Transcriptome analysis has identified changes in many odontoblast genes during the life-cycle of this cell and its responses to injurious challenge. The p38 MAPKinase pathway appears to be central to the transcriptional control of odontoblasts and may provide a key target for therapeutic intervention. The many recent advances in knowledge of pulpal stem cells and molecularsignaling molecules within the tooth, now provide exciting opportunities for clinical translation to novel therapies. Such translation will require the partnership of researchers and skilled clinicians who can effectively apply advances in knowledge to appropriate clinical cases and develop novel therapies which can be realistically introduced into the clinic.

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entistry is entering an excitingera in which the many advances in biotechnology offer opportunities for exploitation in novel and more effective therapies. Regenerative medicine provides many advantages for restorative dentistry in terms

of restoration survival rates and long-term treatment prognosis. In fact, dentistry has long been a pioneer of regenerative medicine, with the introduction of pulp capping some 60 to 70years ago and is well-placed to continue to provide a lead in this area (Zander, 1939; Zander and Glass, 1949). Clinically, there are two situations commonly encountered in pulp disease. First, when the dental pulp is still vital and potentially inflamed, the focus is very much on the maintenance of vitality. The treatment strategy will be to locally regenerate new dentin and promote reorganization ofthe underlying connective tissue. In the second situation, there is complete loss of the pulp, due to cell and tissue death in response to infection and uncontrolled inflammation, resulting in the root canal system becoming empty of any vital tissue and, frequently, highly infected. In this situation, the strategy is to endeavor to regenerate a new vital connective tissue, ideally mimicking thedental pulp. Significant progress in the field of caries management has led to a much improved understanding of the mineralization of teeth and the biological behavior of the dentin-pulp complex. It is apparent that the dentin-pulp complex is able to adapt to a variety of stimuli-invoking defense responses to maintain its vitality, and the main role of the dentin-pulp complex is to secrete dentin.When tooth development is complete, the pulp sustains the dentin through homeostatic and self-protective mechanisms. The dental pulp is also able to re-initiate dentinogenesis to protect itself from external injury and insult. The pulp-healing processes are complex and dependent on the extent of injury, among many other factors. With mild injury, healing involves a simple up-regulation of...