牙周病学：牙髓再生

INTRODUCTION
Regenerative Endodontic Procedures
Tissue Engineering
Guided Tissue Regeneration
Stem cells Growth Factors
Scaffolds
Dental pulp revascularization
Comparison
Conditional endodontic VS
treatment
Regenerative endodontic treatment
STEM CELLS
Growth Factors
▪ extracellularly secreted signals that regulate epithelial– mesenchymal interactions
▪ increase proliferation, induce differentiation or stimulate them to secrete mineralized matrix
Mechanisms:
Mesenchymal stem cells Grow factors Blood clot
Tissue Engineering
Stem cells Growth factors Scaffolds
STEM CELLS
STEM CELLS——DPSCs
▪ multipotent cells ▪ produce mineralized tissue ▪ demonstrate neurogenic potential ▪ produce neurotrophic factors ▪ capable of retaining their regenerative potential
▪ TGF-beta、 BMPs、PDGF、VEGF、EGF…… ▪ How to control the release of GFs in time、location and
dose？
ANGIOGENESIS
▪ VEGF、EGF、PDGF、FGF、PIGF…… ▪ Mechanism: 1. Paracrine signaling :VEGF
2. Autocrine signaling
NEUROGENESIS
▪ Neurogenic potential ▪ Activators of PKC and cAMP pathways and FGF
positively influence neural differentiation of DPSCs
Histologic Observations
Major challenge
▪ Sources of stem cells ▪ Microbial control ▪ Scaffolds ▪ Differentiation control of stem cells ▪ Functional pulp-dentin complex
INTRODUCTION
Conditional endodontic treatment
Indirect pulp therapy Direct pulp capping Pulpotomy Apexification
Regenerative endodontic treatment
Pulp revascularization Tissue engineering
Synthetic: polylactic acid (PLA), polyglycolic acid (PGA), or polycaprolactone (PCL).
Nanofibrous scaffol Platelet-rich plasma、Platelet-rich fibrin
Cell Homing
SCAFFOLDS
3-D structures guide、regulation& mechanical support Biocompatibility、porosity、biodegradablity、mechanical resistence…… Natural: blood clot、collagen、dentin、alginate、PRP&PRF……
The Progress of Regenerative Endodontics
CONTENTS
01 Introduction 02 Pulp revascularization
03 Tissue Engineering
Stem cells /growth factors/scaffolds
04 Thoughts
STEM CELLS——SHED
higher proliferation rate and mineralization potential
STEM CELLS——PDLSCs
STEM CELLS——SCAPs
SCAPs have a higher rate of proliferation and mineralization potential
▪ A variety of more concentrated GFs: PDGF、TGF、VEGF、EGF、
IGF…… ▪ autologous and easy to prepare（10ml whole blood—5ml PRP）
SCHEMATIC REPRESENTATION OF TISSUE ENGINEERING TECHNIQUE
Indications:
Immature permanent teeth with pulp infection/necrosis
Procedures:
irrigation and disinfection of the root canal the periapical tissues are induced bleeding a coronal seal of MTA．