Int J Stem Cells.  2019 Nov;12(3):410-418. 10.15283/ijsc19026.

Regeneration of Neural Networks in Immature Teeth with Non-Vital Pulp Following a Novel Regenerative Procedure

Affiliations
  • 1Department of Oral Diagnostic Sciences, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia. maha.f.mounir@gmail.com
  • 2Faculty of Dentistry, Alexandria University, Alexadria, Egypt.
  • 3Department of Oral Biology, Faculty of Dentistry, Damanhour University, Damanhour, Egypt.
  • 4Department of Oral Biology, King Abdulaziz University, Faculty of Dentistry, Jeddah, Saudi Arabia.

Abstract

BACKGROUND AND OBJECTIVES
Recombinant amelogenin protein (RAP) was reported to induce soft-tissue regeneration in canine infected endodontically treated permanent teeth with open apices. To characterize identities of the cells found in the RAP regenerated tissues compared to authentic pulp by identifying: 1) stem cells by their expression of Sox2; 2) nerve fibers by distribution of the axonal marker peripherin; 3) axons by their expression of calcitonin gene-related peptide (CGRP); 4) the presence of astrocytes expressing glial fibrillary acidic proteins (GFAP).
METHODS
A total of 240 open-apex root canals in dogs were used. After establishment of oral contamination to the pulp, the canals were cleaned, irrigated, and 120 canals filled with RAP, and the other 120 with calcium hydroxide.
RESULTS
After 1, 3, and 6 months, teeth were recovered for immune-detection of protein markers associated with native pulp tissues. Regenerated pulp and apical papilla of RAP group revealed an abundance of stem cells showing intense immunoreactivity to Sox2 antibody, immunoreactivity of peripherin mainly in the A-fibers of the odontoblast layer and immunoreactivity to CGRP fibers in the central pulp region indicative of C-fibres. GFAP immunoreactivity was observed near the odontoblastic, cell-rich regions and throughout the regenerated pulp.
CONCLUSIONS
RAP induces pulp regeneration following regenerative endodontic procedures with cells identity by gene expression demonstrating a distribution pattern similar to the authentic pulp innervation. A- and C-fibers, as well as GFAP specific to astrocytic differentiation, are recognized. The origin of the regenerated neural networks may be derived from the Sox2 identified stem cells within the apical papilla.

Keyword

Amelogenin; Dental pulp necrosis; Apical periodontitis; Calcitonin gene-related peptide; Glial fibrillary acidic protein; Peripherin; Sox2; Stem cell homing; Regenerative endodontics

MeSH Terms

Amelogenin
Animals
Astrocytes
Axons
Calcitonin
Calcitonin Gene-Related Peptide
Calcium Hydroxide
Dental Pulp Cavity
Dental Pulp Necrosis
Dogs
Gene Expression
Glial Fibrillary Acidic Protein
Nerve Fibers
Odontoblasts
Periapical Periodontitis
Regeneration*
Stem Cells
Tooth*
Amelogenin
Calcitonin
Calcitonin Gene-Related Peptide
Calcium Hydroxide
Glial Fibrillary Acidic Protein
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