Dental Pulp Chapter 5

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Dental Pulp Chapter 5
2013-08-10 14:44:36
Dental Pulp

Chapter 5
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  1. Define regeneration:
    mechanisms that can maintain the functional integrity of tissues
  2. Which tissues undergo continual turnover also termed _________________.
    blood and epithelia, known as maintenance or homeostatic regeneration
  3. Blood and epithelia regenerate on a larger scale when damaged, a process called ___________
    injury-induced regeneration
  4. The main reason for pulp needing pulpotomy or tooth extraction is
    pulp having weak regenerative capacity
  5. In what year and who is credited for origination of regenerative dental procedures
    1952 B.W. Hermann, applied CaOH to vital pulp amputation
  6. Who developed Emdogain?
  7. Three objectives of regenerative endo:
    • 1. regenerate pulp-like tissue (pulpodentin complex)
    • 2. regenerate damaged coronal dentin
    • 3. regenerate resorbed root, cervical, or apical dentin
    • AAE defined these in 2007
  8. Who first defined tissue engineering?
    Langer and Vacanti
  9. ______ _____________ is the employment of _________ therapeutic strategies aimed at the ____________, ______, _________, and/or _____________ of tissue function
    • Tissue engineering
    • biologic
    • replacement
    • repair
    • maintenance
    • enhancement
  10. __________ medicine represents applications that ______ or ______ structural and _________ tissues, including bone, _________, and blood vessels
    • Regenerative
    • repair
    • replace
    • functional
    • cartilage
  11. Define progenitor cell
    immature or undifferentiated cells found in postnatal animals
  12. Define stem cell
    cell that has ability to continuously divide AND produce progeny cells that develop into other cells and tissues
  13. Where do all tissue originate from?
    Stem cells
  14. Where are stem cells populations established?
    Niches, they save stem cells from depletion
  15. Stem cell types, two:
    • embryonic/fetal
    • adult/postnatal
  16. Different potentials of stem cells to differentiate is termed:
  17. Which stem cell group has greater plasticity?
    embryonic over postnatal
  18. Define totipotent (1st Stage):
    early embryo cells (1-3 days) can develop into all of the tissues in a new individual
  19. Define pluripotent (2nd Stage):
    cells from blastocyst (5-14 days) can form more than 200 tissue types
  20. Define multipotent (3rd Stage):
    • 1. cells from ecto, endo, mesoderm; from some tissue types
    • 2. postnatal sourced cells (cord blood, fat, and teeth) can mineralize and create soft tissues
  21. When was postnatal stem cell therapy launched?
    1968, first allogenic bone marrow transplant
  22. First stem cell research?
    1954 Nobel Prize to John Enders, growing polio virus in human embryonic kidney cells
  23. Where can autologous stem cells be harvested from?
    Bone marrow, peripheral blood, fat removed by liposuction, periodontal ligament, oral mucosa, skin
  24. What is an autologous cell bank, example?
    Umbilical cord stem cells
  25. What are the most valuable stem cells?
    Neuronal differentiation; with the right induction factors these can become adipogenic, chondrogenic, myogenic, and osteogenic cells
  26. What are the most promising cells for endodontic regeneration?
    Autologous postnatal stem cells
  27. Examples of allogeneic donor cells:
    • 1. blood cells for transfusion
    • 2. bone marrow cells
    • 3. donated egg cells
  28. What is the disadvantage to allogenic stem cells?
    risk of immune rejection and pathogen transmission (same for xenogeneic cells)
  29. Define SHED
    stem cells from human exfoliated deciduous teeth
  30. Sometimes pulp stem cells are called ___________ cells because these cells appear to synthesize and secrete _______ matrix like the ___________ cells they replace
    • odontoblastoid
    • dentin
    • odontoblast
  31. SCAP?
    Stem cells from apical papilla
  32. DFPCs?
    dental follicle progenitor cells
  33. What do SHED, SCAP, and DFPC share?
    ability to give rise to osteogenic, chondrogenic, adipogenic, myogenic, and neurogenic cells
  34. What is the purpose of the odontoblastoid cells (dental pulp stem cells)?
    a odontoblast supporting role because without these the odontoblasts do not survive
  35. Stem cells can be identified and isolated  from mixed cell populations by four techniques:
    • 1. fluorescent antibody cell sorting (FACS) used with CD34 (protein marker)
    • 2. immunomagnetic bead selection
    • 3. immunohistochemical staining
    • 4. physiologic and histologic criteria
  36. What do human dental pulp stem cells express?
    • von Willebrand factor CD146
    • α-smooth muscle actin
    • 3G5 proteins
  37. Activity of NGF (nerve growth factor) and source
    critical for survival and maintenance of sympathetic and sensory neurons

    secreted by neuron's target
  38. Activity of TGF-α and source
    Induces epithelia and tissue structure development

    macrophages, brain cells, and keratinocytes
  39. Activity of PDGF and source
    growth of connective tissue, glial, and smooth muscle

    platelet, endothelial cells, placenta
  40. FGF (fibroblast growth factor) and source
    promotes proliferation of many cells

    many cells
  41. EGF (epidermal growth factor) activity and source?
    prolif of mesenchymal, glial, and epithelial cells

    submaxillary gland and Brunner gland
  42. TGF-β activity and source?
    anti-inflammatory, promotes wound healing, inhibits macrophage and lymphocyte proliferation

    dentin matrix, TH1 cells, NKC
  43. BMP activity and source?
    differe of dental pulp stem cells into odontoblastoid cells

    bone matrix
  44. Application of rhIGF (insulin) with ________ has been found to induce complete _____ ________ and ________ _______ formation
    • collagen
    • dentin bridging
    • tubular dentin
  45. In development of regenerative endondontic techniques what are the 3 major areas of research?
    • 1. postnatal stem cell therapy (harvest)
    • 2. dental pulp constructs (scaffold)
    • 3. root canal revascularization (disinfection)
  46. What is the simplest method to administer cells of appropriate regenerative potential?
    Inject the postnatal stem cells into disinfected root canal systems after the apex is opened wide enough for vascularization
  47. In the human body where can post natal stem cells be obtained?
    • 1. Skin
    • 2. Buccal mucosa
    • 3. fat
    • 4. Bone
  48. What are some approaches of obtaining postnatal stem cells capable of differentiating into the diverse cell populaiton of the pulp?
    • 1. Autologous (Umbilical cord)
    • 2. Allogeneic
    • 3. Xenogeneic

    NO Purified dental pulp stem cell lines are available
  49. Name some advantages of using autologous post natal stem cells?
    • 1. Disease free
    • 2. Easy to harvest and deliver
    • 3. Already used in bone marrow transplant
  50. What are some disadvantages of injection delivery of postnatal stem cells?
    • 1. cell may have low survival
    • 2. migration to other parts of body (mineralization there)
    • 3. do not produce new functioning pulp
  51. Dental pulp stem cells must be organized into _____-________ ________ that can support cell organization and ____________
    • three dimensional
    • scaffold
    • vascularization
  52. Dentin chips and dental pulp constructs?
    Found to stimulate reparative dentin bridge formation

    May provide matrix for stem cell attachment
  53. What are some requirements to scaffolds for stem cells?
    • 1. Biodegradability
    • 2. High porosity/adequate pore size
    • 3. Rate of degradation
  54. Name some synthetic materials used for scaffolding. Drawbacks?
    • 1. Polylactic Acid
    • 2. Polyglycolic Acid
    • 3. Polycaprolactone

    No high porosity or regular pore size
  55. Name some non-synthetic materials used for scaffolding.
    • 1. Collagen or fibrin
    • 2. Polysaccharidic materials
    •         a. Chitosan or glycosaminoglycans
  56. What is a soft 3D scaffold matrix?
    Polymer hydrogel, injectable by syringe
  57. What were past problems with hydrogels?
    limited control over tissue formation and development

    photopolymerizable ones are in research
  58. Revascularization method assumes that the root canal space has been ________ and that the formation of a ______ ____ forms a ______ (_______) that traps cells capable of generating new tissue.
    • disinfected
    • blood clot
    • matrix (fibrin)
  59. Which antibiotics have shown to be useful in disinfection during revascularization?
    Mixture of ciprofloxacin ,metronidazole, and minocycline (also CaOH can be used)
  60. How does tetracycline enhance the growth of host cells?
    Exposes embedded collagen fibers or growth factors
  61. What are the advantages to revascularization?
    simple, cheap, no need for biotech

    own blood cells used, no rejection/pathogens
  62. What are some concerns of revascularization?
    Research can't find source of regenerated issue from blood clot

    Enlarging the apex but allows for angiogensis, but coronal pulp may become hypoxic (possible necrosis)
  63. What are the disadvantages of using a dental pulp construct for regenerative therapy?
    Low cell survival

    must be engineered to fit root canal precisely
  64. What are the major research priorities in developing regenerative endodontic techniques? (List 5)
    • 1. Improve disinfection and shaping
    • 2. Improve smear layer removal
    • 3. Engineer functional pulp tissue
    • 4. Improve delivery methods
    • 5. Measure clinical outcome
  65. Dental pulp stem cells will readily attach and grow on ______ and _______  root canal systems, but none, or very few will ______ to ___________.
    • cleaned and shaped
    • attach
    • smear layer
  66. What do stem cells need to attach and adhere to root canal dentin?
    must be supported within a polymer or collagen scaffold
  67. How thick can the smear layer be on the dentin wall?
    1-5 micrometers
  68. What is the smear layer comprised of?
    • dentin
    • odontoblastic processes
    • inorganic contaminants
    • microorganisms
  69. Other than EDTA what other solutions have been promissing in removing smearl layer?
    • Doxycyclein
    • Tetracycline isomer
    • citric acid
    • MTAD
  70. What is MTAD?
    Aqueous solution of 3% doxycycline hyclate (opposed to monohydrate, has improved water solubility, broad spectrum), 4.25% citric acid, .5% polysorbate 80 detergent
  71. The most promising delivery method for regenerative endodontic procedures is:
    autologous stem cells from oral mucosa
  72. What growth factors would be used in scaffolds for regeneration of pulp tissue?
    rhBMP-2,4,7 and TGF-β1,2,3
  73. What are niches for stem cells?
    Places that regulate how they participate in tissue generation, maintenance, and repair