Research ArticleStem Cells

Deciduous autologous tooth stem cells regenerate dental pulp after implantation into injured teeth

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Science Translational Medicine  22 Aug 2018:
Vol. 10, Issue 455, eaaf3227
DOI: 10.1126/scitranslmed.aaf3227

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Tooth stem cells regenerate smiles

Dental pulp necrosis is one of the most common pathological conditions that results in tooth loss. However, regeneration of functional dental pulp has proved difficult. In a new study, Xuan et al. implanted ex vivo expanded autologous tooth stem cells from deciduous teeth in two animal models and in human patients. They demonstrated regeneration of dental pulp containing an odontoblast layer, blood vessels, and nerves in the implanted teeth and rescue of sensation to stimuli such as temperature. This work suggests that implantation of tooth stem cells can provide partial recovery of teeth injured by trauma.

Abstract

Pulp necrosis arrests root development in injured immature permanent teeth, which may result in tooth loss. However, dental pulp regeneration and promotion of root development remains challenging. We show that implantation of autologous tooth stem cells from deciduous teeth regenerated dental pulp with an odontoblast layer, blood vessels, and nerves in two animal models. These results prompted us to enroll 40 patients with pulp necrosis after traumatic dental injuries in a randomized, controlled clinical trial. We randomly allocated 30 patients to the human deciduous pulp stem cell (hDPSC) implantation group and 10 patients to the group receiving traditional apexification treatment. Four patients were excluded from the implantation group due to loss at follow-up (three patients) and retrauma of the treated tooth (one patient). We examined 26 patients (26 teeth) after hDPSC implantation and 10 patients (10 teeth) after apexification treatment. hDPSC implantation, but not apexification treatment, led to regeneration of three-dimensional pulp tissue equipped with blood vessels and sensory nerves at 12 months after treatment. hDPSC implantation increased the length of the root (P < 0.0001) and reduced the width of the apical foramen (P < 0.0001) compared to the apexification group. In addition, hDPSC implantation led to regeneration of dental pulp tissue containing sensory nerves. To evaluate the safety of hDPSC implantation, we followed 20 patients implanted with hDPSCs for 24 months and did not observe any adverse events. Our study suggests that hDPSCs are able to regenerate whole dental pulp and may be useful for treating tooth injuries due to trauma.

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