er > e . Stem cells Regeneration Definition: Biologically based Procedures designed to replace damaged structures such as dentin structure and cells of the pulp-dentin complex. Srst Shidie Regenerative strategies: Regenerative Endodontics are dependent upon those elements associated with normal tissue development and tissue engineering: (the triad of tissue engineering): Deal t Signaling molecules (Growth factors). . extracellular matrix/cellular scaffold (Hydrogel is the scaffold of choice) Targeting these elements has been approached in a variety of ways (approaches) . Cell-based Approaches or Gafclels Cell-based regenerative strategies include the transplantation of cells to the site of injury in the tissue to promote regeneration. . Cell-free Approaches Cellular synthesis and secretion of tissue components are imperative to the formation of any tissue. However, its regeneration can also be achieved from populations already present in the patient’s body that can be recruited to the site of injury to stimulate self-healing mechanisms and unlock the innate powers of regeneration, where localized areas of cellular necrosis exist within a tissue, without the need to directly transplant cells to the injury site. fox Apiad papilla SC - Safeated Decides teth $C Stem Cells Cells that are able to Proliferate, differentiate into Odontoblasts like cells to form Pulp Tissue. = The plasticity of the stem cell defines its ability to produce cells of different tissues ™ Stem cells are also commonly subdivided into 1. Pluripotent 2. Multipotent cells 16 ‘Scanned with CamScannerv aeNG Pluripotentstem cells have the capacity of becoming specialized cells and belong to all three germ layers. Embryonic stem cells are the best example of pluripotent cells. BUT: | : ethical, legal, and medical (tissue-rejection) issues can render these cell types unsuitable for clinical applications. -Neds True pluripotent stem cells can only be found in the developing embryo, and the harvesting of these cells requires destruction of the embryo, hence the legal and ethical concerns with such practice . Multipotent stem cells: These cells can be found compartmentalized within tissues in “stem cell niches.” The mesenchymal tissues - Mathipdesk cals ar prac Location: Fost-rutal These cells were first found in bone marrow decades ago and were characterized as self-renewing but later received the now widely accepted name mesenchymal stem cells (MSCs), (ted thon flutist Most stem cells found in the orofacial region are MSCs. SCAP (stem cells from apical papilla) {st wed SHED (stem cells from human exfoliated deciduous teeth) DPSC (dental pulp stem cells) from adult pulp -+ Fixx Siedly Chealed -¥ OF Ferma cue PLSC (periodontal ligament stem cells) ‘Scanned with CamScannershy S$ Culhtie a hon) ep ae dakchel yj ster» undegan A Spe t ~ Food Washiy hale te ope of desepy Re & optal ou th Ye lyfe etoven Aptal Pape \ = due 5 clay Ku tebe! by [TONS Swe tas neces iNfon he -sy an . he eationment™ 0 x Ney Hobe: ac it FANT Mectebes ol ah ed ace meek age Sa wall utken ob x we Ciecaledidn wth ercbln ors pene stb Reis 4 Sem Gl Sue Bh Set OME $ cfealeiin Ye cblelals Conveetah pr Treat © Mabsrecsr 5 au a ee tehEchy Rl PON or Fibreduclinng, 4 fee Oh cites meted wad sy tales Wok perodls cet is creak AS le offal win oT vat at Sphe OPEC. Cf athovtn FT peti = Sk ety ute Ped ow) a) te Genalsbastever oly he Gils clise to He opal Bat "Wuben cen 8 2 aed Oud + Wyss > Bene endotoxin, 4 So, QW Free Agprarch ula tehhoducedl (GN Aowetng) ‘Scanned with CamScannerpas we eee a Sep gC eb Gb Hreeton oy Pedi uel Seyse APR WEA Gan ple Heck pwchansnes a othe seal Zhe Dental stem cells: a. SCAP stem cells: * They are derived from the apical part of a developing tooth and have high proliferation, migration and regeneration capabilities. * They contain fibroblast-like and odontoblast like cells. * The apical papilla is a dense reservoir of undifferentiated MSCs with great proliferative and odontogenic differentiation capacity. ; ; * the close proximity of the apical papilla to the apices of teeth in continuum with the root canal space makes this rich source of stem cells readily available for regenerative endodontic therapeutics through autologous cell transfer without the necessity to harvest and manipulate these cells exogenously. b. Dental pulp derived stem cells (DPSC): * These are the most common source of dental tissue derived stem cells and are obtained from the pulp of permanent teeth. Vettel Wiicorns DPSCs can be found throughout the dental pulp but are known to accumulate in the perivascular region and the cell-rich zone adjacent to the odontoblastic layer, Ney Gn dNrechile Yo Gudheead Gl, (utet Rode | * can produce pulp dentin complex. * These cells are recruited to the site of injury following a gradient of chemotactic agents released by resident immune cell ls and from the damaged dentin. * The reparative dentin formed by these cells is distinct from the primary, secondary, and reactionary dentin that has been lost. It is often called “osteodentin”. ¢- Stem cells from human exfoliated deciduous teeth (SHED): * They are derived from exfoliated teeth and ai * They have high regenerative and renewal power, so they have high effect in Wound healing, ~ t Pepreulte. pobkil Specific Yon DYSC * With proteins on the dental pulp, they can differentiate into bone, PDL, nerve cells, pulp and adipocytes © They differentiate into odontoblast-like cell * The SHED are able of forming microvascul blood supply to the generated pulp. + They can differentiate into fibroblasts, . * They induce formation of osteoblasts, thus forming bone. * (SHED, unlike DPSCs, cannot be differentiated into osteoblasts or osteocytes but are able to induce the host cells to undergo osteogenic Sirulske CAF lease 3. Induction of bleeding in the canal + MTA + Coronal seal — (y \uigdliaa, at 4, Periodical follow-ups will take place to observe any continued maturation of the t Toot. — evey 3 Morthes Pengpical ree ‘Bicod ot seats SMTA in Gnital, Ms dy booth renraion Revascularization protocol 20 ‘Scanned with CamScannerClinical considerations for regenerative endodontic procedures Primary goal (essential): The elimination of symptoms and the evidence of bony healing = Secondary goal (desirable): Increased length root wall thickness and/or increased root = Tertiary goal: positive response to vitality testing ‘Scanned with CamScanner