EFFICACY OF STEM CELLS IN ENDODONTIC REGENERATION: A SYSTEMATIC REVIEW

Abstract

Introduction

Regenerative endodontic procedures (REPs) aim to regenerate structural and functional integrity of necrosed or infected dental pulp, while promoting root development and closure. Conventional treatment methods often fail to regenerate dental pulp tissues effectively. This systematic review investigates the efficacy of stem cell therapy in REPs.

Methodology

An electronic search was conducted on the following research databases and registers: PubMed (includes MEDLINE and PubMed Central), Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar, and ClinicalTrials.gov. The study was registered in PROSPERO and PRISMA guidelines were followed to report the review. 19 original studies comprising 1 randomized clinical trial and 18 animal studies were included after applying inclusion and exclusion criteria. The studies evaluated different types of endodontic procedures, including pulp capping, pulpotomy, pulpectomy, and furcation repair, using various types of mesenchymal stem cells, such as dental pulp stem cells, bone marrow-derived stem cells and umbilical cord mesenchymal stem cells (UCMSCs). The outcomes assessed in the studies included pulpal regeneration, resolution of periapical radiolucency, and restoration of tooth vitality. The Systematic Review Center for Laboratory and Animal Experimentation (SYRCLE) and Risk of Bias 2.0 was used for assessing the risk of bias in animal studies and randomized trials, respectively.

Results

The findings indicate that stem cell therapy holds promise for inducing dental pulp regeneration. However, synthesizing the overall efficacy of stem cell therapy compared to conventional methods remains challenging due to variations in methodologies and outcome measures used in animal studies. Despite these inconsistencies, most animal studies reported positive results for pulpal regeneration, regardless of the stem cell type, scaffold type or animal model used. Notably, a clinical trial utilizing umbilical cord mesenchymal stem cells (UCMSCs) combined with platelet-poor plasma demonstrated favorable outcomes in dental pulp revascularization and reperfusion.

Conclusion

The long-term safety and clinical efficacy of stem cell therapy in regenerative endodontic procedures (REPs) require validation through randomized clinical trials before widespread clinical adoption.