Stem Cell Therapy in Dentistry

STEM CELLS

TERMINOLOGIES

Tissue Stem cells :

  • Potten and Loeffler, 1990 definition
  • Stem cells of a particular tissue are undifferentiated cells (relative to a functional tissue) capable of

 1.proliferation;

2. production of a large number of differentiated functional progeny;

3.self-maintenance of their population;

4. regeneration of the tissue after injury;

5.flexibility in the use of these options

  • Amended Definition of Tissue Stem Cells

Stem cells of a particular tissue are:

1. a potentially heterogeneous population of functionally undifferentiated cells, capable of:

2. homing to an appropriate growth environment;

3.proliferation;

4. production of a large number of differentiated progeny;

5.self-renewing or self-maintaining their population;

6.regenerating the functional tissue after injury with

7. flexibility and reversibility in the use of these options

  • Potency -differentiation potential (the potential to differentiate into different cell types) of the stem cell.

1.Totipotent /omnipotent stem cells

  • differentiate into embryonic and extraembryonic cell types. –
  • a complete, viable organism.
  • produced from the fusion of an egg and sperm cell.
  •  Cells produced by the first few divisions of the fertilized egg are also totipotent.

2.Pluripotent stem cells

  • descendants of totipotent cells
  • can differentiate into nearly all cells,  i.e. cells derived from any of the three germ layers.

3. Multipotent stem cells

  •  -can differentiate into a number of cells,
  • - but only those of a closely related family of cells.

4.Oligopotent stem cells

  • can differentiate into only a few cells, such as lymphoid or myeloid stem cells.

5.Unipotent cells

  • can produce only one cell type, their own,but have the property of self-renewal,
  • - distinguishes them from non-stem cells (e.g., muscle stem cells)

Introduction

  • Russian histologist Alexander Maksimov in 1908
  • Stem cells grew out of findings by Canadian scientists in the 1960s
  • Dental exfoliation-genetically regulated event
  • Lost- donot regenerate
  • Stem cells-divide to produce one stem cell and one cell capable of differentation .
  • Stem Cells in Dentistry
  • 2000- Discovery of adult Stem-cells in dental pulp cells, the living tissue at the centre of tooth.
  • 2003- Stem-cells found in baby teeth.
  • 2004- Stem-cells found in periodontal ligament, which holds the teeth in place in gums.
  • 2007- Researchers learn how to reprogram some adult cells from mice to assume a State like Embryonic Stem-cells called induced pluripotent Stem-cells.
  • 2008- Cells in dental pulp identified as adult Stemcells.
  • 2003 Dr. Songtao Shi - baby tooth Stem-cells by using the deciduous teeth of his six year old daughter-  isolate, grow and preserve these Stem cells with regenerative ability, and he named them as SHED (Stemcells from Human ExfoliateD Deciduous teeth)
  • CLASSIFICATION
  • two broad types of Stem-cells
  • Embryonic stem- cells
  •  Adult Stem-cells.
  • Embryonic Stem cells
  • Pluripotent-differentiate into all types of somatic cells and theoretically divide an unlimited number of times
  • Embryoblast cells –part of blastocyst –interest for stem cell research
  • Ability to self regenerate
  • Adult-Stem cells
  • cells are also called as somatic Stem-cells because they refer to body cells
  • can only proliferate a limited number of times.
  • Distinguished according to their developmental potential. There are uni- and bipotent progenitor cells-only be differentiated into mature cells of their parent tissue
  • Multipotent adult stem cells-are not identical to the parent tissue
  • Sources Of Stem-Cells
  • Bone marrow -from the long bones. The best sources are pelvic bones, femur and sheen bone.
  •  Umbilical cord blood -collected just after the birth of the baby.
  •  Embryonic cells -from the blastocyst phase of the embryo.
  • Placental Stem-cells
  •  Menstrual Stem-cells -extra-ordinary improvement over the umbilical cord blood cells-  have a rapid growth rate.
  •  Dental Stem-cells -from the pulp of deciduous or wisdom teeth. - has been found to produce bones, cartilage, and muscle cells if cultured.
  •  Present in natal teeth, mesiodense or supernumerary teeth.
  • Applications- Parkinson’s diseases,paraplegia, leukemia, and brain tumors
  • therapeutic use in dentistry - to regenerate individual tissue types- such as bone,periodontal tissue
  • Someday even entire teeth
  • 2 means of regenerating teeth
  • 1.conventional tissue engineering-the application of cells in a carrier material in vitro under the influence of a stimulus leads to tissue regeneration.
  • 2. using dental epithelium and mesenchymal cells in vivo after direct implantation
  • - Based on knowledge of general embryogenesis and physiological tooth development during childhood
  • CLINICAL APPLICATIONS
  • Craniofacial applications.
  •  Dental pulp applications.
  • Creation of artificial embryonic teeth primordia fromcultured cells.
  • Cementoblast like cells applications.
  • Periodontal regeneration.
  • Over 200 regulatory genes-odontogenesis
  • Growth factors from four families
  • 1. fibroblast growth factor (FGF),
  • 2.Hedgehog,
  • 3.wingless (WNT)
  • 4. transforming growth factor- (TGF-), to which the bone
  • morphogenic proteins (BMPs) belong
  • The basis for the regeneration of teeth or individual dental tissues –
  • is the acquisition of suitable stem cells and
  •  a suitable environment in which these cells can
  •  differentiate into the target tissues
  • Carrier materials
  • collagen sponges
  • HA/TCP (hydroxyapatite tricalcium phosphate
  • calcium phosphate
  • fibrin polymer ceramic
  • alginate
  • or polymers
  •  PCL gelatin scaffolds
  • the use of growth factors such as fibroblast growth factors
  • and some of the transforming growth factor  family, e. g. bone morphogenic proteins

Dental epithelial stem cells

  • The embryonic oral epithelium induces odontogenesis
  • Ameloblasts- arise from epithelial stem cells
  • the only cells of ectodermal origin which play a role in odontogenesis.
  • Lost after tooth eruption- leaving no adult human ectodermal stem cells available for cell therapy.
  • Dental epithelial stem cells –obtained from third molars of newborn or juvenile, still developing animals
  • A source of epithelial stem cells,
  • -the apical bud cells (ABCs), in the apical epithelium is responsible for continuous enamel production
  • Dental mesenchymal stem cells
  • With the exception of ameloblast progenitor cells,all stem cells involved in odontogenesis originate in mesenchyme
  • Mesenchymal stem cells - differentiate into nerve, muscle, vascular, fat, cartilage or bone cells

STEM CELLS

Target  Tissue /tissue  cells

DPSCs

Odontoblasts, dentin and pulp tisue,osteoblast

Chondrocytes

Adipocytes

Endotheliocytes,neurons,Musculature

SHEDs

Odontoblsts ,Osteoblasts,neurons,Adipocytes,endotheliocytes

PDLSCs

Odontoblasts,Periodontal  tissue ,Osteoblasts,Cementoblasts,

Chondrocytes,adipocytes

DFSCs

PDL progenitor cells

Osteoblast

Cementoblasts

Neuroblasts

SCAPs

Odontoblasts,osteoblast

  • Dental pulp stem cells
  • isolated from the dental pulp
  • Depending on specific signals from their environment, DPSCs can either regenerate new stem cells or undergo  a differentiation process.
  • Dental pulp acquired from third molars or pulpectomized teeth left in situ.
  • Even after temporary storage in liquid nitrogen- the DPSCs do not lose their multipotent ability to differentiate
  • In vitro, DPSCs - differentiate to odontoblasts, osteoblasts, endothelocytes, smooth muscle cells, adipocytes, chondrocytes, and neurons.
  • DPSCs differentiate in vitro to osteoblast progenitor cells and mature into osteoblasts which produce LAB (living autologous fibrous bone tissue
  • DPSCs in vivo can form calcified bone tissue with Haversian canals and osteocytes and dentin/pulp-like tissue complexes
  • odontogenic, myogenic, adipogenic, and osteogenic differentiation.
  •  DPSCs influence angiogenesis
  • Regeneration potential of adult stem cells in human dental pulp - tertiary dentin
  • therapeutically employed for direct and indirect pulp capping after caries excavation near the pulp
  • Stem cells from human exfoliated deciduous teeth (SHEDs
  • relatively easily accessible source of adult stem cells
  • coronal pulp of exfoliated deciduous teeth
  • Role
  • in the eruption of permanent teeth
  • influence the osteogenesis
  • In vitro-odontogenically, osteogenically, adipogenically, chondrogenically, or neurally
  • In vivo- neurons, adipocytes, odontoblasts, and osteoinductive and endothelioid cells
  • Periodontal ligament stem cells (PDLSCs)
  • Periodontal ligament - contains stem cells which have the potential to form periodontal structures such as cementum and ligament
  • from the roots of extracted teeth
  • In vitro-differentiate into osteoblasts, cementoblasts,
  • and adipocytes.
  • In vivo, after transplantation into mice, structures resembling bone, cementum, cartilage, and PDL have been found.
  • Dental follicle stem cells (DFSCs)
  • The dental follicle plays a major role in the genesis of cementum, periodontal ligament, and alveolar bone.
  • isolated from the follicles of impacted third molars
  • in vitro exhibit characteristics of cementoblasts and osteoblasts-can differentiate neurally.
  • In vivo, tissue similar to dental cementum and differentiation into PDL progenitor cells
  • Stem cells from the dental apical papilla (SCAPs)
  • SCAPs - stem cells from the apical part of the papilla,
  • a precursor tissue of the dental pulp.
  •  Impacted third molars
  • In vitro, SCAPs -differentiate osteogenically, odontogenically, and adipogenically.
  • In vivo, SCAPs -differentiate into odontonblasts and osteoblasts.
  • Non-dental stem cells
  • Human bone marrow-bone marrow derived mesenchymal stem cells (BMSCs) can replicate themselves and, in experiments, be differentiated into osteoblasts, myoblasts, adipocytes, and neuron-like cells
  • In humans, BMSCs -used therapeutically in bone augmentation by sinus lifts
  • -minimally invasively harvested from the iliac crest and inserted into the maxillary sinus on a carrier.
  • MBMSCs -(mandibular bone marrow stem cells)
  • -possess a high osteogenic potency
  • Mesenchymal cells can be isolated from odontomas and differentiated into dental hard tissue, such as dentin
  • Other sources :
  • From umbilical cord blood
  • cartilage
  • the cornea
  • mammary glands
  • adipose tissue
  • Renal stem cells
  • Medical research- multipotent neural stem cells
  •  from areas such as the hippocampus and subventricular zone
  • Dermal multipotent cells -differentiated to odontoblasts in embryonic tooth-bud medium
  • Dental Stem cell markers
  • Identify,characterize, and isolate stem cells.
  • STRO-1, a trypsin-resistant cell-surface antigen- most common-early surface markers of mesenchymal stem cells
  • STRO-4, binds to heat shock protein–90 beta of multipotent MSCs
  • The osteoblast marker osteocalcin -a stem cell marker of DPSCs
  • The neural marker nestin on dental stem cells
  • Conclusion
  • For dentistry, stem cell biology and tissue engineering are of great interest.
  • A great deal of research must be done before it is possible to cultivat eentire teeth as natural, autologous tooth replacements

 

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