Conceitos e técnicas de regeneração pulpar revisão integrativa da literatura

Abstract

Cavities, trauma and dental anomalies can lead to necrosis of the dental pulp. The therapeutic consequence for diagnosis is generally a pulpectomy, complete removal of the pulp, followed by endodontic treatment and filling with artificial materials. In recent years, the possibility of regeneration, based on the multipotent potential of mesenchymal cells in abundance in the oral cavity, has aroused great interest, both for the completion of root formation and survival of immature teeth as well as for mature teeth, as several biological functions are lost. Thus, based on the concept of tissue engineering, revitalization has emerged as a new treatment option. Objective: to review the available literature on the effectiveness of techniques for pulp regeneration, cell differentiation and the characteristics of the new tissue formed. A search was carried out in the PubMED/Medline, SciELO, Cochrane Library and Google Scholar databases using combinations with the key words: “Pulp regeneration”, “Tissue engineering” and “endodontic techniques”. The inclusion criteria were: articles available in full and online, published in English or Portuguese in the last 10 years. Exclusion criteria: theses, course conclusion works, repeated articles and that the title or summary did not address the proposed content. In the end, 22 articles make up the sample of this review. Results: To obtain true pulp regeneration, new cell lines, molecules and matrices are being proposed. Under in vitro and ex vivo conditions this regeneration appears to be successful. However, in in vivo models the results are closer to clinical conditions and some factors related to the living organism must be taken into account. Conclusion: special attention should be paid to the evolution of models that allow a realistic representation of the clinical situation. This would allow us to precisely study different factors, such as the cellular source (resident versus non-resident stem cells), mechanisms of odontoblast differentiation, the pulpal environment, the role of inflammation, pretreatment of dentin to release signaling molecules, and the supply of suitable matrices.