About this Research Topic

Background

The dental pulp is the reason for life-long tooth resiliency and its innate ability to fight decay. Despite this piece of knowledge, our clinical practice does not reflect appreciation to this vital tissue or our understanding that the tooth is never the same after root canal treatment. With its subjective symptoms and responses to clinical tests, the diagnosis of irreversible pulpitis is reached too soon and taken too lightly for a root canal intervention that, while contentedly keeps the tooth in place, snatches out its remaining vital tissue and with it its whole vitality. With the advances in regenerative therapies together with our increasing understanding of cellular interactions and their immune responses, recent studies and data show that the dental pulp has more resilience and ability to fight decay than previously thought. With such knowledge, even without thorough understanding, we believe and call for clinicians to give an ailing dental pulp a chance to keep the tooth alive.

The regeneration of the dental pulp is a current highly researched goal. While pulp inflammation marks the beginning of a necrosis process that will eventually consume the whole pulp tissue, we also recently understand and acknowledge inflammation to be the prerequisite for the regenerative process including the mobilization of stem cells, neovascularisation, and the deposition of reparative dentine. With our understanding of the pro-regenerative contribution of inflammation and the possibility to clinically harness its course, this writing proposes some approaches to modulate and alter the course of the inflammatory process from destructive to constructive and regenerative. This starts from challenges facing the diagnosis of pulpal inflammatory status, intersecting with the current standard of care for treatment of the inflamed pulp and reaching to potential anti-inflammatory strategies to boost its regenerative potential.

This research topic aims to tackle the following areas:
• Advances in the diagnosis and classification of pulp inflammatory status.
• Updates on treating the cariously-exposed dental pulp.
• The future of vital pulp therapy and regenerative endodontic procedures.
• Cell-free versus cell-based regeneration of the dentin-pulp complex.
• Dental stem cells and stem cell-derived exosomes for regeneration of the dentin-pulp complex.
• The role of macrophages and their population shift from pro-inflammatory to anti-inflammatory in reversible versus irreversible pulpitis.
• The contribution of pulp innervation and locally derived neuropeptides to the inflammatory and regenerative processes.
• Potential strategies to harness the inflammatory process for dental pulp regeneration, namely cell homing approaches for macrophage induction to modulate the inflammation.
• Potential capping materials and clinical applications that could boost macrophage polarization and complement system activation.
• Clinically promoting an anti-inflammatory environment conducive to a regenerative process.
• The challenges facing the regeneration of the dentin-pulp complex.

Keywords: dental pulp, dentin-pulp complex, regenerative therapy, dental stem cells, pulpitis

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