Effect of biomaterials on angiogenesis during vital pulp therapy

Abstract

This review intended to provide an overview of the effects of dental materials, used in dentin-pulp complex and dental pulp regeneration, on angiogenesis processes during regenerative endodontic procedures. An electronic search was performed in PubMed and MEDLINE databases via OVID using the keywords mentioned in the PubMed and MeSH headings for English language published articles from January 2005-April 2014 that evaluated the angiogenic properties of different dental materials used in regenerative endodontic procedures. Of the articles identified in an initial search, only 40 articles met the inclusion criteria set for this review. Vital pulp therapy materials might have positive effects on angiogenesis events, while most of the canal irrigating solutions and antibiotic pastes have anti-angiogenic activity except for EDTA. Future clinical studies will be helpful in defining the mechanisms of action for dental materials that promote or inhibit angiogenesis events at applied areas.

Fig. 1

A flowchart of search strategy to identify English articles from January 2005–April 2014 based on inclusion and exclusion criteria in this review study.

Fig. 2. Schematic presentation of dentin-pulp complex regeneration

A: deep injury imposed to the pulp tissue, which activates regenerative processed; B: Recruitment of pulp stem cells and expression of angiogenic factors such as FGF-2, which are responsible for proliferation of endothelial cells; C: Migration of proliferated endothelial cells to the injured area; D: The angiogenic effects of different pulp capping materials in the regenerative processes; E: Differentiation of stem cells to odontoblast-like cells and secretion of reparative dentin. Please note the vascular structure returning to its normal architecture at the end of the regeneration process.

Fig. 3. Schematic presentation of dental pulp regeneration processes in an immature tooth

A: Immature tooth with intact pulp; B: Necrotic dental pulp and accumulation of stem cells of the apical papilla (SCAP) in periapical area; C: Mechanical provocation of bleeding from the periapical site to transport the SCAPs into the empty canal space and establishment of a coronal seal by MTA cement and composite resin materials; D: Formation of pulp-like tissue in apical and mid third of root, which contributes to the maturation of apical third and apical foramen closure by the formation of a cementum-like tissue.