Pulp Innate Immune Defense: Translational Opportunities

Abstract

Introduction: The improvement of regenerative endodontic procedures requires an understanding of the key clinical questions combined with a fundamental biological knowledge of how the dental tissues behave during health, disease, and repair. Therefore, partnerships between clinicians and basic scientists are essential to drive the field forward and improve patient outcomes.

Methods: This review aimed to provide a background to dentin-pulp biology and the interaction between infection, inflammation, and regeneration.

Results: We have highlighted how the release of neutrophil extracellular traps (NETs) within the pulp are double-edged; while they aim to limit the bacterial infection, they may actually exacerbate cell death and chronic inflammation. Aberrant levels of these structures may occur because of ineffective host immunologic processes, viral infections, or impaired clearance caused by bacterial virulence factors. We also postulate a proinflammatory link in the pulp between NETs and the inflammasome activated by pathogen-associated molecular patterns and damage-associated molecular patterns. Subsequently, we discuss areas potentially fruitful for future clinical exploitation involving NET inhibitors, inflammasome modulators, phototherapies, and novel epigenetic approaches.

Conclusions: Sustained scientist-clinician research partnerships along with an increased understanding of the association between inflammation and regeneration within the dentin-pulp complex will lead to future patient benefit.

Keywords: Mesenchymal stem cells; pulpitis; regenerative endodontics; tissue engineering; vital pulp treatment.