PULP REGENERATION USING TISSUE ENGINEERING AND STEM CELLS: AN UPDATED SYSTEMATIC REVIEW OF THE CLINICAL EVIDENCE. SYSTEMATIC REVIEW
Keywords:
dental pulp; stem cells; tissue engineering; regenerative endodontics; dental pulp stem cells; dentin-pulp regenerationAbstract
DOI: https://doi.org/10.46296/yc.v10i19.0929
Abstract
Background: Cell-based regenerative endodontics aims to restore vascularized, innervated and dentin-forming pulp tissue through the integration of stem/progenitor cells, scaffolds and bioactive signals. Objective: To assess the clinical and radiographic effectiveness and safety of intracanal stem/progenitor cell transplantation in mature and immature permanent teeth. Methods: An updated systematic review was conducted according to PRISMA 2020. A systematic review covering evidence through January 2023 was used as the index review, followed by a targeted update from February 2023 to July 13, 2026 using MEDLINE/PubMed, Europe PMC, trial registries and citation tracking. Human trials, case series and case reports involving intracanal transplantation of isolated viable cells were eligible. Risk of bias was assessed with RoB 2 and JBI tools. Owing to substantial clinical and methodological heterogeneity, a narrative synthesis was performed. Results: Ten clinical publications were included: two controlled trials, one pilot study/case series and seven case reports or small series, representing approximately 91 participants or treated teeth. Interventions used autologous dental pulp stem cells, cultured human dental pulp cells or allogeneic umbilical cord mesenchymal stromal cells, delivered with cell aggregates, atelocollagen, platelet-poor plasma, platelet-rich fibrin, liquid-phase concentrated growth factor, G-CSF or demineralized dentin matrix. Trials reported partial recovery of sensibility and perfusion, periapical lesion reduction and, in immature teeth, continued root development. Descriptive studies reported pulp-like magnetic resonance signals, mineralized tissue formation and no serious adverse events. Overall certainty was low or very low because of small samples, predominance of uncontrolled reports, surrogate outcomes and lack of histological confirmation. Conclusions: Cell-based pulp regeneration is promising but remains experimental. Current evidence is insufficient to support routine replacement of conventional endodontic treatment. Multicenter trials, standardized manufacturing and delivery protocols, validated outcome sets, long-term follow-up and cost-effectiveness analyses are required.
Keywords: dental pulp; stem cells; tissue engineering; regenerative endodontics; dental pulp stem cells; dentin-pulp regeneration.
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