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Int Endod J. 2019 Jun 24. doi: 10.1111/iej.13177. [Epub ahead of print]

Stem/progenitor cell mediated pulpal tissue regeneration: a systematic review and meta-analysis.

Author information

1
Clinic for Conservative Dentistry and Periodontology, Christian-Albrechts-Universität Kiel, Germany.
2
Stem cell research group, Faculty of Dentistry, Cairo University, Egypt.
3
Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Germany.

Abstract

BACKGROUND:

Stem/progenitor cells-mediated pulpal regeneration could represent a promising therapeutic alternative in the field of clinical endodontics.

AIM:

The present study aimed to systematically assess and meta-analyse dental pulpal tissue regeneration, pulpal vitality and apical healing after stem/progenitor cells' transplantation versus no such transplantation.

DATA SOURCES:

MEDLINE, Cochrane CENTRAL and EMBASE were searched up to January 2019 for animal experiments and human trials evaluating the pulpal transplantation of stem/progenitor cells. Cross-referencing and hand search were additionally performed.

STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS:

Based on Randomized Controlled clinical Trials (RCTs) or Controlled Clinical Trials (CCTs), conducted in animals or humans, the effect of stem/progenitor cells' transplantation compared to no-transplantation on pulpal tissue regeneration, pulpal vitality and apical healing was examined.

STUDY APPRAISAL AND SYNTHESIS METHODS:

The primary outcome was histologically determined pulpal tissue regeneration, while pulpal vitality and apical healing were secondary outcomes. The SYstematic Review Centre for Laboratory animal Experimentation (SYRCLE) guidelines and revised Cochrane risk of bias tool (RoB 2.0) were used for risk-of-bias-assessment. Pooled standardised differences in means (SDM) and 95% confidence intervals (95%CI) were calculated using random-effects meta-analysis.

RESULTS:

From 2834 identified articles, eight animal experiments (82 animals with 336 experimental pulpal defects) and one human trial (40 humans with 40 pulpal defects) were included. Risk of bias of most animal studies was high, while the human trial showed 'some concerns'. Stem/progenitor cells transplanted pulps demonstrated significantly increased pulpal tissue regeneration compared with controls (SDM [95%CI]: 6.29 [3.78-8.80]).

LIMITATIONS:

Data on pulpal vitality and apical healing were sparse and inconsistent. Heterogeneity across studies was substantial, publication bias present, and mainly indirect, surrogate outcome measures applied. The overall strength of evidence was very low.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS:

Stem/progenitor cells' transplantation shows promises for pulp regeneration, while clinical routine application is still not in reach. Further investigations, employing a comprehensive set of outcomes including those demonstrating functional pulp regeneration relevant for patient-centred care, are required. This article is protected by copyright. All rights reserved.

KEYWORDS:

Stem cells; meta-analysis; pulp; regeneration; systematic review

PMID:
31232460
DOI:
10.1111/iej.13177

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