Dental Regeneration Via Bioengineering: Systematic Review

Abstract

Introduction: This review explores the bioengineering techniques that use stem cells (SC) for tooth regeneration, highlighting current methodologies, potential clinical applications, and future prospects in dental tissue engineering, while comparing the effectiveness of different scaffold materials and SC of various origins. Material and Methods: An electronic search was performed in PubMed, Scopus, and Web of Science databases on tooth regeneration using natural and synthetic scaffolds, and dental pulp SC (DPSC) or other SC until January 2024. Results: From 251 articles obtained from the initial search, 10 were chosen to be included, complying with inclusion and exclusion criteria. In the natural scaffold group, the average percentages of regenerated enamel, dentin, cementum, and odontoblast-like cells were 15%, 23.6%, 17.4%, 23.6%. In the synthetic scaffold group, the values were 43.4%, 61.8%, 38.7%, and 61.8%. For regeneration of distinguishable crown, root and pulp structures, the natural scaffold group showed the following results – 20.5%, 8.7%, 23.6%; the synthetic scaffold group – 53.2%, 18.8%, and 71.9%. The group of DPSC regenerated 35.8% (enamel), 36.3% (dentin), 32.8% (cementum), and 47% (odontoblasts), while the group of SC of other origin regenerated 34.9%, 53.3%, 18.7%, and 53.3%. For the regeneration of dental parts, the DPSC group presented 38.9% (crown), 10.4% (root), 41% (pulp), while the other SC group showed 17.4%, 11.8%, and 36.1%. Conclusions: All analysed techniques led to the regeneration of all 4 types of dental tissues, but using synthetic scaffolds and DPSC provided structures more similar to a natural tooth. All scaffolds supported stem cell viability and differentiation, except for PLA and its copolymers in their pure form, which hindered the full differentiation potential. DPSC demonstrated the highest regeneration potential of dental tissues. The studies utilizing bioactive agents achieved good results but further research is necessary to clarify how they affect the process of regeneration over longer periods of time.