West Kazakhstan Medical Journal

Published date: Jun 02 2025

Journal Title: West Kazakhstan Medical Journal

Issue title: West Kazakhstan Medical Journal: Volume 67 Issue 2

Pages: 188 - 197

DOI: 10.18502/wkmj.v67i2.17113

Madina A. Kurmanalina Kurmanalinamadina83203@gmail.comDepartment of Therapeutic and Prosthetic Dentistry, West Kazakhstan Marat Ospanov Medical University, Aktobe

Nadiar M. Mussinnadiar_musin@zkmu.kzDepartment of General Surgery, West Kazakhstan Marat Ospanov Medical University, Aktobe

Aigul M. Sumanovasumanova1@mail.ruDepartment of Therapeutic and Surgical Dentistry, Astana Medical University, Astana

Violetta R. Detochkinadetochkina.v@amu.kzDepartment of Therapeutic and Surgical Dentistry, Astana Medical University, Astana

Maryam Mardanimardanim@sums.ac.irOral and Dental Disease Research Center, Department of Oral and Maxillofacial Medicine, School of Dentistry, Shiraz University of Medical Sciences, Shiraz

Nader Tanidehtanidehn@gmail.comStem Cells Technology Research Center, Shiraz University of Medical Sciences, Shiraz

Amin Tamadonamintamaddon@yahoo.comDepartment of Natural Sciences, West Kazakhstan Marat Ospanov Medical University, Aktobe

Regenerative endodontics, particularly through mesenchymal stromal cell (MSC)- based and exosome-based therapies, presents innovative alternatives to traditional endodontic treatments. However, the economic feasibility of integrating these advanced therapies into Kazakhstan’s dental healthcare system has yet to be systematically analyzed. This methodological study aims to establish a framework for evaluating the cost-effectiveness of regenerative therapies compared to conventional endodontic methods. It focuses on identifying the economic factors that influence the potential adoption of these therapies in Kazakhstan. The study outlines a comprehensive methodology for comparing the costs and potential long-term benefits of MSC- and exosome-based therapies. Data were collected from clinical studies, healthcare providers, and literature on cost factors such as treatment expenses, retreatment rates, and complication management.

Keywords: regenerative endodontics, mesenchymal stromal cells (MSCs), exosomes, economic analysis, healthcare innovation, Kazakhstan

[1] Li XL, Fan W, Fan B. Dental pulp regeneration strategies: A review of status quo and recent advances. Bioact Mater. 2024 May;38:258–275. https://doi.org/10.1016/j.bioactmat.2024.04.031PMID:38745589

[2] Astudillo-Ortiz E, Babo PS, Sunde PT, Galler KM, Gomez-Florit M, Gomes ME. Endodontic Tissue Regeneration: A Review for Tissue Engineers and Dentists. Tissue Eng Part B Rev. 2023 Oct;29(5):491– 513. https://doi.org/10.1089/ten.teb.2022.0211 PMID:37051704

[3] Lin LM, Ricucci D, Saoud TM, Sigurdsson A, Kahler B. Vital pulp therapy of mature permanent teeth with irreversible pulpitis from the perspective of pulp biology. Aust Endod J. 2020 Apr;46(1):154–166. https://doi.org/10.1111/aej.12392 PMID:31865629

[4] Wikström A, Brundin M, Romani Vestman N, Rakhimova O, Tsilingaridis G. Endodontic pulp revitalization in traumatized necrotic immature permanent incisors: Early failures and long-term outcomes— A longitudinal cohort study. Int Endod J. 2022 Jun;55(6):630–645. https://doi.org/10.1111/iej.13735 PMID:35332566

[5] Dalir Abdolahinia E, Safari Z, Sadat Kachouei SS, Zabeti Jahromi R, Atashkar N, Karbalaeihasanesfahani A, et al. Cell homing strategy as a promising approach to the vitality of pulp-dentin complexes in endodontic therapy: Focus on potential biomaterials. Expert Opin Biol Ther. 2022 Nov;22(11):1405– 1416. https://doi.org/10.1080/14712598.2022.2142466PMID:36345819

[6] Kishen A, Hussein H. Bioactive molecule carrier systems in endodontics. Expert Opin Drug Deliv. 2020 Aug;17(8):1093–1112. https://doi.org/10.1080/17425247.2020.1777981PMID:32500747

[7] Jazayeri H, Lee SM, Kuhn L, Fahimipour F, Tahriri M, Tayebi L. Polymeric scaffolds for dental pulp tissue engineering: A review. Dent Mater (Internet). 2020 Feb 1; Available from: https://epublications.marquette.edu/dentistry_fac/429 https://doi.org/10.1016/j.dental.2019.11.005.

[8] Zhuang X, Ji L, Jiang H, Liu Y, Liu X, Bi J, et al. Exosomes derived from stem cells from the apical papilla promote dentine-pulp complex regeneration by inducing specific dentinogenesis. Stem Cells Int. 2020 May;2020:5816723. https://doi.org/10.1155/2020/5816723PMID:32565828

[9] Hammouda DA, Mansour AM, Saeed MA, Zaher AR, Grawish ME. Stem cell-derived exosomes for dentin-pulp complex regeneration: a mini-review. Restor Dent Endod. 2023 May;48(2):e20. https://doi.org/10.5395/rde.2023.48.e20 PMID:37284341

[10] Xie Z, Shen Z, Zhan P, Yang J, Huang Q, Huang S, et al. Functional dental pulp regeneration: Basic research and clinical translation. Int J Mol Sci. 2021 Aug;22(16):8991. https://doi.org/10.3390/ijms22168991 PMID:34445703

[11] Huang X, Li Z, Liu A, Liu X, Guo H, Wu M, et al. Microenvironment influences odontogenic mesenchymal stem cells mediated dental pulp regeneration. Front Physiol (Internet). 2021 Apr 22 (cited 2024 Jun 6);12. Available from: https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2021.656588/full https://doi.org/10.3389/fphys.2021.656588.

[12] Wei Y, Lyu P, Bi R, Chen X, Yu Y, Li Z, et al. Neural regeneration in regenerative endodontic treatment: An overview and current trends. Int J Mol Sci. 2022 Dec;23(24):15492. https://doi.org/10.3390/ijms232415492 PMID:36555133

[13] Hade MD, Suire CN, Suo Z. Mesenchymal stem cell-derived exosomes: Applications in regenerative medicine. Cells. 2021 Aug;10(8):1959. https://doi.org/10.3390/cells10081959PMID:34440728

[14] González-González A, García-Sánchez D, Dotta M, Rodríguez-Rey JC, Pérez-Campo FM. Mesenchymal stem cells secretome: The cornerstone of cell-free regenerative medicine. World J Stem Cells. 2020 Dec;12(12):1529–1552. https://doi.org/10.4252/wjsc.v12.i12.1529PMID:33505599

[15] Gulabivala K, Ng YL. Factors that affect the outcomes of root canal treatment and retreatment—A reframing of the principles. Int Endod J. 2023 Mar;56(S2 Suppl 2):82–115. https://doi.org/10.1111/iej.13897 PMID:36710532

[16] Bakopoulou A. Prospects of advanced therapy medicinal products-based therapies in regenerative dentistry: Current status, comparison with global trends in medicine, and future perspectives. J Endod. 2020 Sep;46(9 9S):S175–S188. https://doi.org/10.1016/j.joen.2020.06.026PMID:32950189

[17] Costa LA, Eiro N, Vaca A, Vizoso FJ. Towards a new concept of regenerative endodontics based on mesenchymal stem cell-derived secretomes products. Bioengineering (Basel). 2022 Dec;10(1):4. https://doi.org/10.3390/bioengineering10010004 PMID:36671576

[18] Pan W, Chen H, Wang A, Wang F, Zhang X. Challenges and strategies: Scalable and efficient production of mesenchymal stem cells-derived exosomes for cell-free therapy. Life Sci. 2023 Apr;319:121524. https://doi.org/10.1016/j.lfs.2023.121524 PMID:36828131

[19] Murray PE. Review of guidance for the selection of regenerative endodontics, apexogenesis, apexification, pulpotomy, and other endodontic treatments for immature permanent teeth. Int Endod J. 2023 Mar;56(S2 Suppl 2):188–199. https://doi.org/10.1111/iej.13809 PMID:35929348

[20] Cui D, Yu S, Zhou X, Liu Y, Gan L, Pan Y, et al. Roles of dental mesenchymal stem cells in the management of immature necrotic permanent teeth. Front Cell Dev Biol (Internet). 2021 May 19 (cited 2024 Jun 6);9. Available from: https://www.frontiersin.org/articles/10.3389/fcell.2021.666186 https://doi.org/10.3389/fcell.2021.666186.

[21] Soares DG, Bordini EA, Swanson WB, de Souza Costa CA, Bottino MC. Platform technologies for regenerative endodontics from multifunctional biomaterials to tooth-on-a-chip strategies. Clin Oral Investig. 2021 Aug;25(8):4749–4779. https://doi.org/10.1007/s00784-021-04013-4 PMID:34181097

[22] Siddiqui Z, Acevedo-Jake AM, Griffith A, Kadincesme N, Dabek K, Hindi D, et al. Cells and material-based strategies for regenerative endodontics. Bioact Mater. 2021 Nov;14:234–249. https://doi.org/10.1016/j.bioactmat.2021.11.015 PMID:35310358

[23] Gold MR, Siegel JE, Russell LB, Weinstein MC. Cost-effectiveness in health and medicine. Oxford University Press; 1996. 450 pp. https://doi.org/10.1093/oso/9780195108248.001.0001.

[24] Drummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes. Oxford University Press; 2015.

[25] Neumann PJ, Sanders GD, Russell LB, Siegel JE, Ganiats TG. Cost-effectiveness in health and medicine. Oxford University Press; 2016. 537 pp. https://doi.org/10.1093/acprof:oso/9780190492939.001.0001.

[26] Mishan EJ, Quah E. Cost-benefit analysis. 6th ed. London: Routledge; 2020. https://doi.org/10.4324/9781351029780.