West Kazakhstan Medical Journal

ISSN: 2707-6180 (Print) 2707-6199 (Online)

Pioneering research advancing the frontiers of medical knowledge and healthcare practices.

Pulp Necrosis Treatment: Evaluating the Effectiveness of Stem Cell Therapy: A Minireview

Published date: Jun 02 2025

Journal Title: West Kazakhstan Medical Journal

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

Pages: 150 - 161

DOI: 10.18502/wkmj.v67i2.17125

Authors:

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

Ihtesham ur RehmanIURehman@uclan.ac.ukProfessor of Biomaterials and Regenerative Medicine, School of Medicine and Dentistry, University of Central Lancashire, Preston

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

Zhanara A. ShabanbayevaShabanbayeva77@mail.ruDepartment of Therapeutic and Surgical Dentistry, Astana Medical University, Astana

Abstract:

Pulp necrosis, a prevalent condition in endodontics, poses significant challenges in preserving tooth vitality and function. Traditional treatment methods like root canal therapy often focus on managing symptoms and controlling the infection rather than promoting natural tissue regeneration. This article evaluates the effectiveness of stem cell therapy as an innovative approach to treating pulp necrosis. We review recent advancements and clinical trials that explore the regenerative potential of stem cells, including mesenchymal stem cells (MSCs), from various sources. The review highlights the underlying mechanisms of stem cell therapy, such as differentiation and angiogenesis, and compares these to conventional methods in terms of efficacy and patient outcomes. By examining the current state of research, challenges, and future directions, this article aims to provide a comprehensive understanding of how stem cell therapy could revolutionize the treatment of pulp necrosis and improve clinical practice.

Keywords: pulp necrosis, stem cell therapy, mesenchymal stem cells, regenerative endodontics, tooth vitality, angiogenesis

References:

[1] Chandra R, Tripathi S, De Raktim, Dixit M, Nishchhal A, Franklin S. Vital pulp therapy. J Adv Med Dent Sci Res. 2023;11(4):62–81. https://doi.org/10.21276/jamdsr

[2] Duncan HF. Present status and future directions—Vital pulp treatment and pulp preservation strategies. Int Endod J. 2022;55(Suppl 3):497–511. https://doi.org/10.1111/iej.13688

[3] Donnermeyer D, Dammaschke T, Lipski M, Schäfer E. Effectiveness of diagnosing pulpitis: A systematic review. Int Endod J. 2023 Oct;56(S3 Suppl 3):296–325. https://doi.org/10.1111/iej.13762 PMID:35536159

[4] Andreasen FM, Andreasen JO. Resorption and mineralization processes following root fracture of permanent incisors. Endod Dent Traumatol. 1988 Oct;4(5):202–214. https://doi.org/10.1111/j.1600- 9657.1988.tb00323.x PMID:3248578

[5] Lu Y, Liu Z, Huang J, Liu C. Therapeutic effect of one-time root canal treatment for irreversible pulpitis. J Int Med Res. 2020 Feb;48(2):300060519879287. https://doi.org/10.1177/0300060519879287 PMID:31617430

[6] Saoud TM, Ricucci D, Lin LM, Gaengler P. Regeneration and repair in endodontics—A special issue of the regenerative endodontics—A new era in clinical endodontics. Dent J. 2016 Feb;4(1):3. https://doi.org/10.3390/dj4010003 PMID:29563445

[7] Urkande NK, Mankar N, Nikhade PP, Chandak M. Beyond tradition: Non-surgical endodontics and vital pulp therapy as a dynamic combination. Cureus. 2023 Aug;15(8):e44134. https://doi.org/10.7759/cureus.44134 PMID:37753005

[8] Bansal R, Jain A, Mittal S. Current overview on challenges in regenerative endodontics. J Conserv Dent. 2015;18(1):1–6. https://doi.org/10.4103/0972-0707.148861 PMID:25657518

[9] Kurmanalina MA, Urazalina MM, Abasheva AG, Aitmukhanbetova MA. The Role of mesenchymal stem cells in dentistry: A review. WKMJ. 2024;66(2):126–136. https://doi.org/10.18502/wkmj.v66i2.16455.

[10] Kouchakian MR, Baghban N, Moniri SF, Baghban M, Bakhshalizadeh S, Najafzadeh V, et al. The clinical trials of mesenchymal stromal cells therapy. Stem Cells Int. 2021 Nov;2021(1):1634782. https://doi.org/10.1155/2021/1634782 PMID:34745268

[11] Kwack KH, Lee HW. Clinical potential of dental pulp stem cells in pulp regeneration: Current endodontic progress and future perspectives. Front Cell Dev Biol. 2022 Apr;10:857066. https://doi.org/10.3389/fcell.2022.857066 PMID:35478967

[12] 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

[13] Shi X, Hu X, Jiang N, Mao J. Regenerative endodontic therapy: From laboratory bench to clinical practice. J Adv Res. Forthcoming 2024 Jul;S2090-1232(24)00267-4. https://doi.org/10.1016/j.jare.2024.07.001 PMID:38969092

[14] Bharuka T, Reche A. Advancements in periodontal regeneration: A comprehensive review of stem cell therapy. Cureus. 2024 Feb;16(2):e54115. https://doi.org/10.7759/cureus.54115PMID:38487109

[15] Shi X, Mao J, Liu Y. Pulp stem cells derived from human permanent and deciduous teeth: Biological characteristics and therapeutic applications. Stem Cells Transl Med. 2020 Apr;9(4):445– 464. https://doi.org/10.1002/sctm.19-0398 PMID:31943813

[16] Baldión PA, Velandia-Romero ML, Castellanos JE. Odontoblast-like cells differentiated from dental pulp stem cells retain their phenotype after subcultivation. Int J Cell Biol. 2018 Feb;2018:6853189. https://doi.org/10.1155/2018/6853189 PMID:29670655

[17] Luo L, He Y, Wang X, Key B, Lee BH, Li H, et al. Potential roles of dental pulp stem cells in neural regeneration and repair. Stem Cells Int. 2018 May;2018:1731289. https://doi.org/10.1155/2018/1731289 PMID:29853908

[18] Mattei V, Delle Monache S. Dental pulp stem cells (DPSCs) and tissue regeneration: Mechanisms mediated by direct, paracrine, or autocrine effects. Biomedicines. 2023 Jan;11(2):386. https://doi.org/10.3390/biomedicines11020386 PMID:36830923

[19] Zhou T, Pan J, Wu P, Huang R, Du W, Zhou Y, et al. Dental follicle cells: Roles in development and beyond. Stem Cells Int. 2019 Sep;2019:9159605. https://doi.org/10.1155/2019/9159605 PMID:31636679

[20] Huang GT, Gronthos S, Shi S. Mesenchymal stem cells derived from dental tissues vs. those from other sources: Their biology and role in regenerative medicine. J Dent Res. 2009 Sep;88(9):792–806. https://doi.org/10.1177/0022034509340867 PMID:19767575

[21] Amghar-Maach S, Gay-Escoda C, Sánchez-Garcés MA. Regeneration of periodontal bone defects with dental pulp stem cells grafting: Systematic Review. J Clin Exp Dent. 2019 Apr;11(4):e373–381. https://doi.org/10.4317/jced.55574 PMID:31110618

[22] Goriuc A, Foia L, Cojocaru K, Diaconu-Popa D, Sandu D, Luchian I. The Role and Involvement of Stem Cells in Periodontology. Biomedicines. 2023 Jan;11(2):387. https://doi.org/10.3390/biomedicines11020387 PMID:36830924

[23] Aliborzi G, Vahdati A, Mehrabani D, Hosseini SE, Tamadon A. Isolation, characterization and growth kinetic comparison of bone marrow and adipose tissue mesenchymal stem cells of guinea pig. Int J Stem Cells. 2016 May;9(1):115–123. https://doi.org/10.15283/ijsc.2016.9.1.115PMID:27426093

[24] Staniowski T, Zawadzka-Knefel A, Skośkiewicz-Malinowska K. Therapeutic potential of dental pulp stem cells according to different transplant types. Molecules. 2021 Dec;26(24):7423. https://doi.org/10.3390/molecules26247423 PMID:34946506

[25] Vasanthan J, Gurusamy N, Rajasingh S, Sigamani V, Kirankumar S, Thomas EL, et al. Role of human mesenchymal stem cells in regenerative therapy. Cells. 2020 Dec;10(1):54. https://doi.org/10.3390/cells10010054 PMID:33396426

[26] Tsutsui TW. Dental pulp stem cells: Advances to applications. Stem Cells Cloning. 2020 Feb;13:33–42. https://doi.org/10.2147/SCCAA.S166759 PMID:32104005

[27] Mehrabani D, Hassanshahi MA, Tamadon A, Zare S, Keshavarz S, Rahmanifar F, et al. Adipose tissuederived mesenchymal stem cells repair germinal cells of seminiferous tubules of busulfan-induced azoospermic rats. J Hum Reprod Sci. 2015;8(2):103–110. https://doi.org/10.4103/0974-1208.158618 PMID:26157302

[28] Dong L, Li X, Leng W, Guo Z, Cai T, Ji X, et al. Adipose stem cells in tissue regeneration and repair: From bench to bedside. Regen Ther. 2023 Oct;24:547–560. https://doi.org/10.1016/j.reth.2023.09.014 PMID:37854632

[29] Zhang J, Liu Y, Chen Y, Yuan L, Liu H, Wang J, et al. Adipose-derived stem cells: Current applications and future directions in the regeneration of multiple tissues. Stem Cells Int. 2020 Dec;2020:8810813. https://doi.org/10.1155/2020/8810813 PMID:33488736

[30] Hung CN, Mar K, Chang HC, Chiang YL, Hu HY, Lai CC, et al. A comparison between adipose tissue and dental pulp as sources of MSCs for tooth regeneration. Biomaterials. 2011 Oct;32(29):6995–7005. https://doi.org/10.1016/j.biomaterials.2011.05.086 PMID:21696818

[31] Bar JK, Lis-Nawara A, Grelewski PG. Dental pulp stem cell-derived secretome and its regenerative potential. Int J Mol Sci. 2021 Nov;22(21):12018. https://doi.org/10.3390/ijms222112018 PMID:34769446

[32] Babaki D, M Matin M. Odontoblast-like cytodifferentiation of dental stem cells: A review. Iran Endod J. 2020;15(2):79–89. https://doi.org/10.22037/iej.v15i2.27569 PMID:36704441

[33] Raj AT, Kheur S, Khurshid Z, Sayed ME, Mugri MH, Almasri MA, et al. The growth factors and cytokines of dental pulp mesenchymal stem cell secretome may potentially aid in oral cancer proliferation. Molecules. 2021 Sep;26(18):5683. https://doi.org/10.3390/molecules26185683 PMID:34577154

[34] Singh PV, Singh PV, Anjankar A. Harnessing the therapeutic potential of stem cells in the management of chronic obstructive pulmonary disease: A comprehensive review. Cureus. 2023 Aug;15(8):e44498. https://doi.org/10.7759/cureus.44498 PMID:37711945

[35] Gattazzo F, Urciuolo A, Bonaldo P. Extracellular matrix: A dynamic microenvironment for stem cell niche. Biochim Biophys Acta. 2014 Aug;1840(8):2506–2519. https://doi.org/10.1016/j.bbagen.2014.01.010 PMID:24418517

[36] Huang GT. Pulp and dentin tissue engineering and regeneration: Current progress. Regen Med. 2009 Sep;4(5):697–707. https://doi.org/10.2217/rme.09.45 PMID:19761395

[37] Tanabe S. Signaling involved in stem cell reprogramming and differentiation. World J Stem Cells. 2015 Aug;7(7):992–998. PMID:26328015

[38] Mostafa S, Pakvasa M, Coalson E, Zhu A, Alverdy A, Castillo H, et al. The wonders of BMP9: From mesenchymal stem cell differentiation, angiogenesis, neurogenesis, tumorigenesis, and metabolism to regenerative medicine. Genes Dis. 2019 Jul;6(3):201–223. https://doi.org/10.1016/j.gendis.2019.07.003 PMID:32042861

[39] Liu M, Goldman G, MacDougall M, Chen S. BMP signaling pathway in dentin development and diseases. Cells. 2022 Jul;11(14):2216. https://doi.org/10.3390/cells11142216PMID:35883659

[40] Sagomonyants K, Mina M. Stage-specific effects of fibroblast growth factor 2 on the differentiation of dental pulp cells. Cells Tissues Organs. 2014;199(5-6):311–328. https://doi.org/10.1159/000371343 PMID:25823776

[41] Kurogoushi R, Hasegawa T, Akazawa Y, Iwata K, Sugimoto A, Yamaguchi-Ueda K, et al. Fibroblast growth factor 2 suppresses the expression of C-C motif chemokine 11 through the c-Jun N-terminal kinase pathway in human dental pulp-derived mesenchymal stem cells. Exp Ther Med. 2021 Dec;22(6):1356. https://doi.org/10.3892/etm.2021.10791 PMID:34659502

[42] Farooq M, Khan AW, Kim MS, Choi S. The role of fibroblast growth factor (FGF) signaling in tissue repair and regeneration. Cells. 2021 Nov;10(11):3242. https://doi.org/10.3390/cells10113242 PMID:34831463

[43] Gomez-Sosa JF, Caviedes-Bucheli J, Díaz Barrera LE. Gene expression of vascular endothelial growth factor A and its receptors in dental pulp of immature and mature teeth. Eur Endod J. 2021 Dec;6(3):259– 263. https://doi.org/10.14744/eej.2021.86580 PMID:34967342

[44] Saghiri MA, Asatourian A, Sorenson CM, Sheibani N. Role of angiogenesis in endodontics: Contributions of stem cells and proangiogenic and antiangiogenic factors to dental pulp regeneration. J Endod. 2015 Jun;41(6):797–803. https://doi.org/10.1016/j.joen.2014.12.019PMID:25649306

[45] Rademakers T, Horvath JM, van Blitterswijk CA, LaPointe VL. Oxygen and nutrient delivery in tissue engineering: Approaches to graft vascularization. J Tissue Eng Regen Med. 2019 Oct;13(10):1815–1829. https://doi.org/10.1002/term.2932 PMID:31310055

[46] Birjandi AA, Sharpe P. Wnt signalling in regenerative dentistry. Front Dent Med. 2021;2:725468. https://doi.org/10.3389/fdmed.2021.725468.

[47] Florimond M, Minic S, Sharpe P, Chaussain C, Renard E, Boukpessi T. Modulators of Wnt signaling pathway implied in dentin pulp complex engineering: A literature review. Int J Mol Sci. 2022 Sep;23(18):10582. https://doi.org/10.3390/ijms231810582 PMID:36142496

[48] Zhou B, Lin W, Long Y, Yang Y, Zhang H, Wu K, et al. Notch signaling pathway: Architecture, disease, and therapeutics. Signal Transduct Target Ther. 2022 Mar;7(1):95. https://doi.org/10.1038/s41392-022- 00934-y PMID:35332121

[49] Xing W, Yang J, Zheng Y, Yao L, Peng X, Chen Y, et al. The role of the notch signaling pathway in the differentiation of human umbilical cord-derived mesenchymal stem cells. Front Biosci (Landmark Ed). 2024 Feb;29(2):74. https://doi.org/10.31083/j.fbl2902074PMID:38420823

[50] Walma DA, Yamada KM. The extracellular matrix in development. Development. 2020 May;147(10):dev175596. https://doi.org/10.1242/dev.175596 PMID:32467294

[51] Pang X, He X, Qiu Z, Zhang H, Xie R, Liu Z, et al. Targeting integrin pathways: Mechanisms and advances in therapy. Signal Transduct Target Ther. 2023 Jan;8(1):1. https://doi.org/10.1038/s41392-022- 01259-6 PMID:36588107

[52] Mas-Bargues C, Sanz-Ros J, Román-Domínguez A, Inglés M, Gimeno-Mallench L, El Alami M, et al. Relevance of oxygen concentration in stem cell culture for regenerative medicine. Int J Mol Sci. 2019 Mar;20(5):1195. https://doi.org/10.3390/ijms20051195 PMID:30857245

[53] Ma M. Role of hypoxia in mesenchymal stem cells from dental pulp: Influence, mechanism and application. Cell Biochem Biophys. 2024 Jun;82(2):535–547. https://doi.org/10.1007/s12013-024-01274- 0 PMID:38713403

[54] Wang J, Deng G, Wang S, Li S, Song P, Lin K, et al. Enhancing regenerative medicine: The crucial role of stem cell therapy. Front Neurosci. 2024 Feb;18:1269577. https://doi.org/10.3389/fnins.2024.1269577 PMID:38389789

[55] Song N, Scholtemeijer M, Shah K. Mesenchymal stem cell immunomodulation: Mechanisms and therapeutic potential. Trends Pharmacol Sci. 2020 Sep;41(9):653–664. https://doi.org/10.1016/j.tips.2020.06.009 PMID:32709406

[56] Han Y, Yang J, Fang J, Zhou Y, Candi E, Wang J, et al. The secretion profile of mesenchymal stem cells and potential applications in treating human diseases. Signal Transduct Target Ther. 2022 Mar;7(1):92. https://doi.org/10.1038/s41392-022-00932-0 PMID:35314676

[57] Moradi-Gharibvand N, Hashemibeni B. The Effect of stem cells and vascular endothelial growth factor on cancer angiogenesis. Adv Biomed Res. 2023 May;12(1):124. https://doi.org/10.4103/abr.abr_378_21 PMID:37434939

[58] Rehman A, Nigam A, Laino L, Russo D, Todisco C, Esposito G, et al. Mesenchymal stem cells in soft tissue regenerative medicine: A comprehensive review. Medicina (Kaunas). 2023 Aug;59(8):1449. https://doi.org/10.3390/medicina59081449 PMID:37629738

[59] Salari V, Mengoni F, Del Gallo F, Bertini G, Fabene PF. The anti-inflammatory properties of mesenchymal stem cells in epilepsy: Possible treatments and future perspectives. Int J Mol Sci. 2020 Dec;21(24):9683. https://doi.org/10.3390/ijms21249683 PMID:33353235

[60] Hu L, Yin C, Zhao F, Ali A, Ma J, Qian A. Mesenchymal stem cells: Cell fate decision to osteoblast or adipocyte and application in osteoporosis treatment. Int J Mol Sci. 2018 Jan;19(2):360. https://doi.org/10.3390/ijms19020360 PMID:29370110

[61] Nazanin J, Mina SH, Alireza A, Mohammad G, Madina AK, Nadiar MM, et al. Investigating the effect of exosomes derived from human umbilical cord mesenchymal stromal/stem cells on the regeneration of human pulpectomized tooth: A case report. Iran J Med Sci. Forthcoming 2025.

[62] Xuan K, Li B, Guo H, Sun W, Kou X, He X, et al. Deciduous autologous tooth stem cells regenerate dental pulp after implantation into injured teeth. Sci Transl Med. 2018 Aug;10(455):eaaf3227. https://doi.org/10.1126/scitranslmed.aaf3227 PMID:30135248

[63] Nakashima M, Iohara K, Murakami M, Nakamura H, Sato Y, Ariji Y, et al. Pulp regeneration by transplantation of dental pulp stem cells in pulpitis: A pilot clinical study. Stem Cell Res Ther. 2017 Mar;8(1):61. https://doi.org/10.1186/s13287-017-0506-5 PMID:28279187

[64] Meza G, Urrejola D, Saint Jean N, Inostroza C, López V, Khoury M, et al. Personalized cell therapy for pulpitis using autologous dental pulp stem cells and leukocyte platelet-rich fibrin: A case report. J Endod. 2019 Feb;45(2):144–149. https://doi.org/10.1016/j.joen.2018.11.009PMID:30711169

[65] Feitosa VP, Mota MN, Vieira LV, de Paula DM, Gomes LL, Solheiro LK, et al. Dental pulp autotransplantation: A new modality of endodontic regenerative therapy-follow-up of 3 clinical cases. J Endod. 2021 Sep;47(9):1402–1408. https://doi.org/10.1016/j.joen.2021.06.014PMID:34175322