Regeneration of Neural Networks in Immature Teeth with Non-Vital Pulp Following a Novel Regenerative Procedure

BACKGROUND AND OBJECTIVES: Recombinant amelogenin protein (RAP) was reported to induce soft-tissue regeneration in canine infected endodontically treated permanent teeth with open apices. To characterize identities of the cells found in the RAP regenerated tissues compared to authentic pulp by identifying: 1) stem cells by their expression of Sox2; 2) nerve fibers by distribution of the axonal marker peripherin; 3) axons by their expression of calcitonin gene–related peptide (CGRP); 4) the presence of astrocytes expressing glial fibrillary acidic proteins (GFAP).METHODS: A total of 240 open-apex root canals in dogs were used. After establishment of oral contamination to the pulp, the canals were cleaned, irrigated, and 120 canals filled with RAP, and the other 120 with calcium hydroxide.RESULTS: After 1, 3, and 6 months, teeth were recovered for immune-detection of protein markers associated with native pulp tissues. Regenerated pulp and apical papilla of RAP group revealed an abundance of stem cells showing intense immunoreactivity to Sox2 antibody, immunoreactivity of peripherin mainly in the A-fibers of the odontoblast layer and immunoreactivity to CGRP fibers in the central pulp region indicative of C-fibres. GFAP immunoreactivity was observed near the odontoblastic, cell-rich regions and throughout the regenerated pulp.CONCLUSIONS: RAP induces pulp regeneration following regenerative endodontic procedures with cells identity by gene expression demonstrating a distribution pattern similar to the authentic pulp innervation. A- and C-fibers, as well as GFAP specific to astrocytic differentiation, are recognized. The origin of the regenerated neural networks may be derived from the Sox2 identified stem cells within the apical papilla.

Distribution of Peripherin Immunoreactive Axons in Rat Molar Pulp / 체질인류학회지

Dental pulp is innervated mostly by unmyelinated axons and small myelinated axons. These axons are implicated pain transmission and contain various neurotransmitters and receptors. However, little information, so far, is available on the distribution pattern and characterization of axons involved in the dental pain. In this study, to enhance understanding of dental pain processing, we observed distribution of axons expressing peripherin, an unmyelinated and small myelinated axonal marker, the in rat maxillary molar pulp. Peripherin-immunopositive (+) axons are mostly distributed in the peripheral pulp, and a few peripherin+ axons ascend into the odontoblast layer. Peripherin+ axons expressing NF200 are more frequently observed in the odontoblast layer (86.3+/-3.0%) than in the pulpal core region (79.3+/-2.8%) and nerve plexus region (78.6+/-1.9%). In contrast, peripherin+ axons expressing CGRP are less frequently observed in the odontoblast layer (17.7+/-5.0%) than in the pulpal core (37.7+/-10.1%) and nerve plexus regions (40.0+/-5.7%). These findings indicate that small myelinated axons are implicated in the transmission of dental pain arising from the odontoblast layer while peptidergic unmyelinated axons are implicated in the transmission of dental pain arising from central core and nerve plexus regions of the dental pulp.

Neurochemical Properties of Dental Primary Afferent Neurons

The long belief that dental primary afferent (DPA) neurons are entirely composed of nociceptive neurons has been challenged by several anatomical and functional investigations. In order to characterize non-nociceptivepopulation among DPA neurons, retrograde transport fluorescent dye was placed in upper molars of rats and immunohistochemical detection of peripherin and neurofilament 200 in the labeled trigeminal ganglia was performed. As the results, majority ofDPA neurons were peripherin-expressing small-sized neurons, showing characteristic ofnociceptive C-fibers. However, 25.7% of DPA were stained with antibody against neurofilament 200, indicating significant portion of DPA neurons are related to large myelinated Abeta fibers. There were a small number of neurons thatexpressed both peripherin and neurofilament 200, suggestive of Adelta fibers. The possible transition of neurochemical properties by neuronal injury induced by retrograde labeling technique was ruled out by detection of minimal expression of neuronal injury marker, ATF-3. These results suggest that in addition to the large population of C-fiber-related nociceptive neurons, a subset of DPA neurons is myelinated large neurons, which is related to low-threshold mechanosensitive Abeta fibers. We suggest that these Abeta fiber-related neurons might play a role as mechanotransducers of fluid movement within dentinal tubules.