Fan Ying Zhen
Universiti Sains Malaysia in Kelantan
I would like to thank Dr. Nurul Asma Abdullah for helping me with the article.
Regenerative endodontics is well-known as a biology-based technique intended to replace and heal dentin or cells of the pulp-dentin complex in an injured tooth. This technique can restore dental pulp physiological functions, where it should comprise a triad of elements: growth factors, stem cells and biomaterials. Traumatic dental injuries (TDI) are described as an injury to the teeth, periodontium, or soft tissue around the oral cavity which may occur accidentally due to collision or sports injury. Deep pulp traumatic injury is a type of TDI that involves a crown-root fracture of permanent teeth with pulp involvement. The endodontic treatment known as vital pulp therapy is suggested either during initial treatment or before restoration. A conventional method, like root canal treatment, should be reconsidered as vital pulp therapy, which is believed to have regenerative capabilities. Commercial materials commonly used for vital pulp therapy, such as calcium hydroxide (Ca(OH)2) and Mineral Trioxide Aggregate (MTA) however, demonstrate several drawbacks.
The drawbacks include:
● Failure to provide a long-term biological seal
● Poor sealing capability
● Long setting time
● Poor handling procedure
● Expensive in the market
What are biomaterials?
Biomaterials are used as a medium capable of interacting with the human biological system. Thus, innovative researchers are interested in expanding their research to discover new materials that are able to associate with other substances that have potential to promote dental tissue or bone regeneration. The presence of chitosan has grabbed researchers’ attention due to its non-toxic biological origin and biodegradable nature. Chitosan has been a promising biomaterial that is capable of offering glorious prospects in the advanced tissue engineering area.
Chitosan is a semi-crystalline, natural, non-toxic biopolymer that is derived effortlessly from the partial removal of the acetyl group in chitin. Chitin originated from the exoskeletons of arthropods and fungal cell walls. Chitosan has beneficial applications in various fields, for instance, dentistry, medicine, biomedicine, agriculture, biotechnology, and nanotechnology. The primary sources for chitosan or chitin are from the marine industry as most of the marine crustaceans such as crabs or shrimps’ shells and squids bone plate are identified as food industry wastes. The wastage can be altered into valuable commercial products or biomaterial that are beneficial in human health promotion. Thus, chitosan represents an attractive candidate as it demonstrates a positive effect in regenerative endodontics. Chitosan has exhibited several advantages which include:
Benefit of Chitosan
· Disintegrates on its own after a few months as compared to Ca(OH)2 and MTA that are not biodegradable.
· Variety of hydrolytic enzymes, e.g., chitosanase and chitin deacetylase, which are capable of hydrolyzing chitosan in the human body.
· Biocompatible with the human body (lower undesirable host response)
● Achieves degree of porosity
· Requires porous scaffolds that act as a support
· Enhances proliferation and differentiation of dental-related cells substantially
· Provides favorable environment for the living cells
· Promotes proliferation and attachment of cells
· Provides interconnection between cells and pore structure to enable growth and allows sufficient nutrient transport
· A study by Subhi et al. in 2020 reported that chitosan-based accelerated Portland cement did not exhibit cytotoxicity effect on dental pulp stem cells, which indicate the material is non toxic
· Several studies with clinical tests proved that chitosan does not report any adverse inflammatory or allergic reaction when applied as drug’s vehicle or used in tissue engineering
The use of chitosan with mesenchymal stem cells might stimulate tissue reparation, mineralization, cell migration and reduce inflammation of the dental pulp. Therefore, chitosan has the potential to be developed as an alternative biomaterial for regenerative endodontics as it indicates excellent physical, chemical, mechanical and cytotoxicity properties that are capable of future tissue engineering strategies for enhancing dentin-pulp regeneration.
About the author: Fan Ying Zhen, Biomedicine undergraduate from Universiti Sains Malaysia in Kelantan. The purpose of writing the article is to share possible findings of a new alternative biomaterial to be used for regenerative endodontics in the future. Personally, I am interested in stem cell research that is related to molecular biology and dentistry.