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| Biomimetic regenerative dentistry aims to restore and regenerate dental tissues through methods that closely mimic natural processes. |
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| Demineralization and Remineralization |
| Demineralization is the loss of calcium and phosphate ions from hydroxyapatite (HA) crystals in tooth structures like enamel and dentin, which can lead to dentin hypersensitivity and, if severe, cavity formation. This process is reversible under favorable conditions through remineralization, where the lost minerals are redeposited, restoring the crystal integrity. |
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| Bottom-up Biomimetic Remineralization |
| Focuses on forming nano-sized crystals to fill gaps in demineralized dentin and utilizes amorphous calcium phosphate (ACP) stabilized by non-collagenous proteins (e.g., DMP1, DPP). It mimics natural nucleation and growth of hydroxyapatite crystals to replicate tooth structure. |
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| Biomimetic Dentin Remineralization Materials |
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Bioactive Glass (BAG)
Promotes hard tissue repair and remineralization by releasing calcium, sodium, and phosphorus ions when in contact with water or saliva and alleviates dentin hypersensitivity by occluding dentinal tubules and supports pulp capping due to its non-cytotoxic nature and ability to promote reparative dentin formation. |
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Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP)
CPP-ACP derived from milk proteins stabilizes calcium and phosphate ions in a way that prevents spontaneous crystallization and maintains a super-saturated state at the tooth surface. This complex has proven effective in preventing enamel demineralization and enhancing remineralization, especially when used in toothpastes, chewing gums, and restorative materials. |
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Fluoride Compounds
Fluoride enhances remineralization by replacing hydroxyl groups in hydroxyapatite with fluoride, forming fluoroapatite which is more acid-resistant than hydroxyapatite, thus providing enhanced protection. Biomimetic Mineralization (BIMIN) helps form a protective fluorapatite layer on the tooth surface, promoting remineralization in both enamel and dentin. |
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Zinc Oxide Loaded Materials
Helps reduce matrix metalloproteinase (MMP)-mediated collagen degradation, promotes dentin remineralization, and facilitates the precipitation of crystals in the dentinal tubules. Zinc-loaded materials offer stability in acidic environments and help strengthen remineralized dentin. |
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| Non-collagenous Proteins (NCPs) and Biomimetic Analogues |
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Polydopamine (PDA)
Binds to calcium ions and promotes the nucleation of hydroxyapatite, mimicking the natural process of mineralization. |
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Polyelectrolytes (polyvinylphosphonic acid (PVPA) and polyacrylic acid (PAA))
Used as biomimetic analogs for phosphoproteins such as DMP1 and DPP which support remineralization by forming nanocrystals that infiltrate demineralized collagen matrices, thus enhancing mineral deposition and stabilizing ACP nano-precursors. |
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Polyamidoamine Dendrimer (PAMAM)
Mimic the function of non-collagenous proteins in biomineralization and their structure allows them to sequester calcium and phosphate ions, facilitating the remineralization process and serving as a template for hydroxyapatite formation. |
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Sodium Trimetaphosphate (STMP)
STMP is a phosphophoryn analog that phosphorylates collagen type I, creating negatively charged sites that attract mineral precursors. This promotes remineralization by enhancing nucleation and inhibiting collagen degradation. |
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| Biomimetic Dentin-Pulp Complex Regeneration |
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Vital vs. Non-vital Pulp Therapy
Vital pulp therapy aims to stimulate dentin bridge formation to protect the pulp, whereas non-vital pulp therapy typically involves root canal treatment. Biomimetic approaches to dentin-pulp regeneration involve disinfecting the root canal and applying bioactive materials, such as biomimetic cements, stem cells, or growth factors, to stimulate tissue regeneration. |
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Bioactive Materials for Dentin-Pulp Complex Regeneration
Bioactive materials promote tissue repair and regeneration. These materials can form a chemical bond with tooth structure or stimulate biological responses in the pulp tissue, enhancing dentin formation. Common bioactive materials used in pulp therapy include: |
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Calcium Hydroxide (CaOH₂): Known for its antibacterial properties, calcium hydroxide stimulates the formation of reparative dentin and is used in pulp capping and root canal treatments. It raises pH levels and promotes calcification, making it effective in treating carious lesions and pulp inflammation. |
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Mineral Trioxide Aggregate (MTA): A calcium silicate-based material that induces odontoblast differentiation and dentin mineralization. MTA is widely used for pulp capping and root-end filling due to its superior sealing ability and biocompatibility. |
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Biodentine: A bioactive calcium-silicate material that serves as a dentin substitute. Biodentine promotes odontoblast differentiation and enhances mineralization, making it a suitable material for pulp capping, root perforation repair, and apexification. |
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Enamel Matrix Derivative (EMD): Derived from the developing enamel layer, EMD stimulates odontogenesis and dentin regeneration. It is used in pulp capping and root regeneration procedures. |
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| Cell Homing Strategies in Dental Tissue Regeneration |
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| Cell homing is a regenerative approach that recruits stem or progenitor cells to sites of injury using biological signaling molecules. This strategy is particularly useful in pulp tissue regeneration, where stem cells are directed to the injury site to stimulate tissue repair. |
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Platelet Concentrates (Platelet-rich plasma (PRP) and platelet-rich fibrin (PRF))
These concentrates contain growth factors like platelet-derived growth factor (PDGF) and transforming growth factor-beta (TGF-β), which stimulate tissue regeneration and cell differentiation. They are used in various dental procedures, including pulp regeneration and periodontal healing. |
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Bone Morphogenetic Proteins (BMPs)
BMPs are growth factors that play a key role in tooth development and odontoblast differentiation. Recombinant BMPs, such as BMP2, BMP4, and BMP7, can be applied to pulp tissue to induce reparative dentin formation. |
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Hyaluronic Acid (HA) and Derivatives
A major component of the dental pulp extracellular matrix. HA derivatives can stimulate stem cell differentiation and mineralization, promoting dentin and pulp tissue regeneration. HA's biocompatibility and bioactivity make it an ideal material for regenerative dentistry. |
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Collagen
Used in regenerative dentistry due to its bioactive properties & facilitates cell attachment and differentiation, supporting the repair and regeneration of dentin and pulp tissues. |
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| Conclusion |
| Biomimetic regenerative dentistry represents a transformative approach to dental care, focusing on the natural processes of remineralization and tissue regeneration. Through the use of bioactive materials, non-collagenous protein analogs, and stem cell-based strategies, biomimetic techniques offer the potential for enhanced repair of dental tissues, including enamel, dentin, and pulp. |
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| GGI-CO-A1-AQS-300032384-AM-B25-0187 |
| Reference: |
| Singer, L., Fouda, A., & Bourauel, C. (2023). Biomimetic approaches and materials in restorative and regenerative dentistry: review article. BMC Oral Health, 23(1). https://doi.org/10.1186/s12903-023-02808-3 |
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