Inflammatory Response Mechanisms of the Dentine-Pulp Complex and the Periapical Tissues

URN to cite this document:: urn:nbn:de:bvb:355-epub-444090
DOI to cite this document:: 10.5283/epub.44409

Widbiller, Matthias

; Galler, Kerstin M. ; Weber, Manuel

; Korkmaz, Yüksel

; Feuerer, Markus

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Date of publication of this fulltext: 01 Mar 2021 10:39

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Item type:	Article
Open Access Type:	Gold (with APC)
Journal or Publication Title:	IJMS
Publisher:	MDPI
Volume:	22
Number of Issue or Book Chapter:	1480
Page Range:	pp. 1-23
Date:	2 February 2021
Institutions:	Medicine > Lehrstuhl für Zahnerhaltung und Parodontologie
Keywords:	dental pulp; odontoblast; tertiary dentine; immune response; carious lesion; pulpitis
Dewey Decimal Classification:	600 Technology > 610 Medical sciences Medicine
Status:	Submitted
Refereed:	Yes, this version has been refereed
Created at the University of Regensburg:	Yes
Item ID:	44409

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Abstract

The macroscopic and microscopic anatomy of the oral cavity is complex and unique in the human body. Soft-tissue structures are in close interaction with mineralized bone, but also dentine, cementum and enamel of our teeth. These are exposed to intense mechanical and chemical stress as well as to dense microbiologic colonization. Teeth are susceptible to damage, most commonly to caries, where microorganisms from the oral cavity degrade the mineralized tissues of enamel and dentine and invade the soft connective tissue at the core, the dental pulp. However, the pulp is well-equipped to sense and fend off bacteria and their products and mounts various and intricate defense mechanisms. The front rank is formed by a layer of odontoblasts, which line the pulp chamber towards the dentine. These highly specialized cells not only form mineralized tissue but exert important functions as barrier cells. They recognize pathogens early in the process, secrete antibacterial compounds and neutralize bacterial toxins, initiate the immune response and alert other key players of the host defense. As bacteria get closer to the pulp, additional cell types of the pulp, including fibroblasts, stem and immune cells, but also vascular and neuronal networks, contribute with a variety of distinct defense mechanisms, and inflammatory response mechanisms are critical for tissue homeostasis. Still, without therapeutic intervention, a deep carious lesion may lead to tissue necrosis, which allows bacteria to populate the root canal system and invade the periradicular bone via the apical foramen at the root tip. The periodontal tissues and alveolar bone react to the insult with an inflammatory response, most commonly by the formation of an apical granuloma. Healing can occur after pathogen removal, which is achieved by disinfection and obturation of the pulp space by root canal treatment. This review highlights the various mechanisms of pathogen recognition and defense of dental pulp cells and periradicular tissues, explains the different cell types involved in the immune response and discusses the mechanisms of healing and repair, pointing out the close links between inflammation and regeneration as well as between inflammation and potential malignant transformation.

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