Dental pulp is a unique substance with incredible healing and regenerative properties. Soft and vascularised, pulp is loose connective tissue completely enclosed within the hard structures of a healthy tooth. Pulp contains various cell types, including fibroblasts, odontoblasts, dental pulp stem cells (DPSCs)[i], histiocytes, mast cells and plasma cells.[ii] It also contains an extracellular matrix (ECM) composed of collagen proteoglycans, fibronectin, and non-collagenous protein.[iii]
Dental pulp contains nerve fibres that provide sensation. In a healthy tooth, the vascular system in pulp provides oxygen and nutrients to maintain healthy enamel and dentine, and immune cells in pulp such as macrophages, dendritic cells and lymphocytes either promote or regulate healing while enabling the tooth to resist infection.[iv]
A greater understanding of the properties of dental pulp has brought with it a new respect for this highly effective and versatile natural substance. With this knowledge has developed a range of innovative techniques and materials that can support the protection, preservation and even regeneration of dental pulp.
An increased understanding of fibroblasts and their role in pulpal healing
While the role of odontoblasts has been well-established in maintaining and regenerating the health of dentine and protecting pulp, the important role of fibroblasts has increasingly been understood in recent years. Fibroblasts are general connective tissue cells that produce collagen to support systems throughout the body. These are the most abundant cells in dental pulp.
Often underestimated as merely involved in repair and maintenance of this connective tissue, dental pulp fibroblasts (DPF) are now understood to be far more pivotal in the overall health, immunoregulation and function of dental pulp.i DPFs also play a pivotal role in dental pulp angiogenesis – the process of forming new capillary blood vessels from micro vessels.[v]
The synthesis and replacement of collagen and other elements of ECM in pulp are regulated by DPFs, and fibroblasts are also involved in controlling inflammation and the dentinal-pulp regeneration process. These cells produce many immunoregulatory systems, such as proinflammatory cytokines and chemokines.i
Macrophages – or white blood cells – engage with DPFs in the dental pulp and throughout the body to regulate inflammation and fight infection. The interaction between these cells maintains direct communication that influences the tissue microenvironment, impacting disease onset, progression, outcomes, and resolution. In a healthy tooth, inflammation plays a crucial role in the healing process, prompting changes in macrophages that act to prevent cell damage.i
Regenerative endodontics
Regenerative endodonticsRegenerative endodontic procedures (REPs) consist of tissue engineering to replace these vital cells in the pulp-dentine complex. Primarily effective in the treatment of immature permanent teeth of patients aged 9-13 years,[vi] REP aims to heal damaged cells and promote continued root development using growth-supporting cells, scaffold materials and growth factors.[vii]
Apexification is the traditional treatment for immature permanent teeth with pulp necrosis. However, removing pulp and dentinal tissues weakens the tooth, making it more prone to fracture and reinfection. Pulp revascularisation was developed in the early 2000s to avoid these complications, and has become established practice. This involves thorough preparation of the canal while preserving as much healthy soft tissue as possible. A blood clot is then induced to form a regenerative scaffold, combined with antibiotics, and the procedure is completed with a tight coronal seal.[viii]
Regeneration techniques have evolved to incorporate the use of new scaffold materials and stem cells to support the development of new pulp tissue, replacing lost odontoblasts and fibroblasts. Once introduced, stem cells migrate to the injured area, followed by their proliferation and differentiation into cells that can take over the repair and renewal of dentine and pulp.viii While REP treatment is currently shown to be most effective in the treatment of immature teeth, there is promising evidence emerging that mature teeth may respond well with the use of new kinds of biological and bioengineered scaffolds.[ix]
Precision techniques to preserve natural tissue
Alongside the right biomaterials, for any of these innovative new processes to be effective, a precise approach to canal preparation, cleaning and obturation is required. COLTENE is a global leader in the production of high-quality dental products, materials and equipment, including a complete endodontology programme. For example, new techniques that require precision preparation while preserving as much healthy tissue as possible are made easy with the HyFlex EDM OGSF Sequence from COLTENE. The NiTi files in this sequence include an Opener, Glider, Shaper and Finisher, all of which are highly effective, and regenerable multiple times.
As research progresses in uncovering the remarkable properties of dental pulp, dentists will increasingly have access to innovative techniques, equipment, tools, and materials to protect, preserve and even promote the regrowth of this extraordinary substance.
For more on COLTENE, visit https://colteneuk.com/hyflex-edm-ogsf
email info.uk@coltene.com or call 0800 254 5115.
AUTHOR Nicolas Coomber COLTENE National Account & Marketing Manager
[i] Álvarez-Vásquez JL, Castañeda-Alvarado CP. Dental Pulp Fibroblast: A Star Cell. J Endod. 2022 Aug;48(8):1005-1019. doi: 10.1016/j.joen.2022.05.004. Epub 2022 May 14. PMID: 35577145.
[ii] Ghannam MG, Alameddine H, Bordoni B. Anatomy, Head and Neck, Pulp (Tooth) [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537112/
[iii] Linde A. The extracellular matrix of the dental pulp and dentin. J Dent Res. 1985 Apr;64 Spec No:523-9. doi: 10.1177/002203458506400405. PMID: 3857252.
[iv] Xin-Lu Li, Wei Fan, Bing Fan, Dental pulp regeneration strategies: A review of status quo and recent advances, Bioactive Materials, Volume 38, 2024, Pages 258-275, ISSN 2452-199X, https://doi.org/10.1016/j.bioactmat.2024.04.031.
[v] Nilesh M. Pandya, Naranjan S. Dhalla, Dev D. Santani, Angiogenesis—a new target for future therapy, Vascular Pharmacology, Volume 44, Issue 5, 2006,Pages 265-274, ISSN 1537-1891, https://doi.org/10.1016/j.vph.2006.01.005.
[vi] Wei X, Yang M, Yue L, Huang D, Zhou X, Wang X, Zhang Q, Qiu L, Huang Z, Wang H, Meng L, Li H, Chen W, Zou X, Ling J. Expert consensus on regenerative endodontic procedures. Int J Oral Sci. 2022 Dec 1;14(1):55. doi: 10.1038/s41368-022-00206-z. PMID: 36450715; PMCID: PMC9712432.
[vii] Zou Xiaoying, Yue Lin. Biological basis and clinical exploration of regenerative endodontic therapy[J]. Chinese Journal of Stomatology, 2022, 57(01): 3-9. DOI: 10.3760/cma.j.cn112144-20210928-00444
[viii] Yang Jingwen, Yuan Guohua, Chen Zhi. Pulp Regeneration: Current Approaches and Future Challenges. Frontiers in Physiology VOLUME 7 2016 https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2016.00058 DOI: 10.3389/fphys.2016.00058
[ix] Scelza P, Gonçalves F, Caldas I, Nunes F, Lourenço ES, Tavares S, Magno M, Pintor A, Montemezzi P, Edoardo ED, Mourão CFAB, Alves G, Scelza MZ. Prognosis of Regenerative Endodontic Procedures in Mature Teeth: A Systematic Review and Meta-Analysis of Clinical and Radiographic Parameters. Materials (Basel). 2021 Aug 6;14(16):4418. doi: 10.3390/ma14164418. PMID: 34442940; PMCID: PMC8398537.
