Designing new treatment strategies in vital pulp therapy

Objectives: The development of strategies in vital pulp therapy, which aim to maintain vitality and function of the dentine-pulp complex, represents a major focus of attention. Recent progress in understanding the molecular a nd cellular changes during tooth development and how they are mimicked duri ng dental tissue repair offers the opportunity to now assess whether this k nowledge can be exploited to design new treatment strategies in vital pulp therapy. Data sources and study selection: Current literature on the molecular and c ellular basis of tooth development and dental tissue repair has been review ed in the context of stimulating dentinogenic responses in the tooth togeth er with pertinent published abstracts of relevant conferences and personal communications, Tissue events of direct relevance to clinical application f or vital pulp therapy are discussed. Conclusions: The involvement of growth factors and extracellular matrix mol ecules in signalling and regulating dentinogenic events during tooth develo pment has been identified. During dental tissue repair, many of the process es are mimicked leading to responses of focal deposition of tertiary dentin e at injury sites. The nature and specificity of these responses are determ ined in part by the extent of tissue injury, Traditional clinical strategie s are capable of exploiting endogenous signalling molecules in the tissues to develop more effective treatment modalities. Application of exogenous si gnalling molecules offers opportunities for development of new therapies, a lthough a number of delivery considerations must be addressed before these can be introduced into clinical practice. (C) 2000 Elsevier Science Ltd. Al l rights reserved.