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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Physiol.</journal-id>
<journal-title>Frontiers in Physiology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Physiol.</abbrev-journal-title>
<issn pub-type="epub">1664-042X</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fphys.2016.00357</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Physiology</subject>
<subj-group>
<subject>Editorial</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Editorial: A New Era in Dentistry: Stem Cell-Based Approaches for Tooth and Periodontal Tissue Regeneration</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" corresp="yes">
<name><surname>Mitsiadis</surname> <given-names>Thimios A.</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="author-notes" rid="fn001"><sup>&#x0002A;</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/13660/overview"/></contrib>
<contrib contrib-type="author">
<name><surname>Orsini</surname> <given-names>Giovanna</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/93110/overview"/></contrib>
</contrib-group>
<aff id="aff1"><sup>1</sup><institution>Orofacial Development and Regeneration, Centre for Dental Medicine, Institute of Oral Biology, University of Zurich</institution> <country>Zurich, Switzerland</country></aff>
<aff id="aff2"><sup>2</sup><institution>Department of Clinical Sciences and Stomatology, Polytechnic University of Marche</institution> <country>Ancona, Italy</country></aff>
<author-notes>
<fn fn-type="edited-by"><p>Edited by: Gianpaolo Papaccio, Seconda Universit&#x000E0; degli Studi di Napoli, Italy</p></fn>
<fn fn-type="edited-by"><p>Reviewed by: Vincenzo Desiderio, Seconda Universit&#x000E0; degli Studi di Napoli, Italy</p></fn>
<fn fn-type="corresp" id="fn001"><p>&#x0002A;Correspondence: Thimios A. Mitsiadis <email>thimios.mitsiadis&#x00040;zzm.uzh.ch</email></p></fn>
<fn fn-type="other" id="fn002"><p>This article was submitted to Craniofacial Biology, a section of the journal Frontiers in Physiology</p></fn>
</author-notes>
<pub-date pub-type="epub">
<day>19</day>
<month>08</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="collection">
<year>2016</year>
</pub-date>
<volume>7</volume>
<elocation-id>357</elocation-id>
<history>
<date date-type="received">
<day>15</day>
<month>07</month>
<year>2016</year>
</date>
<date date-type="accepted">
<day>04</day>
<month>08</month>
<year>2016</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#x000A9; 2016 Mitsiadis and Orsini.</copyright-statement>
<copyright-year>2016</copyright-year>
<copyright-holder>Mitsiadis and Orsini</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/"><p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p></license>
</permissions>
<related-article id="RA1" related-article-type="commentary-article" xlink:href="http://journal.frontiersin.org/researchtopic/3533/dental-and-periodontal-tissues-formation-and-regeneration-current-approaches-and-future-challenges" ext-link-type="uri">The Editorial on the Research Topic <article-title>Dental and Periodontal Tissues Formation and Regeneration: Current Approaches and Future Challenges</article-title></related-article>
<kwd-group>
<kwd>tooth</kwd>
<kwd>dentin</kwd>
<kwd>enamel</kwd>
<kwd>stem cells</kwd>
<kwd>scaffolds</kwd>
<kwd>vasculature</kwd>
<kwd>craniofacial</kwd>
<kwd>regenerative dentistry</kwd>
</kwd-group>
<contract-sponsor id="cn001">Universit&#x000E4;t Z&#x000FC;rich<named-content content-type="fundref-id">10.13039/501100006447</named-content></contract-sponsor>
<contract-sponsor id="cn002">Universit&#x000E0; Politecnica delle Marche<named-content content-type="fundref-id">10.13039/501100005758</named-content></contract-sponsor>
<counts>
<fig-count count="0"/>
<table-count count="0"/>
<equation-count count="0"/>
<ref-count count="8"/>
<page-count count="3"/>
<word-count count="1643"/>
</counts>
</article-meta>
</front>
<body>
<p>The continuously increasing progress in stem cell biology has expanded our horizons into the principles of health and disease. This new acquired knowledge and the recent advances in the field of biotechnology have formed the substrate for translation into novel therapeutic solutions (Mitsiadis et al., <xref ref-type="bibr" rid="B5">2015</xref>). Indeed, traditional dental therapies have successfully incorporated a good number of new materials that are more compatible and friendly to dental and periodontal tissues. Although these treatments are suitable and satisfactory for long-lasting dental restorations, the idea of stem cell-based tissue regeneration is tempting and represents the decisive objective of introducing new therapeutic approaches in the clinics. Teeth develop through continuous and reciprocal interactions between cranial neural crest-derived mesenchymal stem cells and oral-derived epithelial stem cells during early embryogenesis (Mitsiadis and Graf, <xref ref-type="bibr" rid="B3">2009</xref>; Smith et al., <xref ref-type="bibr" rid="B8">2009</xref>; La Noce et al., <xref ref-type="bibr" rid="B2">2014</xref>). These highly mineralized organs are composed by collagenous (such as the mesenchyme-derived dentin and cementum structures) and non-collagenous (such as the epithelium-derived enamel structure) extracellular matrices. The alveolar bone is another collagenous hard tissue, which through its close interaction with the periodontal ligament supports tooth stability and function. Tooth vitality is ensured by blood vessels and nerve fibers within the dental pulp and periodontium (Carmeliet and Jain, <xref ref-type="bibr" rid="B1">2011</xref>; Pagella et al., <xref ref-type="bibr" rid="B7">2015</xref>). Regenerative approaches include the formation of new enamel, dentin, pulp, periodontal ligament, and alveolar bone after tooth damage due to genetic pathology, traumatic injuries, caries, and periodontal lesions (Mitsiadis and Harada, <xref ref-type="bibr" rid="B4">2015</xref>). Therefore, the recent progress made in the fields of stem cell biology, tissue engineering, and nanotechnology offers promising opportunities to repair damaged or missing dental tissues (Mitsiadis et al., <xref ref-type="bibr" rid="B6">2012</xref>). Several considerable efforts have been made recently in the dental field and new concepts concerning dental treatment strategies have arisen with the hope to translate basic research findings into the clinics. Repairing teeth by autologous cell grafting is highly desired, but some ethical, economic, and legislative issues should be first resolved.</p>
<p>In this research topic, prominent researchers within the dental field provided important information, gave responses, and generated stimulating hypotheses concerning the development and regeneration of dental and periodontal tissues. A balanced mosaic of original and review articles point out different facets of the interplay between stem cell biology and dental tissue formation, homeostasis, and regeneration.</p>
<p>The different sources of stem cells, their differentiation potential, and the current state of stem cell-based strategies for dental or craniofacial tissue regeneration are discussed in several articles. The cranial neural crest-derived dental stem cells or stem cells from other tissues can be used with success for dental, periodontal, and craniofacial repair purposes (<ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.3389/fphys.2016.00050">Akita et al.</ext-link>; <ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.3389/fphys.2015.00289">Aurrekoetxea et al.</ext-link>; <ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.3389/fphys.2015.00213">Ducret et al.</ext-link>). The appropriate selection of stem cells in conjunction with the creation of an adequate and respective microenvironment is essential for a successful clinical outcome. Therefore, the identification and characterization of stem cell niches within dental tissues, and the analysis of niche-derived signals during tooth homoeostasis and repair is of prime importance (<ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.3389/fphys.2015.00367">Oh and Nor</ext-link>). The exploitation of various adult stem cell populations localized in the different tooth components is challenging. Furthermore, success depends on well-controlled and coordinated cytodifferentiation and mineralization processes during tissue repair and regeneration (<ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.3389/fphys.2015.00221">Eapen and George</ext-link>).</p>
<p>Small-scale engineered biomaterials and tailor made empty scaffolds that will attract specific endogenous stem cell populations can be designed for the regeneration the periodontium (<ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.3389/fphys.2016.00006">Green et al.</ext-link>) as well as of various tissues within the craniofacial complex (<ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.3389/fphys.2016.00062">Mele et al.</ext-link>). Innervation of craniofacial tissues, including teeth, is essential for ensuring their morphology, physiological function, and regeneration (<ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.3389/fphys.2016.00049">Fried and Adameyeko</ext-link>). Equally, blood supply of craniofacial structures and teeth are important for their function, vitality, and longevity, and therefore it is important to develop methods for analyzing angiogenesis in regenerating tissues (<ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.3389/fphys.2016.00146">Woloszyk et al.</ext-link>). One of these methods allowed us to evaluate and compare the ability of human dental pulp stem cells and gingival fibroblasts in attracting vessels into silk fibroin scaffolds (<ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.3389/fphys.2016.00140">Woloszyk et al.</ext-link>). The tissue-engineering concept for dental pulp regeneration implicates stem cells, scaffolds, and signaling molecules (<ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.3389/fphys.2015.00257">Passos et al.</ext-link>; <ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.3389/fphys.2016.00058">Yang et al.</ext-link>). Pulp-derived stem cells have the potential to differentiate into odontoblasts and other cell types and thus could be used for clinical applications. Odontoblasts produce nitric oxide with antibacterial activity, which is an important issue for successful tissue regeneration purposes (<ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.3389/fphys.2015.00185">Farges et al.</ext-link>). During tooth homeostasis and pathology, communication between odontoblasts is activated via specific channels (<ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.3389/fphys.2015.00326">Sato et al.</ext-link>). Hydrogels may be used as stem cell-seeded matrices for pulp and periodontal tissue repair purposes in the clinics (<ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.3389/fphys.2015.00297">Teti et al.</ext-link>). Polymerized resin-based materials could affect cellular physiology and induce cell apoptosis (<ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.3389/fphys.2015.00275">Teti et al.</ext-link>).</p>
<p>Several pathologies exist that lead to root malformations and consequently affect tooth eruption or/and physiology (<ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.3389/fphys.2015.00307">Luder</ext-link>). Tooth eruption is a complicated event that can differ from species to species (<ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.3389/fphys.2016.00145">Liu et al.</ext-link>). Resorption of the alveolar bone that surrounds the tooth root could be an actor of periodontal development and remodeling (<ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.3389/fphys.2015.00319">Gama et al.</ext-link>). Orthodontic forces affect alveolar bone remodeling and periodontal ligament regeneration through defined molecular mechanisms (<ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.3389/fphys.2016.00283">Suttorp et al.</ext-link>). The use of biomimetically enhanced demineralized bone matrices could represent an interesting approach for bone regenerative applications (<ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.3389/fphys.2015.00292">Ravindran et al.</ext-link>). However, the outcome of tissue engineering strategies for bone formation depends on the origin and the culture conditions of the applied stem cells (<ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.3389/fphys.2015.00266">Mattioli-Belmonte et al.</ext-link>; <ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.3389/fphys.2016.00354">Spina et al.</ext-link>).</p>
<p>Amelogenin, one of the most important organic elements of enamel, is re-expressed during dental pathology and repair, indicating that it can act as a signaling molecule for dental tissue repair events (<ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.3389/fphys.2014.00477">Mitsiadis et al.</ext-link>). Furthermore, injection of stem cells at dental pathological sites may enhance the possibility of <italic>de novo</italic> enamel formation. For testing this hypothesis a mouse model was used for the injection of epithelial stem cells derived from the continuously growing incisors (<ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.3389/fphys.2015.00112">Orsini et al.</ext-link>).</p>
<p>Besides many open scientific questions, strategic concerns also need to be addressed. Controversies in scientific data, opinions, and formulated hypotheses set the starting point for additional research that will benefit to the dental field. Repair and regeneration of dental tissues using stem cell-based approaches combined with new biotechnological tools is an exciting and highly relevant area of research. Further evaluation of existing tools is needed in order to optimize future therapeutic strategies in dentistry. The time for applying novel regenerative therapies in dental clinics has come, thus designing a new era, full of excitement and expectations.</p>
<sec id="s1">
<title>Author contributions</title>
<p>The authors contributed to the writing, reading, and editing of the present editorial.</p>
<sec>
<title>Conflict of interest statement</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer VD and handling Editor declared their shared affiliation, and the handling Editor states that the process nevertheless met the standards of a fair and objective review.</p>
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<ack><p>This work was supported by institutional funds from University of Zurich (TM) and by funds from the Polytechnic University of Marche (GO). The authors contributed to the writing, reading, and editing of the present editorial.</p>
</ack>
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