Recent advances in drug repurposing for dentin repair

Exposure of a vital dental pulp following deep caries removal, accidental restorative procedures or trauma can severely affect the dentin-pulp complex in adult permanent teeth. To preserve a biologically functional healthy pulp, promote dentin repair, and minimize invasive and costly procedures, direct pulp capping is commonly used in vital pulp therapies. Despite its well-accepted therapeutic value, current pulp capping inorganic hydraulic calcium-silicate cements like mineral trioxide aggregate show limited targeted bioactive effects. Therefore, repurposing clinically approved drugs or investigational small bioactive agents targeting intracellular signaling pathways relevant to reparative dentinogenesis may translate into novel therapeutic approaches for dentin repair. Here, we review studies published over the past decade that explore two agents for potential repurposing in dentin repair: tideglusib, a glycogen synthase kinase‑3 inhibitor, and metformin, a widely used anti‑diabetic biguanide DESIGN: PubMed was used as the single, web-based search engine and database. Only studies using dental pulp stem cells in which the drugs were investigated as single agents were included.

While incorporated into different biomaterial formulations, both tideglusib and metformin, trigger significant upregulation of odontoblastic differentiation markers and mineral synthesis in dental pulp stem cells in vitro. Tideglusib has also been shown to significantly enhance reparative dentinogenesis in experimental animal models.

Leveraging drug repurposing for dentin repair underscores the significance of translating into dentistry knowledge gained from basic, pre-clinical and clinical research in other medical conditions, laying the groundwork for cost-effective therapeutic strategies and improved outcomes in regenerative dental medicine.