Bioengineered Tooth Replacement Can Open Doors to New Therapies

Tissue engineering offers new possibilities for treating many health issues. For nearly everyone, dealing with dental issues is hard. Once the dentin in our teeth is disrupted by trauma or cavities, the dentin-pulp complex will need help for regeneration. In an effort to stop tooth loss, research is being developed to regenerate and repair the pulp to preserve the tooth.

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Dental Bioengineering Can Open Doors to New Therapies
Tooth loss is a significant health issue. It affects not only how we look but how well we can communicate and our ability to maintain proper nutrition. Artificial dental implants are the mainstay at present, however; they do not have many properties of natural teeth and can be associated with complications leading to failure of the implants.

Recently Tufts University School of Dental Medicine in Boston, MA explored new methods to create bioengineered tooth buds. Enervation of the teeth is essential for them to function correctly. But after an injury, this innervations does not always spontaneously return. The study shows how this new method provides innervations while at the same time avoiding multiple side effects. This study points out a promising future for bioengineered teeth. It also points out that this cutting-edge research has the potential to advance tooth replacement therapy and the science base to bring such regenerative medicine treatments to improve clinical care (Smith et al, 2018).

Materials for dental applications can be essentially divided into two main groups: materials for restorative dentistry and materials for dental implants. The two types of materials differ in their application. A main requirement of material in the first group is compatibility to the oral environment. Restorative dental use is an attempt to substitute natural tooth enamel.

Each tooth has two parts; the outer layer is the enamel. This is the layer that is exposed to the chemical environment in the mouth as well as pressure loads due to chewing and biting. If a crack in the enamel develops or sometimes due to wear, the soft under part of the dentine is affected and becomes exposed to the oral environment. Because this outer coating, the enamel, is exposed to acid attacks, thermal shocks and impacts, tooth enamel has unique properties creating difficulties in replacing it with an artificial restorative material.

This is why bioceramics are a promising alternative. By making use of ceramic-glass composites with a resin has helped to replace those cracked areas. In addition, of late titanium and its alloys have been used as metal implants on which are affixed like restorative crowns to treat tooth loss. These implants for the present are out of the price range of many people and are only recently being covered by some insurance companies.

All three of the glass-ceramic materials are expected to be highly biocompatible with human tissues especially bone. Natural enamel and dentine exhibit unique characteristics that at present ideal material to meet these characteristics do not exist. The keyword here is yet as with other science break-throughs, it is just a matter of time (Baino & Verne, 2017).

Deficiency of the facial bone anatomy has a negative impact on aesthetics and is often a critical causative factor for implant complication and failures. This can be due to tooth extractions and in postextraction sites, the clinician has various treatment options including immediate, early or late implant placement. Early implantation is usually done four to eight weeks after extraction to allow for soft tissue healing. Facial bone wall thickness was significantly correlated with the proximal crest width and with the soft tissue thickness. However, no correlation was found with facial bone wall thickness and when measured against the thickening measured prior to surgery.

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This study assessed the effectiveness of early implantation with contour augmentation and followed patients over the course of ten years. In 19 of 20 patients they followed, contour augmentation was successful. Healthy peri-implant soft tissue conditions and stable bone crest levels were noted at the ten-year visit. This long-term was important to find factors affecting the success of regenerative procedures. In addition, to autograft chips, the study feels the choice of the appropriate bone substrates also influences the long-term treatment. This test showed that there is an effective treatment of early implant placement and use of two-layer composite graft work well in single tooth extraction ( Chappuis et al, 2017).

Cavities and periodontitis are major disorders affecting teeth and associated structures. If these issues are not properly managed they can lead to tooth loss. In the US nearly 8% of adults (20-64), 17% seniors (≥ 65 years as Medicare no longer covers dental care) have periodontitis. Cavities affect 37% of children (2-8) in their baby teeth and 58% adolescents (12-19) in their permanent teeth. This problem has been a challenging one for pediatric dentists and those who focus their treatment on diseases of the dental pulp (endodontists) and effective ways to treat them.

Over the years the therapy of choice has followed disinfection treatment with calcium hydroxide followed by root canal sealing with gutta-percha. The last decade, however, has produced new prospects regarding dental pulp regeneration. This in part is thanks to a procedure called evoked bleeding. This approach has been found to induce dental wall thickening and root end closure. Despite these observations, the regenerative outcome of this patient dependent and unpredictable therapy remains elusive.

This study has found that rather than placing cytotoxic antibiotic pastes and using hypochlorite a gentler approach was needed. This study instead developed by paring easy to fit antibiotic eluting nanofibers and injectable scaffolds may lead to an increased likelihood of achieving dental pulp regeneration in humans. Infection is the foremost reason for the clinical failure of regeneration. Thus, it is extremely important to control and/or eradicate bacterial contamination of the periodontal defect (Bottino et al 2017; Gaison et al, 2018).

Work Cited
Baino, F. & Verne, E. (2017). Production and Characterization of Glass-Ceramic Materials for Potential Use in Dental Applications: Thermal and In Vitro Bioactivity. Applied Science, doi: 10.3390/app7121330

Bottino, MC Pankajakshan,D Nor, J. (2017). Advanced Scaffolds for Dental Pulp and Periodontal Regeneration. Dental Clinics of North America. Doi: 10.1016/j.cden.2017.06.009

Chappuis, V Rahman, L. Buser, D. Janner, S. Belser, U. Buser, D. (2017). Long-term Effectiveness of Contour Augmentation with Guided Bone Regeneration: 10-Year Results. Journal of Dental Research. Doi: 10.1177/0022034517737755

Gaizon, I. Martin-Piedra, MA. Carriel, V. Alaminos,M. Lui, X., D’Souza, RN. (2018). Bioactive Injectable Aggregates With Nanofibrous Microspheres and Human Dental Pulp Stem Cells: A Translational Strategy in Dental Endodontics. Journal of Tissue Engineering and Regeneration. Doi:10.1002/term.2397

Smith, E.E. Angstadt, S. Monterio,N. Zhang, W. Khademhossini, A. Yelick, PC. (2018). Bioengineered Tooth Replacement Opens Doors to New Therapies. Journal of Dental Research, 97(10). https://doi.org/10.1177/0022034518779075

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