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Last edited by HLHJ (talk | contribs) 33 days ago. (Update) |
Regenerative dentistry aims to heal the teeth and their sockets by re-generating the biological structures. It contrasts with restorative dentistry, which mends the teeth and surrounding areas with materials unlike the originals. Some aspects of regenerative dentistry have been used since the 1950s; others are in preclinical development. Most dentists recieve little training the field, as of 2022[update].[1]
Two major strategies are tissue engineering and biological repair. Tissue engineering uses artificial scaffolds or other materials to cause the regeneration of the original structure; biological repair approaches use living cells to build the structures. The two overlap.
Tooth pulp is vascular tissue (it has a blood supply), and it naturally heals. Dentin grows slowly from the pulp (dentinogenesis); it grows slowly throughout life, shrinking the pulp (secondary dentin), and can grow to heal damage (tertiary dentin). Cementum grows very slowly over life (cementogenesis). Mature human enamel is dead, having lost its ameloblasts, and does not grow,[2] though like dentin and cementum, it can remineralize. This is why damaged enamel is generally replaced with artificial materials; it does not spontaneously heal itself.
Tooth regeneration, the regrowing of whole teeth, has seen a great deal of press attention, but optomistic prognostications have not been met.[3]
Tooth pulp and dentin regeneration
editTechniques which make use of the natural healing ability of the pulp and dentin are in clinical use. Regenerative endodontics is used to keep immature teeth growing. Vital pulp treatment (VPT) tries to preserve living pulp.[4] Bioceramics can promote healing when used for pulp capping (which covers healthy or salvagable pulp with a dressing material, to encourage pulp regeneration and tertiary dentin formation).[5]
There is also preclinical research on using pulp stem cells (derived from a patient's own teeth) to seed pulp regrowth.[4] Tissue engineering creates the structural environments needed for tissues to grow. Pulp tissue engineering seeks to regrow a living tooth pulp from a seeded scaffold after the original pulp has had to be removed due to disease, although in some cases the seed may simply be the remaining pulp below the removed portion (endogenous stem cells).[4]
Enamel generation
editWhile not in clinical use, as of 2024[update], assorted techniques are being studied for forming new enamel (amelogenesis). Some use induced pluripotent stem cells (some made from dental pulp stem cells or adult epithelial cells). Techniques using tooth organoids (TOs) and 3D bioprinting are also being tested. Amelogenesis is necessary for tooth regeneration, the growing of whole replacement teeth.[2]
Whole-tooth regeneration
editAnother approach suppresses biochemical signals that normally suppress tooth growth (so that only a limited number of teeth grow, and the mouth does not become jammed with excess teeth). The gene SOSTDC1 produces the protien USAG-1, which normally supresses tooth growth. Antibody treatment that inactivates USAG-1 can cause tooth growth in mice.[6][7][8] Clinical trials in humans with a congenital lack of teeth (tooth agenesis, anodontia, oligodontia) were planned for July 2024.[9]
Subfields
edit- Regenerative endodontics aims to regenerate tooth pulp and dentin[10]
- an alternative to pulpectomy, the most common treatment (removing and replacing all of the pulp) or pulpotomy (removal and replacement of the chamber pulp in the main body of the tooth, but not the root pulp)
- related to pulp capping (which covers healthy or salvagable pulp with a dressing material, to encourage pulp regeneration and tertiary dentin formation)
- cementum regeneration
- enamel regeneration
- Guided bone and tissue regeneration (dentistry): the regeneration of the gums and the tooth sockets in the jaw bones.
- includes socket preservation after tooth removal
References
edit- ^ Paul, K; Islam, A; Volponi, AA (February 2022). "Future horizons: embedding the evolving science of regenerative dentistry in a modern, sustainable dental curriculum". British Dental Journal. 232 (4): 207–210. doi:10.1038/s41415-022-3981-8. PMID 35217737.
- ^ a b Hermans, F; Hasevoets, S; Vankelecom, H; Bronckaers, A; Lambrichts, I (18 March 2024). "From Pluripotent Stem Cells to Organoids and Bioprinting: Recent Advances in Dental Epithelium and Ameloblast Models to Study Tooth Biology and Regeneration". Stem cell reviews and reports. doi:10.1007/s12015-024-10702-w. PMID 38498295.
- ^ "New teeth 'could soon be grown'". BBC. 3 May 2004. Retrieved 29 March 2024.
- ^ a b c Shi, Xin; Mao, Jing; Liu, Yan (14 January 2020). "Pulp stem cells derived from human permanent and deciduous teeth: Biological characteristics and therapeutic applications". Stem Cells Translational Medicine. 9 (4): 445–464. doi:10.1002/sctm.19-0398. ISSN 2157-6564. PMID 31943813. Retrieved 22 September 2024.
- ^ Cushley, S; Duncan, HF; Lappin, MJ; Chua, P; Elamin, AD; Clarke, M; El-Karim, IA (April 2021). "Efficacy of direct pulp capping for management of cariously exposed pulps in permanent teeth: a systematic review and meta-analysis". International endodontic journal. 54 (4): 556–571. doi:10.1111/iej.13449. PMID 33222178.
- ^ Ravi, V.; Murashima-Suginami, A.; Kiso, H.; Tokita, Y.; Huang, C. L.; Bessho, K.; Takagi, J.; Sugai, M.; Tabata, Y.; Takahashi, K. (March 2023). "Advances in tooth agenesis and tooth regeneration". Regenerative Therapy. 22: 160–168. doi:10.1016/j.reth.2023.01.004. ISSN 2352-3204.
- ^ Suzuki, Tomoyuki (June 1, 2024). "Teeth-growing drug to undergo clinical trial at Kyoto University". The Asahi Shimbun. Retrieved 22 September 2024.
- ^ Morris-Grant, Brianna (25 September 2023). "Japanese scientists developing drug to grow new teeth in humans". ABC News. Retrieved 22 September 2024.
- ^ "World's 1st 'tooth regrowth' medicine moves toward clinical trials in Japan". Mainichi Daily News. 9 June 2023. Retrieved 22 September 2024.
- ^ conventional restorative endodontics generally defines itself in relation to the pulp alone, but in regereative dentistry pulp and dentin are considered as a unit