Regenerative dentistry
Regenerative dentistry aims to heal the teeth and their sockets by regenerating 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 receive little training in 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.
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 optimistic prognostications have not been met.[3]
Tissue engineering
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.
Biological repair
Biological repair focuses on the traits of individual cells, seeking to have them form their own structures.
Techniques which make use of the natural biological repair of the pulp and dentin are in clinical use. These include pulp capping (which covers healthy or salvageable pulp with a dressing material, to encourage pulp regeneration and tertiary dentin formation) and the use of regenerative endodontics to keep immature teeth growing. Vital pulp treatment (VPT) tries to preserve living pulp.
Bioceramics can promote healing.[4]
Assorted techniques are being studied for forming new enamel (amelogenesis), such as the use of 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.
Subfields
- Regenerative endodontics aims to regenerate tooth pulp and dentin[5]
- 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 salvageable 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
- ↑ 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 Check
|pmid=value (help). - ↑ 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 Check
|pmid=value (help). - ↑ "New teeth 'could soon be grown'". BBC. 3 May 2004. Retrieved 29 March 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 Check
|pmid=value (help). - ↑ conventional restorative endodontics generally defines itself in relation to the pulp alone, but in regenerative dentistry pulp and dentin are considered as a unit
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