Regenerative dentistry is becoming a buzzword in the industry. We are experiencing exponential growth in all areas of our lives. Healthcare is one aspect that is getting disrupted almost every month. When it comes to medical/dental niche, what’s interesting nowadays is the topic of tissue engineering.
Regenerative dentistry has been popularized due to advancements in biologic therapies that apply differentiation and various growth factors which are capable of inducing natural biologic regeneration. In 1920, it was described that the application of calcium hydroxide for vital pulp therapy in dental procedures. There was also an evaluation for a revascularization method for re‑establishing a pulp‑dentin complex in permanent teeth with pulpal necrosis.
Though the regeneration of a lost tissue is known to mankind for several years, it is just recently that research on regenerative medicine/dentistry has gained momentum and eluded the dramatic yet scientific advancements in the area of molecular biology. Our ever growing understanding of concepts and wisdom in the regeneration of oral/dental tissues coupled with experiments on stem cells has high probability to result in a paradigm shift in the therapeutic armamentarium of dental and oral diseases culminating in a largely intense search for “biological solutions to biological problems.”
Stem cells have been successfully isolated from a variety of human tissues including orofacial tissues. The first ever evidence from pioneering studies has documented the likely breakthrough that stems cells offer for multiple life-threatening diseases that have so far been far more successful than modern medical care. The evidence gathered so far has kickstarted many elegant studies exploring the role of stem cells and their manifold dental applications.
When you take a look at the advancements in regenerative dentistry, you’ll notice a sojourn of the origin of stem cells, their properties, characteristics, and their potential applications. It also focuses on the various challenges and barriers that we have to surmount before translating laboratory results into successful clinical applications heralding the dawn of regenerative dentistry.
What is it that can make regeneration of dental pulp possible? The three key ingredients for regeneration are progenitor/stem cells, morphogens, and the extracellular matrix (ECM) scaffold.
Another thing which scientists and researchers are working on is pulp revascularization. Pulp revascularization is defined as re introduction of vascularity in the root canal system. Though blood vessels are indispensable constituents of dental pulp, pulp regeneration is considered not yet complete without an odontoblastic layer that lines the dentin surface. Also needed is the nociceptive as well as parasympathetic and sympathetic nerve fibers, in addition to interstitial fibroblasts and not forgetting, the stem/progenitor cells that serve to replenish all pulp cells in the regenerated pulp when they undergo apoptosis and turnover.
For regenerative procedures to be successful, it depends a lot on the design of scaffold. Scaffolds made of ceramic can be modified to obtain desired permeability, controlled dissolution rate, and specific surface characteristics to enhance cellular activity. Change in pore size and volume affects the mechanical stiffness of the scaffold.
Through the use of computer‑aided design and 3D printing technologies, scaffolds like polymers can be fabricated into precise geometries with a broad range of bioactive surfaces. Such scaffolds have the potential to provide environments conducive to the growth of specific cell types such as pulpal cells. Future in regenerative endodontics is very promising owing to the discoveries and advancements in scaffold technology.
What then are the practical usage of regenerative dentistry? It has been used for almost 100 years now, the way dentists apply calcium hydroxide so that a dentine bridge can be formed near the pulp-dentine complex. That is one of the oldest applications. Other than that, we are using various materials that are able to regenerate some aspect of the pulp during endodontic procedures. Perhaps in some day, we can fully restore the tooth to vitality even when the pulp is totally necrosed. When the day comes, it will be a victory for technological advancements in regenerative dentistry.