By way of introducing the fascinating and promising area of regenerative endodontics, Peter E. Murray of Nova Southeastern University, answered a few basic questions.
Can you give the 30,000-foot overview of regenerative endodontics?
Regenerative endodontics is expected to become the next big treatment revolution. It is the creation and delivery of tissues to replace a diseased, missing, and traumatized pulp-dentin complex, in addition to tooth-supporting tissues. Some research is focused on accomplishing the regeneration of host-tissues, while others create replacement tissue in the laboratory for transplantation.
This is the ultrastructure of a human tooth with implanted pulp (shown in purple) created from stem cells and a scaffold in the laboratory.
How did it originate? Who is doing most of the research?
Regenerative endodontics originated as part of research that is aimed at unlocking the therapeutic potential of stem cells, growth factors, molecular biology and the human genome. The first paper describing regenerative endodontics was published in the Journal of Endodontics in 2007 by Murray, Garcia-Godoy, and Hargreaves. Dr. Peter Murray and Dr. Franklin Garcia-Godoy are from Nova Southeastern University College of Dental Medicine, Fort Lauderdale, FL. Dr Ken Hargreaves is from the University of Texas Health Science Center at San Antonio, TX.
Are any of the techniques/protocol in clinical use yet? What's the timetable?
In 2007, the Directors of the American Association of Endodontists (AAE) created a committee to investigate and provide guidelines concerning Regenerative Endodontics. In May 2008, the committee launched a database to collect case-reports of the outcomes of regenerative endodontic treatments. In coming years, once enough cases have been collected to provide a reliable guide: The AAE hopes to provide guidelines that will optimize the success of the regenerative treatments.
What are the implications for patient care?
In the coming decades unparalleled advances in endodontics, dentistry, and medicine are set to take place with the availability of artificial oral tissues, including; teeth, oral mucosa, bone, muscle, glands, and skin. Although current treatment modalities offers high levels of success for many conditions, an ideal form of therapy might consist of a regenerative procedure, in which diseased pulp tissues are removed and replaced with healthy pulp tissue in order to revitalize teeth.
Are there other potential applications for dental pulp stem cells?
There is some controversy among researchers about the origin, source, and usefulness of dental pulp stem cells. It seems these cells have the potential to be used to create tissues which are hard, soft, mineralizing, and have neuronal properties. These discoveries mean that these cells have the potential to create many types of tissues in the body. By the same token, other types of stem cells have demonstrated some potential to regenerate tooth tissues. I recently reviewed an article submitted to a stem cell journal that used stem cells taken from hair follicles to regenerate tooth tissues. Many predict a bright future for dental pulp stem cells, several companies have established dental pulp stem cell banks in the hope of capitalizing on the potential therapeutic applications of these cells.
What are some good resources for dentists who want to learn more right now? Courses? Web sites? Literature?
The most valuable resource for dentists will be the AAE guidelines, the best evidence-base are the limited number of articles published in peer-reviewed dental journals.