Journal of Dental Implants
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Table of Contents
EDITORIAL
Year : 2013  |  Volume : 3  |  Issue : 2  |  Page : 85-86

Stem cells and implantology


Diplomate of the International Congress of Oral Implantologists, Mumbai, India

Date of Web Publication25-Sep-2013

Correspondence Address:
Rajiv S Khosla
Diplomate of the International Congress of Oral Implantologists, Mumbai
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-6781.118851

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How to cite this article:
Khosla RS. Stem cells and implantology. J Dent Implant 2013;3:85-6

How to cite this URL:
Khosla RS. Stem cells and implantology. J Dent Implant [serial online] 2013 [cited 2019 Dec 11];3:85-6. Available from: http://www.jdionline.org/text.asp?2013/3/2/85/118851

I am sure most of us in the field of dental implantology have been wondering what could possibly be the next evolution in the field. At present, most dental implant companies have been rehashing the same materials, shapes, and coatings and then simply putting their name on the "new" product. The growth in the number of implant companies in recent years has created greater competition and lower market prices for us. But to excel, it is not enough to just be competitive. There must be more research and innovation.

Stem cell research is not a new medical entity by any means. There has been extensive research for many years now in the other areas of medicine. It has only been recently that the dental field has taken a harder look at stem cells and their use not only in promoting more predictable bone grafting but also in the reconstruction of the entire dental follicle. Medical research has stimulated the "dental research community" to investigate tooth reproduction from stem cells even further. Replacement of the entire tooth (root, crown, pulp, and periodontal structures) has become the focus of research by some of the more "state-of-the-art" companies.

Teeth develop when embryonic epithelial cells in the mouth combine with mesenchymal cells derived from the neural crest. Previous studies have shown that these cells can be combined in the lab to form normal teeth, but the challenge was to find non-embryonic source of the cells that could be used in the clinic. According to research published in the Journal of Dental Research - to test one such source, a team led by King's College London stem cell biologist Paul Sharpe extracted epithelial cells from the gums of adult humans, cultured them in the lab, and mixed them with mesenchymal tooth cells derived from embryonic mice. After a week, the researchers transplanted this mixture into the protective tissue around the kidneys of living mice, where some of the cells developed into hybrid human/mouse teeth containing enamel and dentine with viable roots. That the researchers were able to successfully create and assemble distinct tissues highlights the significance of their work. The research showed that the epithelial cells from adult human gum tissue responded to tooth-inducing signals from the embryonic mouse tooth mesenchyme, making the gum cells a realistic source for clinical use. The next major challenge is to identify a way to culture adult human mesenchymal cells to be tooth-inducing, as at the moment we can only make embryonic mesenchymal cells do this. The method remains a long way from clinical use, but the findings represent a step toward the goal of growing bioengineered replacements for lost teeth. The development of the so-called induced pluripotent stem cells (iPS cells) from adult cells, which allows embryonic-like stem cells to be formed from adult cells, is promising. It may be possible to create the different types of cells needed to culture a tooth germ using iPS technology. This would overcome the need to use embryonic tooth germ cells.

While this study clearly shows that it is possible to grow a tooth and implant it into the jaw to create a fully functional tooth replacement, it must be remembered that this is a "proof-of-concept" study in an animal model. The authors themselves are at pains to point this out. This means there is still a great deal of work to do before growing a replacement tooth becomes a reality for humans. Issues such as immune compatibility and acceptance of the implanted tooth, control and regulation of the tooth-growing process, as well as the long-term survival of the implanted tooth still need to be worked out.

To build a tooth, a detailed recipe to instruct cells to differentiate toward proper lineages and form dental cells is needed. Researchers in the group of Professor Irma Thesleff at the Institute of Biotechnology in Helsinki, Finland have now found a marker for dental stem cells. They showed that the transcription factor Sox2 is specifically expressed in the stem cells of front tooth of the mouse.

A group of experts from the Columbia University in the United States announced the development of a new approach which could see old dental implants become history. The investigation was led by the CU Edward V. Zegarelli, Professor of Dental Medicine, and Dr. Jeremy Mao. What the new technique does is to essentially coordinate the way in which stem cells migrate in three-dimensional (3D) scaffolding. This allows the researchers to use the gums of patients as the scaffolds and infuse them with growth factors. Once the stem cells make their way to their designated location, they start growing a new, anatomically correct tooth, which is completely developed in less than 9 weeks after the original implantation. "These findings represent the first report of regeneration of anatomically shaped tooth-like structures in vivo, and by cell homing without cell delivery. The potency of cell homing is substantiated not only by cell recruitment into scaffold microchannels, but also by the regeneration of periodontal ligaments and newly formed alveolar bone," the CU researchers write in a paper accompanying the findings. The experts add that the method allows for the tooth to grow directly into its socket, and to integrate itself with the surrounding tissue to a degree that is simply impossible to attain using other materials.

Nova Southeastern University's (NSU) dental researchers at the College of Dental Medicine are growing and harvesting human dental stem cells in the lab. The cells normally grow in flat layers of single cells in  Petri dish More Detailses. To get them to form a 3-D tissue structure, researchers seed the cells on tissue engineering scaffolds made from the same polymer material as bio-resorbable surgical sutures. The scaffolds function like those seen around buildings under construction. They provide mechanical support and control the size and shape of a tissue. Once the stem cells are seeded on the scaffolds, researchers add growth factors to signal to the stem cells what type of tissue to grow. The combination of dental stem cells, tissue engineering scaffolds, and growth factors allows researchers to engineer new tooth tissues. NSU scientists are working at similar tooth research labs to create fully functional replacement teeth. NSU is in the process of patenting a "regeneration kit" that will allow dentists to deliver stem cell therapies to replace dead tissue inside a tooth.

A 2009 survey by NSU revealed that 96% of the dentists polled expected stem cell regeneration to dominate the future of dentistry. Additionally, more than half predicted that the technology would be available within the next decade.What does this mean to us and our practices today? I am convinced that this could be the future of dental implantology. Dental implants have been a major part of my life for many years now. This atypical research and development has intrigued me since its inception, and if you are involved with implant dentistry, then you too should be aware of these facts, since this will impact us all in some way in the future! I hope that during my lifetime, I can be a part of this new world of dental implants and be able to use stem cells to replace missing teeth in my patients. This is really exciting. Dentures are the past, conventional dental implants are the present, and implanted bio-engineered teeth grown from stem cells could be the future!

 
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