Research,  Science

Teeth regeneration and regrowth 2020: current research and future treatments

Since there are multiple breakthrough news (mostly containing phrases like No more dental fillings!) all over the web we have decided to put together single page with all current and upcoming state-of-the-art treatments that will revolutionize dentistry. This page is designed to be reliable and up-to-date, but please check last updated date (at the bottom of this article) to be sure if we kept our promise!

Enamel regeneration 2020 – can scientists regrow enamel?

First of all, it is important to separate enamel remineralization and enamel regeneration. In this article, we are discussing only the latter one, which means growing new layers of enamel, which your body is unable to do on its own.

Most promising work regarding regrowing enamel

Repair of tooth enamel by a biomimetic mineralization frontier ensuring epitaxial growth

How exactly regrowing enamel (growing new layers of enamel) works?

We’ll describe that soon.

When will this treatment be available?

The main problem with this treatment is a really slow regrowth rate – 2.7µm for 48 hours treatment which equals approximately 17777 hours needed to regrow one millimeter of enamel. So to be clinically applicable this technology would have to be improved. As of now, it does not look like a viable treatment for dental caries but it may be helpful in the future in treating enamel erosion. We expect this treatment to be commercially available within 15-20 years’ time and only to treat enamel erosion, not dental caries.

Other work regarding regrowing enamel

Materials chemistry: a synthetic enamel for rapid tooth repair
– by dr Kazue Yamagishi, Japan

How it works?

This work, by dr Kazue Yamagishi and her team, is a novel idea of restoring teeth with early decay. Instead of drilling and filling teeth with resins (which are never a perfect and tight sealing of a cavity), she suggests using special toothpaste with HAP crystals (called Synthetic Enamel). After etching tooth with early decay, her toothpaste is applied and creates a perfect seal, unlike resins that are unable to do so. Although the treatment is called a toothpaste it actually is a form of a professional treatment performed on a dental chair that takes about 15 minutes to complete. If you ask us, it’s somewhat similar to clinically available DMG Icon technology (a caries infiltrant), only more biocompatible.

When will this treatment be available?

Initial information on this treatment was published in 2005 in Nature, and toothpaste was announced for 2016 (announcement has been published on dr Kazue Yamagishi’s website, intended for the Japanese market) but as of 2020 it’s still not available and it does not look like it’s going to be in the near future or ever. We have made an attempt to contact dr Kazue Yamagishi to obtain detailed information, but she never got back to us.

Other work regarding regrowing enamel

Hydrogel that can promote the growth of an enamel-like surface on teeth and remineralize the dentin
– by Prof. Janet Moradian-Oldak (Herman Ostrow School of Dentistry at the University of Southern California, Los Angeles, United States)

How it works?

Team of Prof. Janet Moradian-Oldak fabricated hydrogel, which is a form of synthetic enamel, which is an approach similar to the one by dr Kazue Yamagishi. As she explains in an online interview: We focused on the chemical events that happen outside of the enamel-making cells in order to create enamel. This meant using the right ions and proteins that make enamel hydroxyapatite (calcium and phosphate) crystals. We used chitosan gel as an inert carrier within which the chemistry would take place. It is similarly designed to be applied for early carious lesions, preventing them from progressing and also providing much better adherence than traditional resin fillings: We started by using a full-length recombinant synthetic protein called amelogenin to regrow a newly formed synthetic mineralized layer on enamel. (…) We started by using a full-length recombinant synthetic protein called amelogenin to regrow a newly formed synthetic mineralized layer on enamel. (…) We now have a technology which hasn’t quite reached the complex hierarchical structure of enamel but is at a level which will be functional and has improved properties when compared to damaged enamel.

When will this treatment be available?

According to the publications dated May 2019, the hydrogel is a complete product but requires full clinical trials, which in the case of classic drugs may take even up to 10 years. The hydrogel is working on human teeth (which were previously extracted from patients mouth) but it’s not clear if the treatment will work just as good inside the human mouth. Another concern that needs to be checked is whether the product is safe so that it can pass all the regulatory steps. Please keep in mind that although this is the closest to hit the market it is also not as promising as the biomimetic mineralization frontier approach.


Dentin regeneration 2020 – is it possible to regrow dentin?

Dentin is a tissue that is usually covered by enamel (or some kind of dental fillings) and surrounds the entire pulp. This is the second layer that gets affected if you develop dental caries. In contrast to enamel, your body can grow new layers of dentin (called secondary and tertiary dentin) but it does not happen in the way you may think it does.

Most promising work regarding regrowing dentin and its regeneration

Promotion of natural tooth repair by small molecule GSK3 antagonists

How exactly regenerating dentin (growing new dentin) with Tideglusib works?

We’ll describe that soon.

When will this treatment be available?

At this point, there are no clinical trials available yet, but the treatment was confirmed do be viable in humans regarding low toxicity and the ability to regrow larger layers of dentin. We expect this treatment to be available within 10 years’ time. It’s still not clear if this will be a viable kind of treatment that will become publicly available.


Pulp regeneration 2020 – can dead pulp be regenerated or restored?

The pulp is the inner part of each tooth and it’s made of living connective tissue and cells called odontoblasts. It is sealed and protected by dentin but in case of deep caries or trauma can be exposed and infected. So far the only way of treating such conditions was an endodontic treatment which is a form of a therapy that involves the removal of the dental pulp.

Dental pulp regeneration – most promising treatment alternative to root canals

SealBio: A novel, non-obturation endodontic treatment based on concept of regeneration

Novel form of regenerative treatment to replace classic endodontic treatment is SealBio developed in India in 2012. It is a new kind of endodontic treatment protocol that’s non-surgical and developed to manage pulp and periapically involved teeth. It has been found to cure and regenerate an infected root canal through stem cell activation. Sounds good right? Sadly the stem cell activation and sealing are done at apical foramen, and the pulp in the chamber is still removed, so that’s not exactly what you may have thought.

Low Level Laser Therapy for dental pulp regeneration

Since there is no real alternative to root canal therapy, the only way to help regenerate your pulp (successful to a limited extent) is LLLT, which stands for Low-Level Laser Therapy (red soft laser). It has been studied that under certain conditions pulp in dogs’ teeth responded better when subjected to LLLT before direct pulp capping.1 But they have also shown that the use of MTA material instead of gold foil gave better results than the LLLT which suggests that the treatment is not as effective, as we’d like it to be. Surprisingly, some studies show that LLLT irradiation may be also helpful in treating dental caries, as it affects Streptococcus mutans counts.


Regrowing teeth 2020 – is it possible to regrow tooth or grow new teeth?

There are two possible approaches to growing new teeth – implanting whole living teeth or growing teeth directly in the mouth of a patient. Sadly there are no upcoming treatments at this point. However, there were some discoveries and advancements and we will describe them all here soon.

When will this treatment be available?

We are really far away from this technology to be widely available.


Vaccine for dental caries 2020 – when will it be available?

There are multiple approaches regarding vaccination for dental caries, some of them have clinical trials in progress.


Dental implants advancements 2020 – new implant technologies

Since growing and implanting whole teeth is not coming anytime soon we have decided to focus also on dental implants research and innovation since last years there were some impressive advancements in this field as well.

Modern dental implants are a technology that is about 40 years old since their milestones in osseointegration were termed in 1981. The standard screw-type implant has not changed much since that time, but there were some novel approaches listed below. Implants debuted as a metal (titanium) screw

Zirconium as a dental implant material

Bioimplant (RAI – Root Analogue Implant)

This is first CAD/CAM (Computer Aided Design/Computer Aided Manufacturing) implant development system based in Vienna, Austria, Europe (and as of now, available only there). Each procedure consists of three steps:

  • pre op CT/DVT scan
  • tooth extraction in certain manner
  • immediate (same or next day) implant placement with protective splint
  • crown fitting after 8-12 weeks healing period is complete

Main advantages of this approach compared to classic dental implants are the following:

  • there is no need for a sinus lift or bone grafting
  • there is also no need for a classic implant surgery – the whole procedure is simplified and easier, meaning there is no drilling into bones
  • the implant is designed to fit your bone socket, rather than drilled into bone that later fits the implant
  • implant is made fully from zirconium (it’s 100% titanium free)

However it is also important to address limitations of this system:

  • you need to have your tooth still in place
  • success rate is marginally lower than classic implants
  • it is being offered in only one place – in Vienna (Austria, Europe)
  • it is more expensive than classic zirconium implants

Replicate Tooth

This system is based a concept similar to the Bioimplant, but uses titanium instead of zirconium as a base material (titanium base is fused seamlessly to the zirconium crown for aesthetic purposes). While it may sound inferior, the main advantage of this company is that the implants are not produced on-site and thanks to that it is being offered in more places than just one. Yet the FDA approval is not cleared, so currently you cannot get any kind of anatomic implants in the United States.
Please note that as of 2020 Replicate Tooth went bankrupt and their technology will no longer be in commercial use.

References

1 The Effect of Low Level Laser Therapy on Direct Pulp Capping in Dogs – J Lasers Med Sci. 2016 Summer; 7(3): 177–183.

This article is still work in progress and was last updated on July 21, 2020.

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