Year : 2014 | Volume
: 17 | Issue : 1 | Page : 1-
What is on the horizon?
PN Ramachandran Nair
Institute of Oral Biology (Emerited), Dental School, University of Zurich, Switzerland
P N Ramachandran Nair
Institute of Oral Biology (Emerited), Dental School, University of Zurich
|How to cite this article:|
Ramachandran Nair P N. What is on the horizon?
.J Conserv Dent 2014;17:1-1
|How to cite this URL:|
Ramachandran Nair P N. What is on the horizon?
. J Conserv Dent [serial online] 2014 [cited 2021 Sep 17 ];17:1-1
Available from: https://www.jcd.org.in/text.asp?2014/17/1/1/124077
Today, there is much enthusiasm about regenerative endodontic therapy designed to replace "damaged root structures as well as the pulp-dentine complex."  While there is ongoing debate ,,,, on the complexity of the issues involved in pulpal regenerative therapy, there is no conflict of opinion that majority of teeth with infected and necrotic pulp cannot be made completely microbe-free using contemporary treatment procedures. , Further, biofilms are present even in root canal-treated teeth with radiographically healed apical lesions. The endodontic space of a root canal-treated and crown-restored tooth is an open and infected system. It has not yet been shown that regenerative cells establish themselves in such a system and recreate the pulp-odontoblast-dentine complex. The enthusiasts of pulpal regenerative therapy do not see the 'elephant in the room.' There is no evidence yet for the much celebrated claim of "paradigm shift is taking place"  in the clinical management of neither immature nor mature teeth with infected and totally necrotic pulp. This situation reminds what happened in dental research in the 1970s. A huge sum of money was then spent on developing vaccines against caries and periodontal diseases. Now, we know that those investments in research funds and efforts did not lead to the desired results, except for some clever people having made their careers! The enthusiasm with the pulp regenerating therapy is understandable but may turn out to be "barking up the wrong tree." This is because the breakthrough in research is more likely to come elsewhere in the dental medicine, namely from the new generative medicine.
In 1997, Dolly, the most famous sheep, sent a shock wave across the world that continues to redraw the frontiers of biology today. Dolly was newly generated from a single mammary gland cell of an adult sheep. The cloning of Dolly  demonstrated that a fully differentiated somatic cell could recreate a whole individual. The experimental basis for the creation of Dolly was worked out long before, in the early 1960s, by Gurdon on tadpoles.  The birth of Dolly gave considerable stimulus for stem cell research. Broadly speaking, any organ or tissue could be generated from a fully differentiated adult somatic cell. Less than a decade after the birth of Dolly, researchers  showed that any adult somatic cell can be reprogrammed to become induced pluripotent stem cells (IPS). The Nobel Prize in Physiology and Medicine for 2012 was jointly awarded to John Gurdon and Shinya Yamanaka for their respective discoveries. In May 2013, using the technique of somatic cell nuclear transfer, Tachibana and others  derived human embryonic stem cells from adult somatic cells.
These developments in stem cell biology mean that the problems regarding the availability of ethically and legally applicable embryonic stem cells are almost resolved. Yet, the problems related to residual biofilms in teeth with necrotic pulps remain unmanageable. As such, it is tempting to speculate that, in future, such severely compromised and missing teeth would be substituted by whole natural replacement teeth growing and erupting in vivo using one's own stem cells. In other words, in a not so distant future, dentures and dental implants will become obsolete as new whole teeth would be grown in patient's jaw using the stem cell technology. A new generative treatment for severely diseased teeth is on the horizon, instead of the much-heralded regenerative endodontics!
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