Are bioteeth the future for dental implants?

Teeth in gums
Unlike metal implants – which are directly connected to the bone – a bioengineered natural tooth will have all the normal soft tissue connections, such as a periodontal ligament.
Professor Paul Sharpe
Missing teeth could, in future, be replaced with bioengineered replicas made with a patient’s own gum cells, if research being carried out at King's College London comes to fruition. The team of scientists have recently reported their progress in the Journal of Dental Research.

With funding from the National Institute for Health Research (NIHR)'s Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, efforts to reproduce natural teeth for use as dental implants have involved combining human and mice cells to create hybrid teeth as a proof of principle. The research was led by Professor Paul Sharpe, Dickinson Professor of Craniofacial Biology at King’s, who has been investigating the possibility of producing bioengineered teeth for almost 10 years. Professor Sharpe shared some insights into the advances that have been made and the challenges still lying ahead with ScienceOmega.com.

Standard methods of whole-tooth replacement involve implants, but are unable to recreate the root structure of normal teeth. As a consequence, the friction produced by movement when eating and so on can often result in loss of or damage to the jaw bone in the relevant area. The prospect of growing perfect reproductions of the teeth in situ is therefore bound to be welcome news for those requiring single tooth replacement or even dentures.

"They will be natural teeth, each including a natural root," said Professor Sharpe. "Unlike metal implants – which are directly connected to the bone – a bioengineered natural tooth will have all the normal soft tissue connections, such as a periodontal ligament."

Research has, in the past, focussed on the development of embryonic teeth primordia. These are immature teeth akin to those found in an embryo, but they can be transformed into small ‘pellets’ of cells which are able to grow in the completely different conditions found inside an adult’s mouth.

"A lot of progress has been made, but there is still some way to go," Professor Sharpe said of this approach. "I believe it is now clear that this will be possible but more time and investment are needed."

In general, embryonic cells are thought to be an impractical source for embryonic teeth primordia to be used on a larger scale. In their new work, Professor Sharpe and his colleagues channelled their efforts into finding an alternative, source of (adult) cells. They isolated adult human gum tissue from patients at the King’s Dental Institute and grew more in the lab before combining it with teeth-forming cells from mice. When this mixture of cells was transplanted into mice, hybrid human-mouse teeth could be grown. Containing dentine and enamel, the bioengineered teeth also displayed the vital root structure.

"The biggest problem we face is being able to grow sufficient cells in such a way that they maintain their tooth-forming capacity," Professor Sharpe noted. "At present this is not possible. Another significant obstacle will be getting a lab procedure translated into a clinical trial."

Thus far, the researchers have demonstrated that epithelial cells from adult gum tissue can be prompted to give rise to differentiated cell types and contribute to the creation of tooth crown and root with signals from embryonic mesenchymal cells. Epithelial cells from the gum are easily accessible and so the technique is promising, but it will be necessary to grow adult mesenchymal cells in vitro in order that they may be used to stimulate tooth formation.

"The next challenge is to identify a way of culturing mesenchymal cells in which they maintain their tooth-forming capacity," Professor Sharpe explained. "At present we don’t have any funding to carry this out, so the immediate next step will be obtaining the next round of funding in order to do so."

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