Balance in Oral and Bone Health
There is a well-known saying that “everything in life requires balance,” and nowhere is this truer than in the human body. If we take the mouth, for example, an appropriate bacterial balance is just as essential for maintaining good oral health as the balance between the height and structural composition of the alveolar bone is for keeping teeth healthy.
While we know that periodontal problems and implant-related diseases can reduce the height of the alveolar bone, what may not be as well documented are the structural alterations of the bone itself. This is clearly bad news for dentists, especially when it comes to creating an environment conducive to bone regeneration.
Bone Tissue Engineering: The Primary Goal
It is obvious that one of the goals of bone tissue engineering—whether using natural or synthetic materials—has always been to fully restore the balance of cellular tissues so that any restoration involving implants and/or remaining natural teeth has the best possible chance of success.
Challenges and Considerations
Each alveolar defect presents its own unique set of problems. Any variation in location or dimensions may depend on environmental factors and the patient themselves.
Recent Advances
Significant efforts have been made to establish reliable and predictable methods that stimulate bone regeneration. This has opened up new avenues in periodontal regeneration, alveolar ridge reconstruction, and peri-implant tissue regeneration.
Nanotechnology
This field has recently begun to influence tissue engineering. Although biomaterials were already in use, nanotechnology has improved cell differentiation and behavior, as well as 3D restorations.
Relevant Examples
- Nanofiber scaffolds that mimic dentin have enhanced stem cell proliferation.
- Nano-targeted drugs have increased bone formation.
Regulatory Challenges
The FDA and AEM require a comprehensive evaluation before approving clinical approaches, although 28 products are already available on the market.
Stem Cell Therapies
Cellular Applications
Techniques such as cell culture or cell incorporation show promising results. Cells such as fibroblasts, cementoblasts, and follicular cells have demonstrated the ability to mineralize and regenerate periodontal tissue.
Other Cell Sources
Induced pluripotent stem cells can reprogram cells. Those derived from the periosteum are less invasive.
Immunity and Sustainability
Mesenchymal stem cells possess immune properties that promote a regenerative environment, making them sustainable and effective for tissue regeneration.
Gene Therapy
Use of modified cells to release proteins that promote bone growth.
Administration Methods
- Systemic: Ultrasound or gene gun.
- Direct: Injection of DNA into tissue or cells.
- microRNA: Gene regulation, such as inhibition of osteoblastic differentiation.
This latter technique has shown good results in alveolar bone repair.
3D Printing
Applications in Regeneration
It allows for the creation of extracellular matrices (ECM) with high precision for depositing bioactive molecules. Proteins, peptides, DNA plasmids, and living cells have been printed.
Future Prospects
More complex periodontal structures are being investigated, and initial results are promising.
Biohybrid Interfaces
Current Limitations
Modern implants require rigidity, which is not ideal for young patients whose bones are still growing.
Proposed Solution
Interfaces formed by implants and embryonic follicular tissues that adapt to bone growth, mimicking natural connective tissue.
Early results show regeneration of cementum, periodontal ligament (PDL), and alveolar bone, as well as physiological functionality.
So where does this leave us today?
Despite these advances, clinical models with predictable outcomes have yet to be established. To achieve this, the following must be considered:
- Occlusal load and biomechanics.
- Influence of microbial loads.
- 3D compatibility with the original periodontal topography.
- Specific cellular signals that promote tissue regeneration.
These technologies aim to offer affordable, functional, and aesthetically optimal treatments. A revolution in the making.
In line with this research, Mimetis Biomaterials is developing a unique 3D bone printing technology. More information here.
