1. dental regeneration
using stem cells
The 45th Annual Meeting of the
Spanish Society for Periodontics
and Osseointegration (SEPA),
which will be held May 26-28 in
Oviedo, counts on the
participation of world-renowned
scientific experts in the fields of
periodontics, implantology and
dentistry. The highlight will be
the first-time appearance in Spain
of Dr. Paul Sharpe, one of the
leading international experts on
dental regeneration.
The 45th Annual Meeting of SEPA will
gather more than 1,500 people in the
capital city of Asturias to promote
professional progress and gain
insight on useful knowledge that will
help the industry advance step by
step.
A Turning Point
Several very interesting topics will be
discussed in this meeting, including
the most controversial and
cutting-edge issues pertaining to
Dentistry, Periodontics and
Implantology, such as dental
regeneration using stem cells, the
future of periodontology and
periimplantology in Spain (with the
presentation of the Quo vadis,
Periodoncia? study regarding
perspectives on periodontology in
our country in the upcoming 20
years), achieving clinical excellence
(a parallel session will be held on
clinical management as a tool of
excellence) and innovation in dental
aesthetics (not aiming toward
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2. THE SCIENTIFIC PROGRAM WILL from the University of Sheffield, is Professor of
FOCUS ON HOW TO OBTAIN Molecular Embryology at the University of
Manchester, and is currently leading professor
CLINICAL EXCELLENCE IN FIELDS at Guy’s Hospital Dental Institute, where he
SUCH AS PERIODONTAL PLASTIC established the Department of Craniofacial
MICROSURGERY, the treatment of Development.
periimplantitis or the placement of implants
and on the main lines of advancement in the As part of his research, he explores genetic
aesthetics of bone reconstruction. interactions that control tooth development,
as well as the biology and applications of
Stem cells: promises and reality dental stem cells for growing new teeth to
The highlight of the 45th SEPA Annual Meeting take the place of those that are missing.
will be the appearance of Dr. Paul Sharpe, who Although the technology that he applies is still
will show the most advanced lines of research in the experimental stages, it is widely
on dental regeneration using stem cells. believed that it’s potential for replacing dental
Dr. Paul Sharpe is professor of Craniofacial absences is great, since patients’ new teeth
Biology at King’s College London, he has will be identical to the original ones. In 2004,
published more than 200 research papers and Paul Sharpe unveiled the results of his
is one of the most prestigious researchers in experiments in an animal model in which
the field of stem cell application in dentistry. scientists implanted stem cells in gums for
Many specialists in this field consider Professor subsequent development of a new tooth.
Sharpe’s work to be a milestone, as was
Brånemark’s discovery of osseointegration of
dental implants in his era, or Sture Nyman’s
regarding periodontal regeneration. Paul
Sharpe also has his doctorate in Biochemistry
Dr. Paul Sharpe Interview for SEPA Noticias Bulletin
1. Dr Sharpe, it’s an honour to have you with us. There near future?
are big expectations about your conference among I think the most likely is probably not in dentistry. Dental
SEPA Members and the Conference attendees. Is this pulp cells exhibit very similar immune suppressive
the first time that you introduce your investigations in a properties to bone marrow mesenchymal stem cells that
Spanish congress? are being used in clinical trials as immune suppressants.
Yes this is my first time at a SEPA conference and my first If this shows promise, the dental pulp stem cells could
visit to Oveido provide a far more accessible autologous cell source.
2. One of your latest publications talks about reparation For dental applications, the most obvious use is in
and regeneration of dental structures, and about endodontics to replace pulp tissue. The key here is
periodontal ligament and pulpal tissue previously undoubtedly the maintenance of the blood supply.
damaged by disease as well. In what state is this 4. If we go a step further, our highest aspiration as
research now? dentists would be that we will be able to create new
There is a great deal of research being carried out in these teeth. As someone who works in this exciting field, do
areas worldwide and progress is being made. My main you really think we will be able to give birth to teeth?
interest is trying to gain a better understanding of dental With our current knowledge it is possible, at least
stem cells and how they function in vivo to facilitate repair. experimentally using uncultured embryonic cells.
3. With your experience in this field, looking at the However this is a long way from a usable clinical
future & thinking of the general dentist that will read this application and there are several very big issues that
bulletin…What kind of new treatments based on stem need to be resolved. Large cell numbers are required
cells from dental pulp do you think could be used in the that can only realistically be obtained by in vitro
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3. The use of stem cells for generating During his conference in the SEPA
new teeth has gone from a working Annual Meeting, this expert will
hypothesis to being a viable reality point out which new treatments
that may reach dental offices in the using dental pulp stem cells could
not-so-distant future, especially when be used in the near future.
considering the advances in recent According to his research, dental
years regarding the utility and pulp stem cells display immune
viability of stem cells originating from suppressive properties, similar to
periodontal ligament. In the same those of mesenchymal stem cells
context, Paul Sharpe has published from bone marrow (which are
suggestive studies on the repair and being used in clinical trials as
regeneration of dental structures, immune suppressants). If this
periodontal ligament and pulp tissue property is confirmed in dental
that were previously affected by pulp, stem cells could prove to be
disease, offering key elements to help a much more accessible source of
better understand dental stem cells autologous cells.
and how they work in vivo to promote
healing.
expansion. Being able to grow cells in conditions that inserted fibromucosa that allows aesthetic
retain their tooth-forming abilities is, thus, crucial. One reconstruction. Do you think that in short or medium
problem we have found is that teeth made from human term we will have "biological tools" to achieve these
cells grow much slower than those made from mouse goals?
cells. While this may not be a significant problem in a To be honest I think it is impossible to say. People have
clinical context, in the lab it means that experiments to realise that working on cell-based approaches is
take longer…and thus progress is slower. much more difficult and more time-consuming than
5. In your investigations you are studying the developing a drug. Drug development can take 20
evolutionary formation of teeth in different species, years to get from discovery to market!
especially in heterodont animals such as mammals. 7. Once we consider theoretically that we can be able
Do we already know the mechanisms by which an to develop a dental organ using molecular biology
incisor or molar are formed? procedures, what you call "natural tooth
In very simple terms, yes. However control of crown substitution", the dilemma will be how to control the
shape is the least important issue since crowns can be outbreak, the bony insertion and the aesthetic
easily changed by established dental techniques.. Far alignment. How do you see this in the future?
more important is the formation of the roots. These are trivial problems. If the current ideas work then
6. At present we are able to rebuild the destroyed the tooth that forms will do so along with all its support
alveolar ridge in a reasonable manner. However, our tissues, including bone and periodontal ligament.
barrier is in the vertical alveolar ridge reconstruction, Alignment of a growing (erupting) tooth is very easy
along with regeneration of a high quality keratinized with standard orthodontics.
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4. Dr. Maurizio Tonetti
Interview for www.sepaoviedo2011.com
Experts in the field consider that these findings could
lead to clinical applications, among which the most
1. What are your expectations for the Oviedo
obvious would be in endondontics for replacing pulp SEPA Meeting ?
tissue, where the key issue, without a doubt, would be
SEPA has a tradition of excellence and
a continuous supply of blood. WITH REGARD TO innovation combined with a special
THE POSSIBILITY OF GENERATING NEW atmosphere of collegiality and true
Mediterranean savoir vivre at all their
TEETH FROM STEM CELLS, THE STUDIES meetings. I expect the Oviedo meeting to be
another landmark in terms of science, clinical
CARRIED OUT BY PAUL SHARPE AND HIS translation and enjoyment.
COLLEAGUES SUGGEST THAT CURRENT
2. Your lecture is about soft tissue management,
KNOWLEDGE MAKES THIS POSSIBLE, at How have we improved the techniques in soft
least experimentally, using uncultured embryonic tissue management and where are we going?
cells. Nevertheless, a usable clinical application in the Surgery and consequent soft tissue
dental practice is very far from being achieved. management has changed radically in the last
few years. Thanks to a better understanding of
wound healing biology. The impact of risk
In collaboration with SEPA factors and the individuality of the patient, we
now start to enjoy unprecedented levels of
success: in regeneration, plastic surgery,
aesthetics, and conventional periodontal and
implant surgery.
3. Do the membranes still have a place in the
Con la regenerative techniques?
colaboración de:
Yes. Membranes have changed a lot; as have
the materials that we have available to
promote regeneration. What has not changed
is the need to support and stabilize soft
tissues during healing, and membranes are still
a great way to achieve more stable soft
tissues. It is also clear that membranes may
increase complications, and thus there is a
need for advanced training to use them
successfully.
4. Is the prevalence of peri-implant lesions
responsible for the pendule going back to
save more teeth and delay implant
placement?
8. Finally, from a practical standpoint… Would
this kind of treatment of high precision It is a big part of the issue but unfortunately
require a multi-disciplinary approach? not all. Besides the high prevalence of
peri-implantitis, we start to realize that: i)
Molecular biologists, periodontal surgeons, chewing on implants is not at all like having a
orthodontists, restorative dentists skilled in natural tooth; ii) with adequate skills from the
aesthetics ... whole team more and more teeth can be
Once a simple, reliable and reproducible saved and preserved over time; iii) patients
approach is validated it will be treated like a require planning solutions for their dentition
for a lifetime.
implant and will in fact be a cell implant. The
implant will be grown in specialised 5. What is your opinion about stem cells in
laboratories, supplied to a dentist who, using regeneration and the research work of Prof
very simple surgical techniques, will insert the Sharpe on tooth regeneration?
implant into the soft tissue without any bone
I am fascinated by the tremendous knowledge
drilling. Growth of the implant will be followed on tooth development that has been
with standard X-rays and orthodontics applied generated in recent years. I see both
following eruption. The crown will be capped to tremendous potential and great challenges
create the correct visible shape. before a clinical application will become
possible. I also foresee that before the times
we will be able to “regenerate” teeth, we may
be able to use hybrid tissue engineered and
prosthetic devices such as metal implants with
a functional periodontal ligament.
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