New Delhi: With advances in stem cell technology giving promising results in many areas, the field of Dentistry is no more a stranger to this advancement.
Latest in the field is the “SealBio” technique, which has been developed by researchers at the Department of Conservative Dentistry and Endodontics, Centre for Dental Education and Research at the All India Institute of Medical Sciences (AIIMS), New Delhi and is based on “regenerative concept” to manage pulp and periapically involved teeth.
A team, headed by Dr Naseem Shah, professor and head, Department of Conservative Dentistry and Endodontics and Chief, Centre for Dental Education and Research, AIIMS has developed the stem cell-based therapy that would help regenerate the apical cementum and bone (lost due to root canal infection) after it is cleaned and disinfected; consequently, healing of the apical pathology and achieving a biological seal, which is preferable over an artificial barrier of filling materials, is achieved, restoring the tooth’s structure and function.
In simple terms, a root canal procedure involves three steps i.e. opening and cleaning, disinfecting the root canal space and filling with filling materials like gutta-percha cones and sealer cement. The “SealBio” technique is employed at the third stage of the process; instead of filling, the method induces the locally available, indigenous stem cells in the periapical area to build-up mineralized tissue barrier naturally.
Speaking about her research Dr Shah told India Medical Times, “The word ‘SealBio’ means achieving a biological seal, instead of an artificial barrier of sealer and gutta-percha cones at the apical end of root canal system. Hence the name is indicative of healing through natural defence mechanisms of the body. The technique saves time and cost.
“This started in 2004 in relation to immature teeth first. When the development of the tooth got affected by any trauma or accident, it resulted in arrest of root development, resulting in shortened height and wide open apex and ultimately a fragile tooth. The healing and regeneration of such a tooth was achieved successfully with regenerative technique called ‘revascularization’. After the success achieved in immature teeth with ‘revascularization’ in healing of periapical lesions and hard tissue deposition at apical and lateral walls of the root canals in immature teeth, we hypothesized that the technique could also work in fully formed mature tooth with pulp and periapical infection. A simple modification of root canal preparation technique and using regenerative approach, a new technique was then developed for fully mature permanent teeth.
“After taking informed consent and clearance by the ethics committee of AIIMS, we undertook eighteen cases (11 males, 7 females in age range of 15-76 years, mean age being 44.7 years) of pulp and periapical infection. The technique that we used laid heavy stress on thorough disinfection of canal space and tight coronal seal. Special care was taken to clean the apical third of the canal space. Apical clearing, apical foramen widening and over-instrumentation into the periapical region were done to induce bleeding near the apical foramen. The bleeding and clot formed in the area of apical foramen can lead to seeding of stem cells, their proliferation, differentiation and mineralized tissue formation, sealing the apical foramen. It is hypothesized that the clot formed provides a scaffold into which locally residing stem cells can get seeded and the cascade of healing process can initiate.
“So instead of filling the space with filling materials to achieve the apical seal, we let the apical seal get formed by natural, mineralized tissue around the apical foramen. The technique provides objective, non-invasive method to achieve periapical healing and mineralized tissue deposition. The soft tissue healing was excellent; intraoral sinus, buccal soft tissue swelling and bone expansion had completely resolved in all the cases. A small sub-set of six teeth evaluated by pre- and post-treatment CBCT (cone beam computed tomography) has shown increased density of bone and cementum, supporting the premise that mineralized tissue deposition does occur at the root apex. The healing process can take from 4-6 weeks to 6-24 months depending on the size of the existing pathology at the root apex.
“This clinical study can prove to be the most simple, easy to perform and cost-effective method of regenerative endodontic treatment. However, it is not to be confused here that the objective of the study is to reduce the cost of the treatment but it is to provide patients with the most simple and easy to perform technique, based on sound scientific principles which is cost-effective and minimally-invasive way of root canal treatment,” said Dr Shah.
Dr Seema Yadav, professor, Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, New Delhi, speaking about the novel research conducted by Dr Naseem Shah and her team told India Medical Times, “She has done so many helpful researches. The latest stem cell research by her is a breakthrough in the area of dentistry. She has reduced the whole process of root canal treatment to just sterilization and then leading to natural healing. We are not doing anything of this sort in our institute yet, but we would like to reproduce her method at our place, as ultimately, the purpose of any research is to make treatments easier and more effective for the patients.”
Dr Shah also said, “One must look for more cost-effective, minimally-invasive treatment methods as much as possible and I would be more than happy if multi-centres across the country could replicate the research and benefit by it.”
Advancements in dental stem cell technology and its progress in India could soon make root canal fillings obsolete. The need is to replicate this innovative therapy across the country in a conducive environment, so that it benefits the patients and improves their quality of life.
by Vidhi Rathee
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