Faster and safer dental implants, with shorter healing times. Optimal exploitation of growth factors that allow tissue regeneration. Intelligent gels with proteins and hyaluronic acid to promote the development of bone tissue and periodontium, i.e. gums and more, in order to replicate what is natural and original in each patient’s mouth. All of this, with the support of AI and IT skills: the dentist will increasingly benefit from dental 3D printing, cutting-edge technology that facilitates the rapid and personalized production of prostheses, crowns, bridges, starting from a digital scan of the oral cavity.
In short, we are faced with prospects of technological development and beyond that make it clear how the treatment of oral pathologies is destined to change in the future. Research developments will also have a significant economic impact, also in light of the epidemiological characteristics of an increasingly elderly population. It is in this area that the so-called regenerative dentistry moves, an area in constant and rapid growth with spending which in Italy today stands at around 92 million euros per year and which within 5 years is estimated to reach almost 138 million.
An expansion driven by the growing demand for dental implants linked to the aging of the population with around 10 million interventions in Italy, by the growing demand for minimally invasive procedures and by the progress of research that has never been so advanced. The experts who gathered in Florence for the international Osteology-SIdP congress, organized by the Italian Society of Periodontology and Implantology (SIdP) and the Osteology Foundation, took stock.
How to deal with periodontal disease
Periodontitis is a deep inflammation of the gums caused by bacteria present in dental plaque that is not adequately removed with correct oral hygiene. The incidence progressively increases after the age of thirty and unfortunately it is an enemy underestimated by the majority of the population: too many believe that having bleeding or receding gums is normal or that nothing much can be done about it. In some cases the problem is superficial, due to less than optimal methods for brushing the teeth, but for four out of ten Italians the diagnosis is periodontitis, or a situation in which the bacteria present in the plaque have managed to enter under the gums, destroying the anchorage that keeps the tooth firmly attached to the bone.
Unfortunately, the majority only become alarmed when they feel their teeth moving and shifting, so the consequence, if the disease is not treated adequately and in time, is the loss of teeth. This involves a very negative change in diet, because to eat a diet rich in fresh fruit and vegetables like the Mediterranean one requires good chewing; furthermore, vegetables rich in vitamin C are used to keep gums healthy and must therefore be a cornerstone of daily nutrition.
Those who have lost teeth, on the other hand, tend to choose softer foods and favor carbohydrates, refined sugars and fats with a negative impact on health and wallet: it costs more to replace a single tooth lost due to periodontitis than to treat the entire mouth of a patient intercepted in time. In short: periodontitis is a very widespread disease in the adult population and, if not treated, can lead to bone resorption and gum retraction, resulting in tooth loss.
“Surgical periodontal therapies allow the regeneration of lost tissues thanks to the use of various biomaterials which are positioned within a “defect” area to increase the volume or regenerate the quantity of lost bone and gum, generally for the replacement with an implant of a missing tooth following trauma or periodontitis”
explains Francesco Cairo, SIdP president and Professor of Periodontology at the University of Florence.
“The graft material can be taken from the patient himself or have animal or synthetic origin, with evolutions that are increasingly biocompatible and safe for the patient. Regeneration operations are generally performed in an outpatient setting and under local anesthesia, with a rather simple surgical course. However, the healing process at the bone level lasts several months and, if the regeneration was carried out for the purpose of the subsequent implant, this can be positioned after a period of time from 4 to 12 months. The development of innovative regenerative therapies has today led to minimally invasive approaches that speed up the maturation of the graft, reducing healing times by up to 5 months, based on the individual response”.
Stem cells and more
Cells can then be recovered from extracted teeth which can become a “base” for treatment. According to experts, therapy with stem cells derived from the pulp of extracted teeth is among the most advanced treatments for regenerating bone and gums, allowing “natural” tissue regrowth with excellent clinical results and less use of tissue taken from the patient himself.
“Another promising regenerative and minimally invasive, highly effective procedure is the treatment of severe bone resorption with platelets extracted from the patient’s plasma. This technique uses substances that stimulate the residual cells around the root of the tooth and which are activated to reform the lost tissues”
reports Cairo.
To promote the regeneration of grafts there are also new molecules. These are gels containing proteins derived from the dental enamel matrix and more recently from polynucleotides and hyaluronic acid, capable of promoting growth by combining their properties.
“On the one hand, hyaluronic acid creates a hydrated environment, attracts growth factors and has an antibacterial effect, on the other hand, the nucleotides promote a trophic and protective environment for cell repair and growth promoting faster healing”
indicates Raffaele Cavalcanti, vice president of SIdP.
Finally, the ability to regenerate bone of a compound, PDRN, derived from the purified DNA of fish, including trout and salmon, is being studied.
“Many in vitro studies, on animal models and clinical trials have shown PDRN’s ability to promote angiogenesis, reduce inflammation and stimulate fibroblast proliferation, when injected locally in association with biomaterials. PDRN is a promising adjuvant and the first clinical evidence is encouraging but limited: further studies and long-term follow-up will be needed to validate its effectiveness”
Cavalcanti reports.
The role of AI
Alongside innovations in biomaterials, the use of artificial intelligence is growing, capable of analyzing thousands of radiographic images, identifying anomalies invisible to the human eye and formulating personalized diagnoses. In addition to diagnosis, artificial intelligence allows us to anticipate the risk of complications by supporting surgeons in planning interventions and selecting the most suitable materials, reducing errors and improving clinical results.
“But despite the advance of artificial intelligence, the dentist’s role remains central in clinical judgment”
Cairo points out. The expert points out that the surgery of the future will therefore be increasingly less invasive and more biological and digital, reducing the need for synthetic materials and accelerating healing times.
“New regenerative techniques are becoming more widespread and in demand because they offer better results with less discomfort and dental clinics and practices are gearing up to make regenerative treatments as widely available, thus transforming regenerative dentistry into an essential part of dental care”
concludes Cairo.
