Engineering of dental tissues; reality or distant prospect

Abstract

Tissue engineering envelops a fast developing multidisciplinary field. Both from a medical and dental social point of view, there is great need to safeguard tissues and organs to overcome the shortage of donor organs and to reduce the health care cost. The ability to replace malfunctioning body parts has long been an issue of fiction and vision throughout the development of medical practice. One of the most striking examples is the legend of St. Cosmas and St. Damien, which describes the replacement of a man’s gangrenous leg with the limb of a dead black man. Apart from this legendary example, the more realistic replacement of damaged body tissue started in dentistry. The French surgeon Ambroise Pare (1510–1590) described the replacement of missing teeth by donor teeth, which were taken form “serfs”. It goes without saying that this kind of early transplantation was prone to failure due to existing lack of knowledge about immunology and sterility as well as the underlying phenomena of wound healing. The discovery of the sterility principles meant an enormous step forward. However, especially, all recent progress, as made in the field of molecular sciences as well as biomaterials and chemical engineering, seem to make the original dream of complete tissue and organ replacement reality. The question is whether this suggestion is indeed true which advantages and disadvantages are associated with this technique and what the final use of tissue engineering will be for the general practitioner. Tissue engineering can best be described as the creation of tissue. Tissue engineering is based on the tissue engineering paradigm, i.e. scaffold materials (a biomaterial in the shape of the newly to be regenerated tissue), stem cells (primordial cells which possess the potency to differentiate and proliferate in all kinds of different tissues), and signaling molecules (growth factors responsible for the differentiation of stem cells). In principle, tissue engineering can be applied for each existing tissue defect. At the moment, bone, periodontal ligament, gingiva and a complete tooth are important applications for dental tissue engineering.