Reported advances in the field of regenerative medicine, hinging on the use of stem cells, evoke both scepticism and hope. Claims of miracle cures by unmonitored clinics for afflictions ranging from Parkinson’s disease and Alzheimer’s, multiple sclerosis, cancers, heart diseases, spinal injuries, paralysis to general symptoms of ageing have proved counter-productive. For, without certified clinical trials, such claims fall flat.
As a premier research and teaching centre, which also provides specialised medical care, the All India Institute of Medical Sciences (AIIMS) in the Capital is cautious about testimonies. These require clearance after rigorous verification.
The institute has promoted research in the application of stem cells to treat diverse maladies. A breakthrough dental regeneration technique has been developed by the Department of Conservative Dentistry and Endodontics, Centre for Dental Education and Research. A team, headed by Prof. Naseem Shah, centre chief and department head, has pioneered the SealBio technique for infected root canal cure and regeneration, where necrosis has set in. It is unique to AIIMS.
Natural healing
The method hinges on the premise that human intervention should facilitate natural healing by activating the body’s own regenerative power. In this case, it is achieved by the simple expedient of activating stem cells in a decaying tooth’s root canal, after it is rigorously cleaned and disinfected. The root canal is then restored to health by the gradual build up of tissue by stem cells over a period, extending from a few weeks to some months. This does away with the century-old convention of filling up the root canal, after it is cleaned up, with gutta percha , a rubber derivative.
No need for implant
Since the AIIMS method induces tissue build up, chance of saving the infected tooth is greater, precluding the need for an implant or other artificial object in the mouth. A research paper, titled ‘SealBio: A novel, non-obturation endodontic treatment based on concept of regeneration’, authored by Dr. Naseem Shah and Dr. Ajay Logani, and published in Journal of Conservative Dentistry , dated October-December 2012, details the procedure. It cites 18 case studies, of patients ranging from 15-76 years, with severely infected teeth. Activating stem cells involves ‘over-instrumentation into the periapical region’ with a very fine surgical needle so as to induce bleeding. Subsequently, the cavity in the crown is restored, and a thorough follow up of cases is done over the following months. Healing of lesions, as their size decreases, and increase in bone and cementum density is documented via X-rays. All cases showed excellent healing.
This excerpt demystifies the method so that even a lay person can understand it: “Apical cleaning, apical foramen widening and over instrumentation into periapical region were done to induce bleeding near apical foramen. It is hypothesised that the clot formed provides a scaffold into which locally residing stem cells can get seeded and the cascade of healing process can initiate.”
Earlier technique
An earlier technique, based on methods developed elsewhere, also activated stem cells through over-instrumentation for ‘revascularisation of immature teeth’. That is, non-vital teeth were vitalised, allowing tissue to build up. SealBio takes the process further, with 50 cases having been successfully treated since 2008, after the AIIMS Ethical Committee gave the clearance. It takes about three-six months to two years for new bone regrowth. Failed root canals from outside AIIMS are retrieved via BioSeal. Briefly, a root canal procedure has three components: opening, cleaning and shaping; disinfecting; and filling with gutta percha . But the AIIMS method does away with the third component by inducing tissue build up. It certainly qualifies as a breakthrough technique as it saves time, is less costly and simpler.
Research on regenerative procedures is an ongoing process in the department. Though Dr. Shah is cautious about the possibility of regrowing teeth in the mouth by activating stem cells that reside there, she finds commonalities between SealBio and the regenerative method devised by Dr. Jeremy Mao, the Edward V. Zegarelli Professor of Dental Medicine at Columbia University Medical Center. The latter is based on a three-dimensional biological scaffold, into which stem cells are directed so that a tooth grows in situ. Dr. Shah expects that the innovation will take some years to translate into reality if a stem cell tooth is to be made durable. Columbia University is reported to have filed for patents. Dr. Mao seeks to apply the technique commercially.
Ongoing researches
Similar trends are reported from other research centres as human ingenuity strives to overcome mortal shortcomings. American defence scientists at the Armed Forces Institute of Regenerative Medicine have seriously undertaken a programme to regenerate skin, muscles, tendons, fingers, noses, ears and other parts by deploying stem cells. It epitomises the collective yearning to be whole.
