DTP/ 433 Applications of regenerative techniques in adult orthodontics

Management of the growing adult orthodontic patient population must contend with challenges particular to orthodontic treatment in adults. These include a limited rate of tooth movement, increased incidence of periodontal complications, higher risk of iatrogenic root resorption and pulp devitalisation, resorbed edentulous ridges, and lack of growth potential. The field of regenerative dentistry has evolved numerous methods of manipulating cellular and molecular processes to rebuild functional oral and dental tissues, and research continues to advance our understanding of stem cells, signalling factors that stimulate repair and extracellular scaffold interactions for the purposes of tissue engineering. We discuss recent findings in the literature to synthesise our understanding of current and prospective approaches based on biological repair that have the potential to improve orthodontic treatment outcomes in adult patients. Methods such as mesenchymal stem cell transplantation, biomimetic scaffold manipulation, and growth factor control may be employed to overcome the challenges described above, thereby reducing adverse sequelae and improving orthodontic treatment outcomes in adult patients. The overarching goal of such research is to eventually translate these regenerative techniques into clinical practice, and establish a new gold standard of safe, effective, autologous therapies. Introduction Engagement with orthodontic treatment amongst adults is on the rise, with a noticeable shift in the orthodontic patient demographic over the past two decades (1, 2). This may be attributed to improved dental awareness amongst the general public, better accessibility of dental services, and increased social acceptability (2, 3, 4). The physiological, pathological and behavioural differences between adult orthodontic patients and their child and adolescent counterparts create unique considerations and challenges in their treatment (4–6). Almost all current treatments rely on introducing foreign materials into or onto the dentofacial tissues, whereas the ideal therapy would utilise our understanding of tissue biology to regenerate natural tissues. Regenerative dentistry encompasses repair and regeneration of functional dental tissues by understanding tissue development, growth, underlying mechanisms of molecular signalling, that drive repair process, and employment of biocompatible scaffolds. Recent years have seen remarkable progress towards the goal of regenerating autologous dental and craniofacial tissues for therapeutic use (7), and these techniques can be applied to some of the clinical problems faced in orthodontic treatment of adult patients. This review summarises current and cutting-edge research in the field of regenerative dentistry and presents the perspective towards translation of these into therapeutic approaches of adult orthodontic patients. We critically discuss six themes relevant to adult orthodontic challenges which may be tackled with regenerative approaches (Figure 1). Cell turnover and healing potential are diminished with age, limiting speed of orthodontic tooth movements (4–6). Completion of bony growth in adolescence results in increased reliance on surgical corrections (4, 6). Adults experience a higher incidence of periodontal disease which affects the reaction of the periodontium to orthodontic forces, and tooth loss leaves edentulous alveolar ridges that resorb and impair orthodontic tooth movement into the space (4, 5). Root resorption, a common adverse consequence of orthodontic treatment, shows greater risk in adult patients (8), as does tooth devitalisation (9). Fuente: https://www.frontiersin.org/articles/10.3389/fdmed.2022.1100548/full