How far away is tooth regeneration?
Oops. Hole in my tooth.
Other teeth are fine, so it's not genetic or general bad hygiene, but apparently internal resorption resulting from mechanical trauma of some kind.
In any event, various dentists are debating root canal vs. implant (as the pain rapidly intensifies...).
A root canal makes future regenerative treatment easier. An implant is a stable solution but it requires months and three separate steps. Cannot purpose such an odyssey right now – chewing carefully for months as the titanium peg "sets", etc., etc. There is way too much work to do and that's all I can focus on.
So my question: anyone have any guesstimate as to when stem cell regeneration of teeth will go into human trials? I started looking into this myself but I then I realized someone out there might already have betrodden this research path thoroughly. If not, I'll dig into PubMed and report back if anyone's curious.
The tooth might be too far gone for a root canal to work. That's the rub: it's borderline. But if regeneration might not be more than a couple years away, then the root canal would have to hold for just a couple years, so it might be worth the risk.
We are quite a ways from regenerating teeth. Ten years would be my earliest guess and that would be with a lot of prayer. If you have a good dentist, he can explain all the RBAs (risks, benefits and alternatives). Trust his advice. An implant preserves the bone so in the future it should still provide a fertile field for implanting a regenerated tooth or tooth bud. A radiograph of that tooth would be key to predicting prognosis of root canal.
I would not get another root canal. I have two dental implants, implanted in 2009, which replaced my only two teeth that had root canals. Both root canals caused serious jaw bone degradation. I had to spend thousands to have multiple bone grafts done to rebuild bone so the implantations could be done. n of 1 experience.
Dear Dorian and David, thank you very much for the advice!
I had been told the opposite – though not by dentists – about bone preservation with, resp'ly, root canals and implants. I've been so swamped with work I haven't had time to look into this, but thinking through this a bit, what you say makes sense.
I'm getting a third opinion Monyday by the way.
BrianMDelaney Tooth regeneration has been a pet focus of mine for decades. For me one of the biggest measures of technological progress is, of all things Dentistry. For most of human history we suffered from bad teeth, and often died from them due to the proximity to the brain and nasal cavities, all sensitive areas. The BC Egyptians were a fascinating study, as bread was a staple of their lives and from the mummies we know they suffered horribly from abscesses and the like. Finally it was figured out that it probably was due not to the bread itself but how it was prepared (from preserved bread in tombs). Which was that it was kneaded on the ground on a stone platform, thus would pick up large amounts of grit that wore the teeth down.
Anyhow, I had one root canal from a nerve that got infected for unknown reasons, ten years ago or more, which was capped and has been fine since, FWIW. I've followed implants and have talked to everybody I know who has done or is considering them, and am always querying my dentist/hygienist on the latest in the industry. Regeneration has been a focus of course.
Unfortunately AFAIK it's not clear still. In general the industry is good about pursuing new technologies as there's lots of $$ on it. Mitigating that is that the procedures need to be something that can be done 'in the chair', which means it needs to be affordable by dentists/oral surgeons, and they need to adopt it. For example, 3D subtractive printed crowns cost 100k$+ in initial equipment investment. It's a great innovation which makes a crown much easier, but many dentists don't want to make the investment and deal with the technology.
On implants it's muddled with little data. My dentist - who is a fan of new tech and has the 3D crown equipment, is agnostic on implants. A friend at work who was considering it, in discussions I found it's a complex issue. Bone degradation is the biggest issue. I'll check up with him on if he went through with it.
On regeneration ... last I heard they didn't know of any work going on. FWIW if it was me I'd get the root canal and wait for regeneration (I'm waiting for regeneration too). Yes 10 years away probably. Implants are really expensive but more importantly is too new and artificial I think. On a root canal I'd get a specialist who does nothing else rather than your dentist. The teeth, especially the back ones, have all sorts of twisty odd nerves that need to be cleaned out, and somebody who specializes in that will know exactly what they're doing. Your dentist will then cap the tooth, and yes ideally he has 3D too! Good luck Brian and keep us updated!
Dan, a belated huge thanks for your exceptionally detailed and helpful reply. (Continued work emergency, hence the late response.)
One key bit of info that I will trust you on: tooth regeneration is not right around the corner. That affects my decision.
I've heard from some very sharp people about how root canals – even if done well – can increase the odds of harmful bacteria reaching the brain.
Your concerns about bone degradation with implants I hadn't heard of. If grafts build the bone back up – and the "peg" is allowed to set properly – I would think that wouldn't be a problem. But maybe the peg/base moves around a lot, and is placed so deep that, over time, the bone degrades.
The truth is, the more dentists I show images of the tooth to, the more I hear, "Sorry, but it's *probably* too far gone for a root canal to work." But there are a few who the root canal might work.
But that's why I was hoping tooth regeneration – even Phase I trials – might only be a year or two away: if the root canal failed (i.e., so little tooth was left that it just cracks/falls apart), then I could jump into a new trial of stem cell regeneration or the like.
BrianMDelaney While we are slow to see new treatment in USAcommercialized often due to FDA redtape, I'm looking to Japan first for organ regeneration coming to market. While Takashi Tsuji is known for his research on hair regeneration, his company and partners are also working on other organ systems. Likely teeth also.