Back from the dead? Advanced regenerative procedures revitalize dental pulp.

Cell therapy is advancing at a swift pace and with results recognized by the world's medical community. Improving the quality of life of patients is now possible in the area of endodontics, as recently evidenced by the randomized clinical trials and case studies published by researchers from the University of los Andes and its spinoff cell therapy biotech, Cells for Cells. Both located in Santiago, that was also named by mainstream media as the “Chilecon valley” of Latin America.

In the US alone, more than 41,000 root canal procedures are performed every day, relieving patients from tooth pain but leaving them without teeth vitality. Indeed, conventional endodontics, although it eliminates the infection and prevents its extension into the oral cavity, it generates a complete loss of vitality of the treated tooth, which leads to loss of sensitivity and sometime changes in the enamel color, thus, affecting patient’s esthetics.
Regenerative endodontics uses the concept of tissue engineering to restore the root canals to a healthy state, allowing for continued development of the root and surrounding tissue.

First, testing patient’s own cells.

The article “Personalized Cell Therapy for Pulpitis Using Autologous Dental Pulp Stem Cells and Leukocyte Platelet-rich Fibrin: A Case Report”1 published by the research team led by Dr. Claudia Brizuela, professor at the University of Los Andes, was highlighted on the cover of the Journal of endodontics and received the Honorable Mention Award from the same journal. The distinction was recognized in April, 2020 as part of AAE20 Congress in Nashville, USA. The innovation of this study lied in the application of a personalized cell therapy for pulpitis with autologous (own patient’s) dental pulp stem cells and platelet-rich fibrin. This procedure paved the way for the consequent cell-based clinical studies aiming.

From baby’s cord to pulp cavity.

The cell therapy delivered in plasma-based biomaterial is based on mesenchymal stem cells (MSCs) obtained from the umbilical cords of newborn babies, expanded in the campus’ GMP facility and applied for the treatment of teeth with irreversible damage to the pulp-dental complex (symptomatic or asymptomatic irreversible pulpitis, pulp necrosis, symptomatic or asymptomatic periodontitis apicalis, acute apical abscess and chronic apical abscess).
“This was a blunt step forward from the regenerative medicine to the regenerative endodontics. We asked whether we are able to apply the knowledge we gained from previous trials performed in heart and joint diseases to the area of endodontics”, quotes Dr. Maroun Khoury, the chief scientific officer of Cells for Cells-REGENERO, Professor at the University of Los Andes and senior authors of the article.
Humorously, the authors named the controlled trial “RANOKURE”, for the resemblance between the damaged tooth and the crater of the Rano Kau, a dormant volcano on Easter island, in the Pacific Ocean.

Sensivity for cold and hot test: passed.

Dr. Brizuela, presented the first clinical evidence for the safety and efficacy of endodontic use of CELLISTEM®ER, that was recently published this year, in the prestigious Journal of Dental Research2. After the 12-month follow-up, no adverse events were reported, and the patients showed 100% clinical efficacy in both groups. Interestingly, in the treated group, sensitivity tests revealed an increase of the positive pulp response (from 6% to 56% on the cold test, from 0% to 28% on the hot test, and from 17% to 50% on the electrical test). The implantation of CELLISTEM®ER inside the compromised tooth allowed the restoration of the lost sensitive functions and increased blood flow inside the tooth. These relevant outcomes are currently not achievable with the available treatments including: conventional endodontics (gutta-percha filling), tooth extractions and dental implants. In addition, a repair of the alveolar bone was observed in the event of an apical lesion.

Root perforation, sealed.

The article " Allogeneic Cellular Therapy in a Mature Tooth with Apical Periodontitis and Accidental Root Perforation: A Case Report "3, published by the same team, in Journal of endodontics. “This case report reveals another potential use of allogeneic cellular therapy in a complex case of a permanent tooth with apical periodontitis and root perforation”, Dr. Brizuela.

“The innovative approach, based on established biological principles and up-cycling strategies (using hospital waste), not only presents a promising alternative for the treatment of periapical pathologies, but it also transforms the cell therapy field into affordable and straightforward procedures, that can be potentially applied in any dental clinic”, comments Dr. Khoury.

1. Meza, G. et al. Personalized Cell Therapy for Pulpitis Using Autologous Dental Pulp Stem Cells and Leukocyte Platelet-rich Fibrin: A Case Report. J. Endod. 45, (2019).
2. Brizuela, C. et al. Cell-Based Regenerative Endodontics for Treatment of Periapical Lesions: A Randomized, Controlled Phase I/II Clinical Trial. J. Dent. Res. 99, (2020).
3. Cordero, C. B. et al. Allogeneic Cellular Therapy in a Mature Tooth with Apical Periodontitis and Accidental Root Perforation: A Case Report. J. Endod. 0, (2020).

Av Plaza 2501, Las Condes, Santiago, Chile
Email mkhoury@c4c.cl

Cells for Cells is a Chilean-based biotech company dedicated to the research, development and commercialization of cell therapies and tissue-engineered solutions. The company counts with a broad portfolio of more than 10 technologies including Cellistem®OA, a clinical trial-supported cell therapy for the treatment of knee osteoarthritis, Inkure®, a bioink for the treatment of focal chondral lesions, Oxium®Exo, a culture media for the production of exosomes, and Veintis™, a bioinspired tissue-engineered vascular graft for vascular bypass applications.

This release was published on openPR.