Molecular biology Lecture 1

What is the dental profession responsible for?

Prevention, diagnosis, and treatment of diseases and disorders of the oral cavity and related structures

How long does it take for 14% of new scientific discoveries to enter real life practice?

An average of 17 years to enter day-to-day practice

What is the meaning of translation in molecular technology?

• The application of the results of basic biomedical research to the practice of medicine

• The process of converting discoveries made in the lab into clinical interventions that provide a direct benefit to human health

How can translation now occur?

From bench to bedside and bedside to bench; many journeys in both directions

What is translational medicine?

The conversion of promising research outcomes into therapeutic, diagnostic or preventive agents

1. Basic research

2. Clinical research

3. Improved health

Basic and oral health clinical research are …

Interdependent

What leads research from basic to clinical?

Translation from basic science to human studies

What leads clinical research to improved health?

Translation of new knowledge into clinical practice

What is translational research used for?

To foster and promote multi-investigator and multi-institutional collaboration and sharing

• Multiple methods and technologies are used

What governs cell, animal, and human research?

Numerous federal regulations, institutional policies, and best practices

What are some groups that handle regulations and policies of treatment upon living organisms?

• Federal regulations (CFRs

• FDA regulations

• HHS privacy (HIPPA)

• Export controls and shipping

• Conflict of Interest (COI)

• NIH Grants Policy

• Inter-entity material transfer agreement

• Institutional oversight

• Industry agreements

What Impact has genomics had on dentistry?

• Caries (proneness)

• Oral cancer

• Periodontal disease

• Oral microbiology

• Orthodontics and Craniofacial Development

• Acute and Chronic Pain Management

What does a phenotype consist of?

• Genomics

• Proteomics

• Transcriptomics

• Metobolomics

What is a phenotype?

Composition of an organism’s observable characteristics or traits

What are some different phenotypes of the craniofacial musculoskeletal complex?

• Malocclusion

• Facial Asymmetry

• Development of the temporomandibular joint + associated pain perception

What can the translation of phenotypes do for clinical approaches?

Lead to better treatment, diagnoses, and understanding of problems

• Pharmacogenetics

• Therapeutics agents

• Diagnostics + biomarkers

• Tissue Engineering

What are the phases of translational research?

T1 - T4

What is the T1 phase of translational research?

First phase of translational research = BENCH TO BEDSIDE

• moves a basic discovery into a clinical application

What must a researcher make sure to do before conducting phase T1 of translational research?

Data should be valuable and researchable for future study and can continue on a grandeur scale (make sure results and methodology make sense before continuing)

What is the T2 phase of Translational Research?

“Bedside to Practice”

• Research provides evidence of the value of taking the basic discovery in the clinical setting

What is phase T3 of translational research?

Research that moves the evidence-based guidelines developed in T2 into health practice

• Basic knowledge into human trial and trying in controlled environment on humans

What is the T4 phase of translational research?

Research to evaluate “real world” health outcomes

• In the market/on shelves (not all countries may deem safe)

Does translational research pose ethical dilemmas?

Yes

What is important to know about the “ground rules” of translational research?

It is governed by:

• Regulations + compliance

• Ethical + philosophical mores

Some ethical dilemmas a translational researcher may face related to moving from basic science to clinical trials (+human trials) are:

1. Conflicts of interest arising from industry collaborations

2. Issues with informed consent in patient recruitment

3. Data manipulation to achieve desired results

4. Concerns about sharing preliminary data with potential founders

5. Ensuring the integrity of the research process and prioritizing patient well-being throughout the translation process

Do all industries + companies go by ethical standards?

No

In order to ensure no rights, laws, or ethical rules are broken what should we prioritize?

The human or patient must be put FIRST and you must protect them from harm at all costs

What is the meaning of the ethical consideration of informed consent?

Ensures that patients fully understand the risks and benefits of participating in a clinical trial and have the ability to withdraw at any time

What is the meaning of the ethical consideration of patient privacy?

Protecting patient data and maintaining confidentiality throughout the research process

What is the meaning of the ethical consideration of a benefit risk analysis?

Carefully weighing the potential benefits of a new treatment against the risks to patients

What is the meaning of the ethical consideration of conflict of interest management?

Disclosing and appropriately managing any potential conflicts of interest related to industry collaborations or financial incentives

What is the meaning of the ethical consideration of scientific rigor?

Adhering to established research methodologies and data analysis practices to ensure reliable and reproducible results

What are some technologies that will shape and are shaping the future of dentistry?

1. Artificial Intelligence

2. Smart toothbrush

3. Virtual reality

4. Teledentistry

5. Computer-assisted design and 3D printing

6. Intra-oral camera

7. Regenerative dentistry (zirconia crowns)

8. CRISPR

9. Laser

What is AI used for in dentistry?

AI helps dentists spot, treat, and predict dental issues such as:

• Detects and monitors growth of cancer cells

• Detecting dental caries

• Detecting periodontal disease

How does AI work in dentistry?

Using neural networks and radiographs to allow for early detection and timely treatment of patients to prevent tooth loss and complications

Despite the advantages of AI in dentistry …

Ethical concerns regarding accuracy still exist within the dental community

What are smart toothbrushes used for?

For efficient brushing using sensors to detect plaque and other dental issues providing valuable insight into oral health with user-friendly features (including online platforms - apps)

• Reduces risk of plaque buildup, decay, and periodontal disease

What is virtual reality used for in dentistry?

• Training

• Ease anxiety and phobia of dental setting for the patient (viewing a procedure or what to expect from their visit)

What is augmented reality used for in dentistry?

• Education (teaching steps of a procedure - providing feedback)

• Works like a face filter app on your phone

• Helping to improve accuracy and look of cosmetic dental treatments such a as porcelain veneers

• Help patients know what they will look like after the treatment before getting started or finishing

What is teledentistry?

An online platform for dentists to meet with patients to discuss their concerns if they are unable to make it in person

• Makes services more accessible and patient-oriented

• Patients can send images to discuss their dental health with their dentist

• Emergency assessment, faster pain relief, keeping track of treatments, ad safety to patients

What is CAD/CAM design technology + 3D printing used for in dentistry?

The dentist drills the affected tooth and takes a picture. The image is transferred to a 3D printing machine and a crown is made.

• Saves time for both dentists and patients

• Makes crowns quickly

What is CAD/CAM also referred to?

Computer-assisted design and computer-assisted manufacture

What is computer-aided root canal therapy?

A mini-computer that helps dentists precisely clean infected root canals because computer digitally displays root lengths and enables the doctor to accurately seal roots.

Computer-aided root canal therapy should be …

Used for all root canal treatments

How can 3D imaging help with root canals?

• Can take a low-dose HD image of a tooth to help dentist find all roots + determine any hidden ones

• Reveals possible presences of unusual root anatomy

• Provides significant advantage for pre-treatment planning and post-treatment evaluation of failing root canal therapy

What is 3D bioprinting?

A relatively new and emerging field in which advances have led to the printing of biocompatible materials for the production of medical devices as well as the replacement of human tissues and organs

What does 3D bioprinting allow us to do for treatments?

Provide a more precise diagnosis, followed by optimally comfortable, safe, and predictable treatments

What kinds of treatments are examples of 3D bioprinting or use 3D bioprinting?

• Safe surgical implant placement

• 3D Nerve Tracking

• 3D: Sinus (air space) location, airway evaluation

• 3D: Guided implant placement, implant planning

• 4D Jaw motion tests - TMJ jaw/joint analysis

• Advanced gum disease diagnosis

• Emergency Trauma Evaluation: Teeth + Bone Fractures

• 3D: Root canals, root crack diagnosis

• 3D Safety for Wisdom Teeth Extraction

• Advanced Orthodontics Diagnostics

What materials are used for 3D bioprinting?

• Materials with appropriate cross linking mechanisms to allow for proper deposition and biocompatibility over the long term

• Materials must support the proliferation of cells, as well as cellular function and attachment

What are the applications of 3D bioprinting in dentoalveolar repair?

• Maxillofacial injury + disease

• Pathology

• Trauma (in conjunction with the use of scaffolds)

What is important for the 3D bioprinting process?

• Cell types

• Printing techniques

• Materials selection

How is 3D guided surgical implant placement done?

A low dose 3D scan combined with dental implant software technologies work together to create surgical guides for precise implant placement

Once digital planning for surgical implantation is complete, what happens?

The software creates and saves a digital file that includes a record of the implant position with its relation to your boney anatomy.

• Then the digital file + stereolithography = 3D printing technology for oral appliance.

What is an autograft?

An autograft is when the skin, organs, tissues, or even protein sample is taken from one part of the body and transplanted to another part of the body to treat several craniofacial anomalies and abnormalities.

What are allografts?

The transplantation of cells, tissues, or organs, to a recipient from a genetically non-identical donor of the same species (from someone else).

What is common to both autograft + allograft procedures?

The graft must be manually shaped to precisely fit the defect during surgery, possibly leading to inaccuracies and lack of superior esthetics.

What are the advantages of 3D bioprinting technology?

• Replace human tissue by full body transplant

• Allows scientists to eliminate the wait list of organ transplants

• Higher survival rate of printed cells

• Offers high precise resolution

What are the disadvantages 3D bioprinting technology?

• It is not always sure that the organ can fit into the human body developed from 3D printing

• 3D printers can create dangerous items such as guns and knives

• Printing capabilities of complicated tissues

What is the intra-oral camera used for in dentistry?

To obtain highly detailed and accurate images of the view inside the mouth of the patient

What areas are the intraoral camera’s best used for?

Patient’s rear teeth

What are intraoral cameras “replacing”?

Dental mirrors

What does intraoral camera technology help prevent?

Pain for the patient during dental procedures due to errors

What are the benefits of intra-oral dental cameras?

• Early detection of dental problems

• Improves patient/doctor communication during treatment planning

• Proof + validation of disease - builds patient’s trust

• Optimize insurance reimbursements

• Case documentation for education and future reference

• Diagnosis for hidden problems like small dental cavities or tooth cracks

• Improves treatments because patients confidently choose the best treatment more often

What is regenerative dentistry?

A relatively novel concept that brings the idea of self-healing teeth and tooth regeneration through biological therapy that ensures damaged teeth can heal themselves

What do we often consider beyond repair?

Once teeth are decayed

What is the most optimal option in any dental procedure?

Salvaging your natural teeth

What is one thing that regenerative dentistry can do for patients?

Regrow teeth and less chance of root canal treatments

What is CRISPR?

A genome-editing method that helps dentists find, isolate, and turn off genes associated with oral cancer. It is also used to change the functioning of bacteria that are responsible for plaque.

What is zirconia?

A metal free dental material (ceramic) called the “white metal” that can be milled by a computerized cutting machine (CAD/CAM) into the shape of a tooth crown, dental post, bridge, and full arch implant bridge for strong aesthetic treatments

What are the technologies for safety, asepsis, and prevention?

• Clean water technologies

• Medical grade sterilization

• Instrument sterilization pouches

• Touchless digital dental x-rays

• Laser gum treatments

• No needle “drill-less” fillings

What is the best method for medical grade and dental instrument sterilization?

Pressurized steam at high temperatures

What are touchless digital dental X-rays?

New 3D/4D X-rays created by a computerized parallel sensor technology with accurate measurements and precise/predictable diagnostics

Are digital X-rays faster than traditional radiographs?

Yes

What is the primary purpose of the new touchless radiograph technology?

Locate cavities however they are also often used to check the support of the bone under the tooth and the placement of an implant

What are lasers used for? And for what problems?

Soft tissue surgeries for problems like:

• Gingivitis

• Periodontal disease and some other issues

What two purposes do laser gum treatments have?

Health + Esthetics

How effective are lasers at killing bacteria?

98% killing of bacteria embedded in tooth roots

What is one of the main goals of effective gum therapy?

To remove bacteria and disinfect the roots

What do lasers tend to do?

Produce less pain and use less anesthesia

What are microsurgical gum procedures?

A type of MIS or minimally invasive surgery for the gums

What is minimally invasive surgery (MIS) for gums?

A state-of-the-art procedure whereby the Guam’s are lifted without cutting a mucogingival flap or disturbing the gum papilla.

What can MIS microsurgical care be used for?

To treat a variety of gum problems and is especially well-suited for cosmetic gum procedures that require a great deal of precision and accuracy

Compared to traditional gum surgery, what makes oral plastic surgery + microsurgical gum procedures better?

• Patient experiences less pain

• Significantly quick recovery and healing

• Predictable healing and consistent esthetic results

• Minimally invasive

• Less post treatment side effects

• Gums are generally are thin on the facial (cheek side) of the upper and lower anterior teeth

• Reduced potential for scarring