Dr. Anibal Diogenes, UT Health Science Center San Antonio School of Dentistry researcher uses a child's own stem cells to repair damaged teeth that would otherwise have to undergo a root canal.

Bringing teeth back to life

Monday, September 8, 2014by Rosanne Fohn and Natalie Gutierrez

Dr. Anibal Diogenes’ research with children could have worldwide implications for patients who need relief from tooth pain.

When 6-year-old Lia Diogenes looked at the “stars” on her father’s computer, she learned that they were actually stem cells her dad is studying to make it easier to heal infections in children’s teeth.

Anibal Diogenes, D.D.S., Ph.D., is an endodontist, a dental specialist who focuses on the internal part or pulp, of the tooth. A common procedure endodontists perform is a root canal, designed to help save an infected tooth.

Dr. Diogenes, assistant professor in the School of Dentistry at The University of Texas Health Science Center at San Antonio, is leading a pediatric stem-cell clinical trial on endodontic regeneration.  This pioneering research in the Department of Endodontics is making it possible for children’s teeth not only to be saved, but to continue growing and developing. The process uses the children’s own stem cells, found in the soft tissues surrounding the roots of their teeth.

“Once I explained to Lia what I was doing, she said that I could use her stem cells when she lost her baby teeth ― as long as I would give them back to her for the tooth fairy,” her father said.

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Saving developing teeth

“In South Texas and many other parts of the world, there is a lack of adequate preventive dental care. Diets high in sugar can put the developing teeth at risk for decay and infections. If infected teeth are not treated, it can lead to tooth loss,” Dr. Diogenes said.

“Tooth loss in a child is devastating. When the tooth is lost, the remaining teeth can shift, affecting function, aesthetics and even facial development. We are intent on not only treating the infection but enabling the tooth to continue to grow and retain its full function,” he said.

In children, it can take more than two years for a new tooth to fully develop after piercing through the gum. “The dental pulp drives this development. If the tooth becomes infected, the pulp begins to die,” Dr. Diogenes said. “And further development is not possible after conventional root canal therapy. “

Conventional therapy involves treating the infection and then filling the inside of the tooth with an inert material to prevent reinfection. Unfortunately, the tooth can no longer grow or develop.

“Only regenerative endodontics can restore the vitality of the tooth,” Dr. Diogenes said.  “This is a groundbreaking field in endodontics. We hope to develop this process in children and then transfer it to adults.”

Pioneers in endodontic regeneration research

The Health Science Center is playing a major role in this research. Dr. Diogenes led the first clinical study that proved children’s oral stem cells could regenerate their teeth. The discovery led to Health Science Center researchers contributing to the definition of the term “regenerative endodontics” and the national guidelines for dental practitioners. And research is continuing with a $1.7 million grant from the American Association of Endodontists Foundation, with supplemental funding from the School of Dentistry.

Dr. Diogenes said he is thrilled to be involved in this research. “I decided on endodontics very early while I was still in dental school in Brazil. I found it to be the most rewarding part of dentistry. I enjoy taking care of patients who have pain and making a big difference for them,” he said.

The School of Dentistry’s international reputation – and the successful pain research led by Kenneth Hargreaves, D.D.S., Ph.D., chair of the Department of Endodontics, who now supervises Dr. Diogenes’ research – is what led Dr. Diogenes to the Health Science Center.  

After being in private practice in his native Brazil and earning his master’s degree in molecular biology at the University of Nebraska, Dr. Diogenes earned his Ph.D. in pharmacology and completed a residency and certificate in endodontics at the Health Science Center.  “I received excellent training here, from basic science to clinical endodontics,” he said.

Preparing the next generation

And now he can pay it forward. Dr. Diogenes recently was named director of the Advanced Endodontics Residency Program. “This means a lot to me. Now I have the opportunity to guide the next generation of endodontists,” he said, not to mention young scientists like his daughter, who may one day decide to enter dentistry or another health care field.

“I find it great that even children are interested in biological processes. When Lia gave me her baby teeth, I isolated her stem cells and established a cell line in my lab. She’s already contributing to science because her stem cells are being used in translational research,” he smiled. “And what we are doing here could have worldwide implications.”