Methods for treating dental conditions using tissue scaffolds

Abstract

The invention provides methods, apparatus and kits for regenerating dental tissue in vivo that are useful for treating a variety of dental conditions, exemplified by treatment of caries. The invention uses tissue scaffold wafers, preferably made of PGA, PLLA, PDLLA or PLGA dimensioned to fit into a hole of corresponding sized drilled into the tooth of subject to expose dental pulp in vivo. In certain embodiments the tissue scaffold wafer further comprises calcium phosphate and fluoride. The tissue scaffold wafer may be secured into the hole with a hydrogel, a cement or other suitable material. Either the wafer or the hydrogel or both contain a morphogenic agent, such as a member encoded by the TGF-β supergene family, that promotes regeneration and differentiation of healthy dental tissue in vivo, which in turn leads to remineralization of dentin and enamel. The tissue scaffold may further include an antibiotic or anti-inflammatory agent.

1 . A composition for treating dental tissue, comprising 
 a tissue scaffold wafer comprising a scaffolding material associated with calcium phosphate and fluoride.    
   
   
       2 . The composition of  claim 1  further comprising a physiologically effective amount of a morphogenic agent that promotes growth of dentin tissue.  
   
   
       3 . The composition of  claim 2  wherein the morphogenic agent is encoded by a member of the TGF-β supergene family.  
   
   
       4 . The composition of  claim 2  wherein the morphogenic agent is selected from the group consisting of BMP-2, BMP 4, BMP-7, VEGF, FGF-1, FGF-2, IGF-1, IGF-2, PDGF, GDF-1, GDF-2, GDF-3, GDF-4, and GDF-5.  
   
   
       5 . The composition of  claim 2  wherein the morphogenic agent is selected from the group consisting of BMP-2, BMP 4, BMP-7, and GDF-5.  
   
   
       6 . The composition of  claim 1  further comprising an active agent selected from the group consisting of an anti-bacterial agent and an anti-inflammatory agent.  
   
   
       7 . The composition of  claim 1  wherein the tissue scaffold is comprised of scaffolding polymer selected from the group consisting of PLLA, PDLLA, PGA and PLGA.  
   
   
       8 . The composition of  claim 1  wherein the tissue scaffold is comprised of PLGA.  
   
   
       9 . A vacuum manipulator for manipulating a tissue scaffold wafer, comprising: 
 a vacuum tube having a proximal end, a distal end, and walls between the proximal and distal ends enclosing the vacuum tube;    an attachment at the distal end of the vacuum tube to permit fluid communication between a vacuum source and the vacuum tube;    a suction cup attached to the proximal end of the vacuum tube in fluid communication with the vacuum tube, the suction cup being sized to fit onto a surface of a wafer comprised of dental scaffolding material; and    a valve assembly positioned at the distal end of the vacuum tube proximate to the vacuum source, the valve assembly being operable to close and open fluid access between the vacuum tube and a vacuum source and to open and close fluid access between the vacuum tube and a pressure source.    
   
   
       10 . The vacuum manipulator of  claim 9  wherein the valve assembly is manipulated by a manual dial.  
   
   
       11 . The vacuum manipulator of  claim 9  further including an in-line filter disposed in the vacuum tube between the suction cup and the distal end, the in-line filter having sufficient pore volume to allow passage of the fluid between the suction cup and the vacuum tube while preventing the passage of a pathogen.  
   
   
       12 . The vacuum manipulator of  claim 9  wherein the vacuum tube has a bend along the length thereof to orient the proximal end for insertion into a mouth of human along a plane defined by crowns of teeth.  
   
   
       13 . The vacuum manipulator of  claim 9  wherein the vacuum source is comprised of a pliable bulb shaped member.  
   
   
       14 . The vacuum manipulator of  claim 9  wherein the attachment for the vacuum source is comprised of a hose attachable to an external vacuum source.  
   
   
       15 . The vacuum manipulator of  claim 9  further comprising a source of positive pressure in fluid communication with the vacuum tube through the vacuum assembly.  
   
   
       16 . The vacuum manipulator of  claim 15  wherein the positive pressure source is ambient air pressure.  
   
   
       17 . The vacuum manipulator of  claim 15  wherein the pressure source is a source of positive air flow that is greater than ambient air pressure.  
   
   
       18 . The vacuum manipulator of  claim 9  wherein the valve assembly is adjustable to allow a controlled amount of at least one of positive or negative pressure to be drawn or applied within the vacuum tube.