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Fraser D, Caton J, Benoit DSW. Periodontal Wound Healing and Regeneration: Insights for Engineering New Therapeutic Approaches. FRONTIERS IN DENTAL MEDICINE 2022. [DOI: 10.3389/fdmed.2022.815810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Periodontitis is a widespread inflammatory disease that leads to loss of the tooth supporting periodontal tissues. The few therapies available to regenerate periodontal tissues have high costs and inherent limitations, inspiring the development of new approaches. Studies have shown that periodontal tissues have an inherent capacity for regeneration, driven by multipotent cells residing in the periodontal ligament (PDL). The purpose of this review is to describe the current understanding of the mechanisms driving periodontal wound healing and regeneration that can inform the development of new treatment approaches. The biologic basis underlying established therapies such as guided tissue regeneration (GTR) and growth factor delivery are reviewed, along with examples of biomaterials that have been engineered to improve the effectiveness of these approaches. Emerging therapies such as those targeting Wnt signaling, periodontal cell delivery or recruitment, and tissue engineered scaffolds are described in the context of periodontal wound healing, using key in vivo studies to illustrate the impact these approaches can have on the formation of new cementum, alveolar bone, and PDL. Finally, design principles for engineering new therapies are suggested which build on current knowledge of periodontal wound healing and regeneration.
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Treatment of intrabony periodontal defects in controlled diabetic patients with an enamel matrix derivative: a split-mouth randomized clinical trial. Clin Oral Investig 2021; 26:2479-2489. [PMID: 34643808 DOI: 10.1007/s00784-021-04215-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/26/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This split-mouth randomized controlled trial aimed to evaluate the effect of enamel matrix derivative (EMD) associated with a simplified papilla preservation flap (SPPF) compared to SPPF alone in the surgical treatment of intrabony defects (ID) in type 2 diabetic mellitus (T2DM) patients. MATERIAL AND METHODS Thirteen patients with controlled T2DM presenting with ID in at least two quadrants were included. In each patient, the test site (TS) was treated with SPPF plus EMD, whereas the control site (CS) was treated only with SPPF. Prior to surgery and at 6 months after intervention, the following parameters were evaluated: clinical attachment level (CAL), probing pocket depth (PPD), and gingival recession (GR). RESULTS The TS and CS demonstrated a mean CAL gain of 3.31 ± 0.96 mm and 1.61 ± 1.12 mm, and a PPD reduction from 8.15 ± 0.98 to 3.00 ± 0.57 mm and 7.53 ± 0.96 to 4.69 ± 0.63 mm after 6 months, respectively. In both sites, the mean CAL gain and PPD reduction improved significantly after 6 months compared to baseline; however, the improvement was higher in the TS (p < 0.001). CONCLUSIONS Both surgical procedures presented with clinical improvements in controlled T2DM patients. However, the additional use of EMD showed enhanced clinical results after 6 months with regard to CAL gain and PPD reduction. CLINICAL RELEVANCE This study showed a better PPD reduction and CAL gain when an EMD was applied in addition to SPPF. Therefore, EMD may be used to enhance clinical outcomes in periodontal ID of controlled T2DM patients.
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Ramenzoni LL, Annasohn L, Miron RJ, Attin T, Schmidlin PR. Combination of enamel matrix derivative and hyaluronic acid inhibits lipopolysaccharide-induced inflammatory response on human epithelial and bone cells. Clin Oral Investig 2021; 26:1773-1783. [PMID: 34460002 PMCID: PMC8816768 DOI: 10.1007/s00784-021-04152-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/16/2021] [Indexed: 12/01/2022]
Abstract
Objectives The aim of this study was to evaluate the in vitro effect of enamel matrix derivative (EMD) and hyaluronic acid (HA) and their synergistic combination on lipopolysaccharides (LPS)-induced inflammation in human keratinocytes and osteoblasts. Material and methods Cells were challenged with LPS (1 μg/ml) and cultured in the following treatment groups with EMD (30 mg/ml) and HA (30 mg/ml): LPS, EMD, HA, EMD + HA, EMD + LPS, HA + LPS, and EMD + HA + LPS. Cell viability, inflammatory cytokine expression, and cell migration were determined using colorimetric assay, quantitative real-time polymerase chain reaction (qPCR), and scratch wound healing assay, respectively. Results Cell viability was decreased when exposed to LPS compared to the controls. Overall, LPS treatment expressed upregulation on inflammatory cytokine tumor necrosis factor alpha (TNF-α), interleukin 1 beta (IL-1β), and interleukin 6 (IL-6). EMD and HA reduced up to 3.0-fold the cytokine expression caused by LPS (p < 0.05). EMD and HA statistically induced higher migration in osteoblasts and keratinocytes, respectively. Migration was impaired by LPS, whereas it significantly increased after addition of EMD and HA. Conclusions EMD and HA are advantageous biomaterials that individually generate strong directional migratory keratinocyte and osteoblast response. Their combination also enhances cell viability, and anti-inflammatory and migratory abilities to promote healing specially under LPS inflammatory stimulus. Future in vivo and animal research is necessary to further characterize the effect of EMD and HA on periodontal regeneration. Clinical relevance The use of EMD in conjunction with HA resulted in a reduction of inflammation and improvement of tissue healing at wound sites. Both biomaterials combined may potentially improve the effectiveness of bone regeneration in periodontal bone defects, pointing to the potential clinical relevance of both materials in regenerative periodontal surgery.
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Affiliation(s)
- Liza L Ramenzoni
- Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland. .,Laboratory of Applied Periodontal and Peri-Implantitis Sciences, Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.
| | - Laura Annasohn
- Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.,Laboratory of Applied Periodontal and Peri-Implantitis Sciences, Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Richard J Miron
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Thomas Attin
- Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Patrick R Schmidlin
- Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.,Laboratory of Applied Periodontal and Peri-Implantitis Sciences, Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Histologic evidence of periodontal regeneration in furcation defects: a systematic review. Clin Oral Investig 2019; 23:2861-2906. [PMID: 31165313 DOI: 10.1007/s00784-019-02964-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 05/16/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To systematically review the available histologic evidence on periodontal regeneration in class II and III furcations in animals and humans. MATERIALS AND METHODS A protocol including all aspects of a systematic review methodology was developed including definition of the focused question, defined search strategy, study inclusion criteria, determination of outcome measures, screening methods, data extraction and analysis, and data synthesis. The focused question was defined as follows: "What is the regenerative effect obtained by using or not several biomaterials as adjuncts to open flap surgery in the treatment of periodontal furcation defects as evaluated in animal and human histological studies?" SEARCH STRATEGY Using the MEDLINE database, the literature was searched for articles published up to and including September 2018: combinations of several search terms were applied to identify appropriate studies. Reference lists of review articles and of the included articles in the present review were screened. A hand search of the most important dental journals was also performed. CRITERIA FOR STUDY SELECTION AND INCLUSION Only articles published in English describing animal and human histological studies evaluating the effect of surgical treatment, with or without the adjunctive use of potentially regenerative materials (i.e., barrier membranes, grafting materials, growth factors/proteins, and combinations thereof) for the treatment of periodontal furcation defects were considered. Only studies reporting a minimum of 8 weeks healing following reconstructive surgery were included. The primary outcome variable was formation of periodontal supporting tissues [e.g., periodontal ligament, root cementum, and alveolar bone, given as linear measurements (in mm) or as a percentage of the instrumented root length (%)] following surgical treatment with or without regenerative materials, as determined histologically/histomorphometrically. Healing type and defect resolution (i.e., complete regeneration, long junctional epithelium, connective tissue attachment, connective tissue adhesion, or osseous repair) were also recorded. RESULTS In animals, periodontal regeneration was reported in class II and III defects with open flap debridement alone or combined with various types of bone grafts/bone substitues, biological factors, guided tissue regeneration, and different combinations thereof. The use of biological factors and combination approaches provided the best outcomes for class II defects whereas in class III defects, the combination approaches seem to offer the highest regenerative outcomes. In human class II furcations, the best outcomes were obtained with DFDBA combined with rhPDGF-BB and with GTR. In class III furcations, evidence from two case reports indicated very limited to no periodontal regeneration. CONCLUSIONS Within their limits, the present results suggest that (a) in animals, complete periodontal regeneration has been demonstrated in class II and class III furcation defects, and (b) in humans, the evidence for substantial periodontal regeneration is limited to class II furcations. CLINICAL RELEVANCE At present, regenerative periodontal surgery represents a valuable treatment option only for human class II furcation defects but not for class III furcations.
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Duan X, Lin Z, Lin X, Wang Z, Wu Y, Ji M, Lu W, Wang X, Zhang D. Study of platelet-rich fibrin combined with rat periodontal ligament stem cells in periodontal tissue regeneration. J Cell Mol Med 2019; 22:1047-1055. [PMID: 29368432 PMCID: PMC5783838 DOI: 10.1111/jcmm.13461] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 09/28/2017] [Indexed: 12/13/2022] Open
Abstract
The objective of this study was to investigate the advantages and feasibility of periodontal tissue regeneration using platelet‐rich fibrin (PRF) combined with rat periodontal ligament stem cells (PDLSCs) for the first time. We first determined the effect of PRF on rat PDLSCs in vitro. We next conducted an in vivo study, in which a tissue engineering technique was performed to repair periodontal defects in five groups: a blank group, collagen group (implanted collagen membrane), collagen + cells group (implanted collagen membrane and rat PDLSCs), PRF group (implanted PRF membrane) and PRF + cells group (implanted PRF membrane and rat PDLSCs). PRF greatly enhanced cell proliferation, mRNA and protein expression levels of bone sialoprotein (BSP), osteocalcin (OC), and runt‐related transcription factor 2 (RUNX2) and activity of alkaline phosphatase (ALP) in vitro. Transplantation of PRF combined with rat PDLSCs resulted in higher expression of osteopontin (Opn), collagen I (COL1A) and RUNX2 at both 12 and 24 days after surgery. Micro‐computed tomography and histological analysis showed substantially more new bone formation in the PRF + cells group at 24 days after surgery. Based on these results, we discuss the role of PRF in the proliferation and differentiation of rat PDLSCs and suggest that PRF combined with rat PDLSCs provides a valuable tool for periodontal tissue engineering.
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Affiliation(s)
- Xuejing Duan
- School of Stomatology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong Province, China
| | - Zhiyong Lin
- School of Stomatology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong Province, China
| | - Xiujuan Lin
- School of Stomatology, Qianfoshan Hospital affiliated to Shandong University, Jinan, Shandong Province, China
| | - Zhiqiang Wang
- School of Stomatology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong Province, China
| | - Yihua Wu
- School of Stomatology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong Province, China
| | - Mei Ji
- School of Stomatology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong Province, China
| | - Wei Lu
- School of Stomatology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong Province, China
| | - Xiaoyang Wang
- School of Stomatology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong Province, China
| | - Dongsheng Zhang
- School of Stomatology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong Province, China
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Multilayered membranes with tuned well arrays to be used as regenerative patches. Acta Biomater 2017; 57:313-323. [PMID: 28438703 DOI: 10.1016/j.actbio.2017.04.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 04/13/2017] [Accepted: 04/19/2017] [Indexed: 11/20/2022]
Abstract
Membranes have been explored as patches in tissue repair and regeneration, most of them presenting a flat geometry or a patterned texture at the nano/micrometer scale. Herein, a new concept of a flexible membrane featuring well arrays forming pore-like environments to accommodate cell culture is proposed. The processing of such membranes using polysaccharides is based on the production of multilayers using the layer-by-layer methodology over a patterned PDMS substrate. The detached multilayered membrane exhibits a layer of open pores at one side and a total thickness of 38±2.2µm. The photolithography technology used to produce the molds allows obtaining wells on the final membranes with a tuned shape and micro-scale precision. The influence of post-processing procedures over chitosan/alginate films with 100 double layers, including crosslinking with genipin or fibronectin immobilization, on the adhesion and proliferation of human osteoblast-like cells is also investigated. The results suggest that the presence of patterned wells affects positively cell adhesion, morphology and proliferation. In particular, it is seen that cells colonized preferentially the well regions. The geometrical features with micro to sub-millimeter patterned wells, together with the nano-scale organization of the polymeric components along the thickness of the film will allow to engineer highly versatile multilayered membranes exhibiting a pore-like microstructure in just one of the sides, that could be adaptable in the regeneration of multiple tissues. STATEMENT OF SIGNIFICANCE Flexible multilayered membranes containing multiple micro-reservoirs are found as potential regenerative patches. Layer-by-layer (LbL) methodology over a featured PDMS substrate is used to produce patterned membranes, composed only by natural-based polymers, that can be easily detached from the PDMS substrate. The combination of nano-scale control of the polymeric organization along the thickness of the chitosan/alginate (CHT/ALG) membranes, provided by LbL, together with the geometrical micro-scale features of the patterned membranes offers a uniqueness system that allows cells to colonize 3-dimensionally. This study provides a promising strategy to control cellular spatial organization that can face the region of the tissue to regenerate.
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Shirakata Y, Miron RJ, Nakamura T, Sena K, Shinohara Y, Horai N, Bosshardt DD, Noguchi K, Sculean A. Effects of EMD liquid (Osteogain) on periodontal healing in class III furcation defects in monkeys. J Clin Periodontol 2017; 44:298-307. [DOI: 10.1111/jcpe.12663] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2016] [Indexed: 01/09/2023]
Affiliation(s)
- Yoshinori Shirakata
- Department of Periodontology; Kagoshima University Graduate School of Medical and Dental Sciences; Kagoshima Japan
| | - Richard J. Miron
- Department of Periodontology; Nova Southeastern University; Fort Lauderdale FL USA
- Department of Periodontics and Oral Medicine; University of Michigan School of Dentistry; Ann Arber MI USA
| | - Toshiaki Nakamura
- Department of Periodontology; Kagoshima University Graduate School of Medical and Dental Sciences; Kagoshima Japan
| | - Kotaro Sena
- Department of Periodontology; Kagoshima University Graduate School of Medical and Dental Sciences; Kagoshima Japan
| | - Yukiya Shinohara
- Department of Periodontology; Kagoshima University Graduate School of Medical and Dental Sciences; Kagoshima Japan
| | - Naoto Horai
- Shin Nippon Biomedical Laboratories, Ltd; Kagoshima Japan
| | - Dieter D. Bosshardt
- Robert K. Schenk Laboratory of Oral Histology; University of Bern; Bern Switzerland
| | - Kazuyuki Noguchi
- Department of Periodontology; Kagoshima University Graduate School of Medical and Dental Sciences; Kagoshima Japan
| | - Anton Sculean
- Department of Periodontology; School of Dental Medicine; University of Bern; Bern Switzerland
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Avila-Ortiz G, De Buitrago JG, Reddy MS. Periodontal regeneration - furcation defects: a systematic review from the AAP Regeneration Workshop. J Periodontol 2016; 86:S108-30. [PMID: 25644295 DOI: 10.1902/jop.2015.130677] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of this review is to present the available evidence regarding the effectiveness of different regenerative approaches for the treatment of furcation defects in specific clinical scenarios compared with conventional surgical therapy to provide clinical guidelines for the therapeutic management of furcation defects and to identify priorities for future research that may advance the understanding of periodontal regenerative medicine. METHODS A comprehensive search based on predetermined eligibility criteria was conducted to identify human original studies and systematic reviews on the topic of periodontal regeneration of furcation defects. Two reviewers independently screened the title and abstract of the entries yielded from the initial search. Subsequently, both reviewers read the full-text version of potentially eligible studies, made a final article selection, and extracted the data of the selected studies considering specific clinical scenarios. The clinical scenarios contemplated in this review included the following: 1) facial and interproximal Class I defects in maxillary molars; 2) facial and lingual Class I defects in mandibular molars; 3) facial and interproximal Class II furcation defects in maxillary molars; 4) facial and lingual Class II furcation defects in mandibular molars; 5) Class III furcation defects in maxillary molars; 6) Class III furcation defects in mandibular molars; and 7) Class I, II, or III furcation defects in maxillary premolars. Endpoints of interest included different clinical, radiographic, microbiologic, histologic, and patient-reported outcomes. RESULTS The initial search yielded a total of 1,500 entries. The final selection consisted of 150 articles, of which six were systematic reviews, 109 were clinical trials, 27 were case series, and eight were case reports. A summary of the main findings of previously published systematic reviews and the available evidence relative to the indication of regenerative approaches for the treatment of furcation defects compared with conventional surgical therapy are presented. Given the marked methodologic heterogeneity and the wide variety of materials and techniques applied in the selected clinical trials, the conduction of a meta-analysis was not viable. CONCLUSIONS On the basis of the reviewed evidence, the following conclusions can be drawn. 1) Periodontal regeneration has been demonstrated histologically and clinically for the treatment of maxillary facial or interproximal and mandibular facial or lingual Class II furcation defects. 2) Although periodontal regeneration has been demonstrated histologically for the treatment of mandibular Class III defects, the evidence is limited to one case report. 3) Evidence supporting regenerative therapy in maxillary Class III furcation defects in maxillary molars is limited to clinical case reports. 4) In Class I furcation defects, regenerative therapy may be beneficial in certain clinical scenarios, although most Class I furcation defects may be successfully treated with non-regenerative therapy. 5) Future research efforts should be primarily directed toward the conduction of clinical trials to test novel regenerative approaches that place emphasis primarily on patient-reported outcomes and also on histologic demonstration of periodontal regeneration. Investigators should also focus on understanding the influence that local, systemic, and technical factors may have on the outcomes of regenerative therapy in furcation defects.
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Miron RJ, Fujioka-Kobayashi M, Zhang Y, Caballé-Serrano J, Shirakata Y, Bosshardt DD, Buser D, Sculean A. Osteogain improves osteoblast adhesion, proliferation and differentiation on a bovine-derived natural bone mineral. Clin Oral Implants Res 2016; 28:327-333. [PMID: 26919609 DOI: 10.1111/clr.12802] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The use of enamel matrix derivative (EMD) has been shown to facilitate periodontal regeneration by histologically resulting in formation of cementum, periodontal ligament and bone. Recently, a new liquid carrier system for EMD has been introduced with better physicochemical properties specifically designed for bone graft mixing (Osteogain). The aim of this study was to investigate the combination of Osteogain with a bovine-derived natural bone mineral (NBM) on osteoblast migration, adhesion, proliferation and differentiation. MATERIALS AND METHODS Undifferentiated mouse ST2 stromal bone marrow cells were seeded onto 1)NBM particles alone or 2)NBM + Osteogain. Samples were compared for cell migration at 8 h, cell adhesion at 4 h, cell proliferation at 1, 3 and 5 days and real-time PCR at 3 and 14 days for genes encoding runt-related transcription factor 2 (Runx2), collagen1alpha2 (COL1a2), alkaline phosphatase (ALP) and osteocalcin (OCN). Furthermore, alizarin red staining was utilized to investigate the mineralization at 14 days. RESULTS Osteogain significantly upregulated cell adhesion over twofold onto NBM particles and promoted cell proliferation at 3 and 5 days after seeding. Furthermore, the combination of NBM with Osteogain significantly upregulated genes encoding Runx2, ALP, COL1a2 and OCN (from 1.5- to 3-fold) and increased alizarin red staining over 3 fold at 14 days when compared to NBM particles alone. CONCLUSION Pre-coating Osteogain onto NBM bone grafting particles significantly increased cell adhesion, proliferation and differentiation of osteoblasts in vitro. Future animal studies are now necessary to further investigate the regenerative potential of Osteogain in combination with a bone grafting material prior to clinical use for bone regeneration.
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Affiliation(s)
- Richard J Miron
- Department of Periodontology, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Oral Surgery and Stomatology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Masako Fujioka-Kobayashi
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Yufeng Zhang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Jordi Caballé-Serrano
- Department of Oral Surgery and Stomatology, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Oral and MaxilloFacial Surgery, School of Dental Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Yoshinori Shirakata
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Dieter D Bosshardt
- Department of Periodontology, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Oral Surgery and Stomatology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel Buser
- Department of Oral Surgery and Stomatology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, Bern University Hospital, University of Bern, Bern, Switzerland
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Miron RJ, Shuang Y, Sculean A, Buser D, Chandad F, Zhang Y. Gene array of PDL cells exposed to Osteogain in combination with a bone grafting material. Clin Oral Investig 2016; 20:2037-2043. [DOI: 10.1007/s00784-015-1702-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 12/28/2015] [Indexed: 01/31/2023]
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Dai J, Ma Y, Shi M, Cao Z, Zhang Y, Miron RJ. Initial changes in alveolar bone volume for sham-operated and ovariectomized rats in ligature-induced experimental periodontitis. Clin Oral Investig 2015; 20:581-8. [DOI: 10.1007/s00784-015-1531-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 07/03/2015] [Indexed: 01/11/2023]
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12
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Amin HD, Olsen I, Knowles J, Dard M, Donos N. Interaction of enamel matrix proteins with human periodontal ligament cells. Clin Oral Investig 2015; 20:339-47. [PMID: 26121967 PMCID: PMC4762925 DOI: 10.1007/s00784-015-1510-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 06/09/2015] [Indexed: 12/22/2022]
Abstract
Objectives It has recently been shown that enamel matrix derivative (EMD) components (Fraction C, containing <6 kDa peptides (mainly a 5.3 kDa tyrosine-rich amelogenin peptide (TRAP)), and Fraction A, containing a mixture of >6 kDa peptides (including a leucine-rich amelogenin peptide (LRAP))) differentially regulate osteogenic differentiation of periodontal ligament (PDL) cells. The present study examined whether EMD and the EMD Fractions (i) bind and internalize into PDL cells and (ii) precipitate and form insoluble complexes on PDL cells. Materials and methods Biotin-labelled EMD/EMD Fractions were incubated with PDL cells under various different culture conditions and confocal and electron microscopies were carried out to examine the binding and intracellular trafficking of these proteins. Results The results reported here show, for the first time, that at least some components in Fraction A and the TRAP peptide in Fraction C can bind and be internalized by human PDL cells via receptor-mediated endocytosis. In addition, Fraction A was found to form insoluble aggregate-like structures on PDL cells, whereas Fraction C was soluble in culture media. Conclusion Soluble amelogenin isoform TRAP appears to be internalizing into a subset of PDL cells. Moreover, TRAP uptake is most likely controlled by receptor-mediated endocytosis. Clinical relevance Information on interaction between PDL cells and EMD/TRAP might prove useful in designing targeted interventions (i.e. use of chemically prepared soluble amelogenin peptides) to repair/regenerate periodontal tissues. Such interventions can also (i) avoid the use of rather crude animal-derived enamel matrix protein (EMP)/EMD preparation and (ii) preparation of cost-effective and more controlled chemically synthesized amelogenin peptides for the clinical use. Electronic supplementary material The online version of this article (doi:10.1007/s00784-015-1510-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Harsh D Amin
- Division of Biomaterials and Tissue Engineering, UCL Eastman Dental Institute, University College London, London, UK
- Periodontology Unit, UCL Eastman Dental Institute, University College London, London, UK
| | - Irwin Olsen
- Division of Biomaterials and Tissue Engineering, UCL Eastman Dental Institute, University College London, London, UK.
| | - Jonathan Knowles
- Division of Biomaterials and Tissue Engineering, UCL Eastman Dental Institute, University College London, London, UK
- Department of Nanobiomedical Science & BK21 Plus NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan, 330-714, Republic of Korea
| | - Michel Dard
- Department of Periodontology and Implant Dentistry, New York University, College of Dentistry, New York, USA
| | - Nikolaos Donos
- Periodontology Unit, UCL Eastman Dental Institute, University College London, London, UK.
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Sanz M, Jepsen K, Eickholz P, Jepsen S. Clinical concepts for regenerative therapy in furcations. Periodontol 2000 2015; 68:308-32. [DOI: 10.1111/prd.12081] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2014] [Indexed: 11/26/2022]
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Heng NH, Zahlten J, Cordes V, Ong MMA, Goh BT, N’Guessan PD, Pischon N. Effects of Enamel Matrix Derivative and Transforming Growth Factor-β1 on Connective Tissue Growth Factor in Human Periodontal Ligament Fibroblasts. J Periodontol 2015; 86:569-77. [DOI: 10.1902/jop.2015.120448] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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15
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Qi Y, Feng W, Cai J, Sun Q, Li S, Li M, Song A, Yang P. Effects of conservatively treated diseased cementum with or without EMD on in vitro cementoblast differentiation and in vivo cementum-like tissue formation of human periodontal ligament cells. Cell Prolif 2014; 47:310-7. [PMID: 24930868 DOI: 10.1111/cpr.12116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 04/08/2014] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES The present study aimed to evaluate the effects of conservatively treated diseased cementum on in vitro cementoblast differentiation and in vivo cementum-like tissue formation of human periodontal ligament cells (hPDLCs), and observe differential effects of enamel matrix derivative (EMD) on in vivo cementum formation by hPDLCs. MATERIALS AND METHODS Forty-eight cementum slices and 48 dentin slices were prepared from periodontitis compromised teeth, and hPDLCs were inoculated on to all root slices. Twenty-four co-cultured root slices of each group were used for mRNA expression of cementum attachment protein and CEMP1. With application of EMD, 24 co-cultured root slices (divided into groups C, D, C+E, D+E) were transplanted subcutaneously into nude mice. All root fragments were reviewed by histological analysis and immunohistochemical staining for bone sialoprotein. RESULTS mRNA expressions of cementum attachment protein and cementum protein - 1 from hPDLCs on cementum slices were statistically higher than those of dentin slices. Seven specimens of group C and 10 specimens of group C+E revealed a layer of cementum-like tissue (NFC) on surfaces of pre-existing cementum. NFC was thicker in group C+E than in group C. All NFCs were positively stained for bone sialoprotein, however, there was no NFC formation on dentin slices. CONCLUSION Conservatively treated diseased cementum promoted in vitro cementoblast differentiation and in vivo cementum-like tissue formation by hPDLCs, and the in vivo effect was enhanced by the presence of EMD.
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Affiliation(s)
- Y Qi
- Shandong Provincial Key Laboratory of Oral Biomedicine, Jinan, China
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Surgical Approaches Based on Biological Objectives: GTR versus GBR Techniques. Int J Dent 2013; 2013:521547. [PMID: 23843792 PMCID: PMC3697289 DOI: 10.1155/2013/521547] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 03/30/2013] [Accepted: 05/19/2013] [Indexed: 01/07/2023] Open
Abstract
Guided tissue regenerative (GTR) therapies are performed to regenerate the previously lost tooth supporting structure, thus maintaining the aesthetics and masticatory function of the available dentition. Alveolar ridge augmentation procedures (GBR) intend to regain the alveolar bone lost following tooth extraction and/or periodontal disease. Several biomaterials and surgical approaches have been proposed. In this paper we report biomaterials and surgical techniques used for periodontal and bone regenerative procedures. Particular attention will be adopted to highlight the biological basis for the different therapeutic approaches.
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Amin HD, Olsen I, Knowles JC, Dard M, Donos N. Effects of enamel matrix proteins on multi-lineage differentiation of periodontal ligament cells in vitro. Acta Biomater 2013; 9:4796-805. [PMID: 22985741 DOI: 10.1016/j.actbio.2012.09.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 08/03/2012] [Accepted: 09/10/2012] [Indexed: 12/13/2022]
Abstract
The adult periodontal ligament (PDL) is considered to contain progenitor cells that are involved in the healing of periodontal wounds. Treatment with enamel matrix derivative (EMD), a heat-treated preparation derived from enamel matrix proteins (EMPs), has been shown to be of some clinical benefit in eliciting periodontal regeneration in vivo. Although there is extensive information available about the effects of EMD on periodontal regeneration, the precise influence of this material on alveolar bone and the formation of blood vessels and proprioceptive sensory nerves, prominent features of functionally active periodontal tissue, remain unclear. The aim of the present study was therefore to examine the effects of EMD on the ability of human periodontal ligament cells (HPCs) to undergo multi-lineage differentiation in vitro. Our results showed that HPCs treated with EMD under non-selective growth conditions did not show any evidence of osteogenic, adipogenic, chondrogenic, neovasculogenic, neurogenic and gliogenic "terminal" differentiation. In contrast, under selective lineage-specific culture conditions, EMD up-regulated osteogenic, chondrogenic and neovasculogenic genes and "terminal" differentiation, but suppressed adipogenesis, neurogenesis and gliogenesis. These findings thus demonstrate for the first time that EMD can differentially modulate the multi-lineage differentiation of HPCs in vitro.
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Affiliation(s)
- Harsh D Amin
- Division of Biomaterials and Tissue Engineering, Department of Clinical Research, UCL Eastman Dental Institute, University College London, London, UK
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Döri F, Arweiler NB, Szántó E, Agics A, Gera I, Sculean A. Ten-year results following treatment of intrabony defects with an enamel matrix protein derivative combined with either a natural bone mineral or a β-tricalcium phosphate. J Periodontol 2012; 84:749-57. [PMID: 22873657 DOI: 10.1902/jop.2012.120238] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The purpose of the present study is to evaluate the 10-year results following treatment of intrabony defects treated with an enamel matrix protein derivative (EMD) combined with either a natural bone mineral (NBM) or β-tricalcium phosphate (β-TCP). METHODS Twenty-two patients with advanced chronic periodontitis and displaying one deep intrabony defect were randomly treated with a combination of either EMD + NBM or EMD + β-TCP. Clinical evaluations were performed at baseline and at 1 and 10 years. The following parameters were evaluated: plaque index, bleeding on probing, probing depth, gingival recession, and clinical attachment level (CAL). The primary outcome variable was CAL. RESULTS The defects treated with EMD + NBM demonstrated a mean CAL change from 8.9 ± 1.5 mm to 5.3 ± 0.9 mm (P <0.001) and to 5.8 ± 1.1 mm (P <0.001) at 1 and 10 years, respectively. The sites treated with EMD + β-TCP showed a mean CAL change from 9.1 ± 1.6 mm to 5.4 ± 1.1 mm (P <0.001) at 1 year and 6.1 ± 1.4 mm (P <0.001) at 10 years. At 10 years two defects in the EMD + NBM group had lost 2 mm, whereas two other defects had lost 1 mm of the CAL gained at 1 year. In the EMD + β-TCP group three defects had lost 2 mm, whereas two other defects had lost 1 mm of the CAL gained at 1 year. Compared with baseline, at 10 years, a CAL gain of ≥3 mm was measured in 64% (i.e., seven of 11) of the defects in the EMD + NBM group and in 82% (i.e., nine of 11) of the defects in the EMD + β-TCP group. No statistically significant differences were found between the 1- and 10-year values in either of the two groups. Between the treatment groups, no statistically significant differences in any of the investigated parameters were observed at 1 and 10 years. CONCLUSION Within their limitations, the present findings indicate that the clinical improvements obtained with regenerative surgery using EMD + NBM or EMD + β-TCP can be maintained over a period of 10 years.
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Affiliation(s)
- Ferenc Döri
- Department of Periodontology, Semmelweis University, Budapest, Hungary
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Miron RJ, Saulacic N, Buser D, Iizuka T, Sculean A. Osteoblast proliferation and differentiation on a barrier membrane in combination with BMP2 and TGFβ1. Clin Oral Investig 2012; 17:981-8. [DOI: 10.1007/s00784-012-0764-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Accepted: 05/25/2012] [Indexed: 02/06/2023]
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Gene array of primary human osteoblasts exposed to enamel matrix derivative in combination with a natural bone mineral. Clin Oral Investig 2012; 17:405-10. [PMID: 22552595 DOI: 10.1007/s00784-012-0742-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 04/16/2012] [Indexed: 01/06/2023]
Abstract
OBJECTIVES The application of an enamel matrix derivative (EMD) for regenerative periodontal surgery has been shown to promote formation of new cementum, periodontal ligament, and alveolar bone. In intrabony defects with a complicated anatomy, the combination of EMD with various bone grafting materials has resulted in additional clinical improvements, but the initial cellular response of osteoblasts coming in contact with these particles have not yet been fully elucidated. The objective of the present study was to evaluate the in vitro effects of EMD combined with a natural bone mineral (NBM) on a wide variety of genes, cytokines, and transcription factors and extracellular matrix proteins on primary human osteoblasts. MATERIAL AND METHODS Primary human osteoblasts were seeded on NBM particles pre-coated with versus without EMD and analyzed for gene differences using a human osteogenesis gene super-array (Applied Biosystems). Osteoblast-related genes include those transcribed during bone mineralization, ossification, bone metabolism, cell growth and differentiation, as well as gene products representing extracellular matrix molecules, transcription factors, and cell adhesion molecules. RESULTS EMD promoted gene expression of various osteoblast differentiation markers including a number of collagen types and isoforms, SMAD intracellular proteins, osteopontin, cadherin, alkaline phosphatase, and bone sialoprotein. EMD also upregulated a variety of growth factors including bone morphogenetic proteins, vascular endothelial growth factors, insulin-like growth factor, transforming growth factor, and their associated receptor proteins. CONCLUSION The results from the present study demonstrate that EMD is capable of activating a wide variety of genes, growth factors, and cytokines when pre-coated onto NBM particles. CLINICAL RELEVANCE The described in vitro effects of EMD on human primary osteoblasts provide further biologic support for the clinical application of a combination of EMD with NBM particles in periodontal and oral regenerative surgery.
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Song A, Cai J, Pan K, Yang P. Pre-existing root cementum may promote cementoblast differentiation of human periodontal ligament cells. Cell Prolif 2012; 45:249-58. [PMID: 22452325 DOI: 10.1111/j.1365-2184.2012.00815.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 02/05/2012] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To observe whether preserved healthy cementum could promote differentiation of human periodontal ligament cells to cementoblasts. MATERIALS AND METHODS Symmetrical root slices from each healthy premolar were distributed into either the control group (cementum removed) or test group (cementum preserved). After isolation and characterization, human periodontal ligament cells were inoculated onto root slices for 7 days co-culture. Two slices per group were studied for cell morphology by scanning electronic microscopy. Twenty-three slices were detected for expression of cementum attachment protein and cementum protein 23, two putative cementoblast markers, by real-time polymerase chain reaction. Twenty slices were transplanted into nude mice and analysed using histology and immunohistochemistry for osteopontin and bone sialoprotein expression after 8 weeks. RESULTS Cells of the test group had smoother fibroblast morphology and higher cementum protein 23 and cementum attachment protein expression than those of the control group (P < 0.01). In the test group, 14 root slices revealed cementum-like matrix formation resting on old cementum; no splits were observed between newly formed matrix and old cementum. In the control group, 17 specimens had fibrous tissue formation along the root surface and varying width of splits could be seen between new fibrous tissue and dentine surface. Only three specimens demonstrated presence of newly formed thin cementum-like matrix. Newly formed cementum-like matrix was positive for osteopontin and bone sialoprotein. CONCLUSIONS The results demonstrate that healthy root cementum may promote differentiation of human periodontal ligament cells towards cementoblasts.
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Affiliation(s)
- A Song
- Department of Periodontology, School of Stomatology, Shandong University, Jinan, China
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Four-year results following treatment of intrabony periodontal defects with an enamel matrix derivative alone or combined with a biphasic calcium phosphate. Clin Oral Investig 2011; 16:1191-7. [DOI: 10.1007/s00784-011-0611-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 08/10/2011] [Indexed: 11/27/2022]
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