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Huang TH, Chen JY, Suo WH, Shao WR, Huang CY, Li MT, Li YY, Li YH, Liang EL, Chen YH, Lee IT. Unlocking the Future of Periodontal Regeneration: An Interdisciplinary Approach to Tissue Engineering and Advanced Therapeutics. Biomedicines 2024; 12:1090. [PMID: 38791052 PMCID: PMC11118048 DOI: 10.3390/biomedicines12051090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 04/30/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
Periodontal defects present a significant challenge in dentistry, necessitating innovative solutions for comprehensive regeneration. Traditional restoration methods have inherent limitations in achieving complete and functional periodontal tissue reconstruction. Tissue engineering, a multidisciplinary approach integrating cells, biomaterials, and bioactive factors, holds tremendous promise in addressing this challenge. Central to tissue engineering strategies are scaffolds, pivotal in supporting cell behavior and orchestrating tissue regeneration. Natural and synthetic materials have been extensively explored, each offering unique advantages in terms of biocompatibility and tunable properties. The integration of growth factors and stem cells further amplifies the regenerative potential, contributing to enhanced tissue healing and functional restoration. Despite significant progress, challenges persist. Achieving the seamless integration of regenerated tissues, establishing proper vascularization, and developing biomimetic scaffolds that faithfully replicate the natural periodontal environment are ongoing research endeavors. Collaborative efforts across diverse scientific disciplines are essential to overcoming these hurdles. This comprehensive review underscores the critical need for continued research and development in tissue engineering strategies for periodontal regeneration. By addressing current challenges and fostering interdisciplinary collaborations, we can unlock the full regenerative potential, paving the way for transformative advancements in periodontal care. This research not only enhances our understanding of periodontal tissues but also offers innovative approaches that can revolutionize dental therapies, improving patient outcomes and reshaping the future of periodontal treatments.
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Affiliation(s)
- Tsung-Hsi Huang
- Department of Orthopedic Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan 330, Taiwan; (T.-H.H.); (Y.-H.C.)
| | - Jui-Yi Chen
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan; (J.-Y.C.); (W.-H.S.); (W.-R.S.); (C.-Y.H.); (M.-T.L.); (Y.-Y.L.); (Y.-H.L.); (E.-L.L.)
| | - Wei-Hsin Suo
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan; (J.-Y.C.); (W.-H.S.); (W.-R.S.); (C.-Y.H.); (M.-T.L.); (Y.-Y.L.); (Y.-H.L.); (E.-L.L.)
| | - Wen-Rou Shao
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan; (J.-Y.C.); (W.-H.S.); (W.-R.S.); (C.-Y.H.); (M.-T.L.); (Y.-Y.L.); (Y.-H.L.); (E.-L.L.)
| | - Chih-Ying Huang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan; (J.-Y.C.); (W.-H.S.); (W.-R.S.); (C.-Y.H.); (M.-T.L.); (Y.-Y.L.); (Y.-H.L.); (E.-L.L.)
| | - Ming-Tse Li
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan; (J.-Y.C.); (W.-H.S.); (W.-R.S.); (C.-Y.H.); (M.-T.L.); (Y.-Y.L.); (Y.-H.L.); (E.-L.L.)
| | - Yu-Ying Li
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan; (J.-Y.C.); (W.-H.S.); (W.-R.S.); (C.-Y.H.); (M.-T.L.); (Y.-Y.L.); (Y.-H.L.); (E.-L.L.)
| | - Yuan-Hong Li
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan; (J.-Y.C.); (W.-H.S.); (W.-R.S.); (C.-Y.H.); (M.-T.L.); (Y.-Y.L.); (Y.-H.L.); (E.-L.L.)
| | - En-Lun Liang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan; (J.-Y.C.); (W.-H.S.); (W.-R.S.); (C.-Y.H.); (M.-T.L.); (Y.-Y.L.); (Y.-H.L.); (E.-L.L.)
| | - Yu-Hsu Chen
- Department of Orthopedic Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan 330, Taiwan; (T.-H.H.); (Y.-H.C.)
- Department of Biology and Anatomy, National Defense Medical Center, Taipei 114, Taiwan
| | - I-Ta Lee
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan; (J.-Y.C.); (W.-H.S.); (W.-R.S.); (C.-Y.H.); (M.-T.L.); (Y.-Y.L.); (Y.-H.L.); (E.-L.L.)
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Hu J, Ou-Yang ZY, Zhao YQ, Zhao J, Tan L, Liu Q, Wang MY, Ye Q, Feng Y, Zhong MM, Chen NX, Su XL, Zhang Q, Feng YZ, Guo Y. Evaluation of the Efficacy of Stem Cells Therapy in the Periodontal Regeneration: A Meta-Analysis and Mendelian Randomization Study. Stem Cell Rev Rep 2024; 20:980-995. [PMID: 38388709 DOI: 10.1007/s12015-024-10690-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 02/24/2024]
Abstract
Stem cell therapy for periodontal defects has shown good promise in preclinical studies. The purpose of this study was to evaluate the impact of stem cell support on the regeneration of both soft and hard tissues in periodontal treatment. PubMed, Cochrane Library, Embase, and Web of Science were searched and patients with periodontal defects who received stem cell therapy were included in this study. The quality of the included articles was assessed using Cochrane's tool for evaluating bias, and heterogeneity was analyzed using the I2 method. An Mendelian randomization investigation was conducted using abstract data from the IEU public databases obtained through GWAS. Nine articles were included for the meta-analysis. Stem cell therapy effectively rebuilds periodontal tissues in patients with periodontal defects, as evidenced by a reduction in probing depth, clinical attachment level and bone defect depth . And delta-like homolog 1 is a protective factor against periodontal defects alternative indicator of tooth loosening. The findings of this research endorse the utilization of stem cell treatment for repairing periodontal defects in individuals suffering from periodontitis. It is recommended that additional extensive clinical investigations be carried out to validate the efficacy of stem cell therapy and encourage its widespread adoption.
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Affiliation(s)
- Jing Hu
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ze-Yue Ou-Yang
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ya-Qiong Zhao
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jie Zhao
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Li Tan
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qiong Liu
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Min-Yuan Wang
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qin Ye
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yao Feng
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Meng-Mei Zhong
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ning-Xin Chen
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiao-Lin Su
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qian Zhang
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yun-Zhi Feng
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Yue Guo
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Therapeutic and Metagenomic Potential of the Biomolecular Therapies against Periodontitis and the Oral Microbiome: Current Evidence and Future Perspectives. Int J Mol Sci 2022; 23:ijms232213708. [PMID: 36430182 PMCID: PMC9693164 DOI: 10.3390/ijms232213708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 11/09/2022] Open
Abstract
The principles of periodontal therapy are based on the control of microbial pathogens and host factors that contribute to biofilm dysbiosis, with the aim of modulating the progression of periodontitis and periodontal tissue destruction. It is currently known how differently each individual responds to periodontal treatment, depending on both the bacterial subtypes that make up the dysbiotic biofilm and interindividual variations in the host inflammatory response. This has allowed the current variety of approaches for the management of periodontitis to be updated by defining the goals of target strategies, which consist of reducing the periodontopathogenic microbial flora and/or modulating the host-mediated response. Therefore, this review aims to update the current variety of approaches for the management of periodontitis based on recent target therapies. Recently, encouraging results have been obtained from several studies exploring the effects of some targeted therapies in the medium- and long-term. Among the most promising target therapies analyzed and explored in this review include: cell-based periodontal regeneration, mediators against bone resorption, emdogain (EMD), platelet-rich plasma, and growth factors. The reviewed evidence supports the hypothesis that the therapeutic combination of epigenetic modifications of periodontal tissues, interacting with the dysbiotic biofilm, is a key step in significantly reducing the development and progression of disease in periodontal patients and improving the therapeutic response of periodontal patients. However, although studies indicate promising results, these need to be further expanded and studied to truly realize the benefits that targeted therapies could bring in the treatment of periodontitis.
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Sánchez N, Fierravanti L, Núñez J, Vignoletti F, González-Zamora M, Santamaría S, Suárez-Sancho S, Fernández-Santos ME, Figuero E, Herrera D, García-Sanz JA, Sanz M. Periodontal regeneration using a xenogeneic bone substitute seeded with autologous periodontal ligament-derived mesenchymal stem cells: A 12-month quasi-randomized controlled pilot clinical trial. J Clin Periodontol 2021; 47:1391-1402. [PMID: 32946590 DOI: 10.1111/jcpe.13368] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/25/2020] [Accepted: 09/05/2020] [Indexed: 12/20/2022]
Abstract
AIM To evaluate the safety and efficacy of autologous periodontal ligament-derived mesenchymal stem cells (PDL-MSCs) embedded in a xenogeneic bone substitute (XBS) for the regenerative treatment of intra-bony periodontal defects. MATERIAL AND METHODS This quasi-randomized controlled pilot phase II clinical trial included patients requiring a tooth extraction and presence of one intra-bony lesion (1-2 walls). Patients were allocated to either the experimental (XBS + 10 × 106 PDL-MSCs/100 mg) or the control group (XBS). Clinical and radiographical parameters were recorded at baseline, 6, 9 and 12 months. The presence of adverse events was also evaluated. Chi-square, Student's t test, Mann-Whitney U, repeated-measures ANOVA and regression models were used. RESULTS Twenty patients were included. No serious adverse events were reported. Patients in the experimental group (n = 9) showed greater clinical attachment level (CAL) gain (1.44, standard deviation [SD] = 1.87) and probing pocket depth (PPD) reduction (2.33, SD = 1.32) than the control group (n = 10; CAL gain = 0.88, SD = 1.68, and PPD reduction = 2.10, SD = 2.46), without statistically significant differences. CONCLUSION The application of PDL-MSCs to XBS for the treatment of one- to two-wall intra-bony lesions was safe and resulted in low postoperative morbidity and appropriate healing, although its additional benefit, when compared with the XBS alone, was not demonstrated.
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Affiliation(s)
- Nerea Sánchez
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Ludovica Fierravanti
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Javier Núñez
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Fabio Vignoletti
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - María González-Zamora
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Silvia Santamaría
- Margarita Salas Center for Biological Research (CIB-CSIC), Madrid, Spain
| | - Susana Suárez-Sancho
- GMP-Cell Production Unit, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Red de Terapia Celular (TERCEL) and CIBER Cardiovascular (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - María Eugenia Fernández-Santos
- GMP-Cell Production Unit, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Red de Terapia Celular (TERCEL) and CIBER Cardiovascular (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Elena Figuero
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - David Herrera
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Jose A García-Sanz
- Margarita Salas Center for Biological Research (CIB-CSIC), Madrid, Spain
| | - Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense, Madrid, Spain
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Nuñez J, Vignoletti F, Caffesse RG, Sanz M. Cellular therapy in periodontal regeneration. Periodontol 2000 2019; 79:107-116. [PMID: 30892768 DOI: 10.1111/prd.12250] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Periodontitis is a chronic inflammatory condition leading to destruction of the tooth supporting tissues, which if left untreated may cause tooth loss. The treatment of periodontitis mainly aims to arrest the inflammatory process by infection control measures, although in some specific lesions a limited periodontal regeneration can also be attained. Current regenerative approaches are aimed to guide the cells with regenerative capacity to repopulate the lesion and promote new cementum and new connective tissue attachment. The first phase in periodontal tissue regeneration involves the differentiation of mesenchymal cells into cementoblasts to promote new cementum, thus facilitating the attachment of new periodontal ligament fibers to the root and the alveolar bone. Current regenerative approaches limit themselves to the confines of the lesion by promoting the self-regenerative potential of periodontal tissues. With the advent of bioengineered therapies, several studies have investigated the potential use of cell therapies, mainly the use of undifferentiated mesenchymal cells combined with different scaffolds. The understanding of the origin and differentiation patterns of these cells is, therefore, important to elucidate their potential therapeutic use and their comparative efficacy with current technologies. This paper aims to review the in vitro and experimental studies using cell therapies based on application of cementoblasts and mesenchymal stem cells isolated from oral tissues when combined with different scaffolds.
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Affiliation(s)
- Javier Nuñez
- Faculty of Odontology, Complutense University of Madrid, Madrid, Spain
| | - Fabio Vignoletti
- Faculty of Odontology, Complutense University of Madrid, Madrid, Spain
| | - Raul G Caffesse
- Faculty of Odontology, Complutense University of Madrid, Madrid, Spain
| | - Mariano Sanz
- Faculty of Odontology, Complutense University of Madrid, Madrid, Spain
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Li L, Su W, Xie X, Lei L, Bao J, He S, Chen S, Yang Y, Yan F, Li H. A novel in situ bone elevation method to achieve vertical periodontal augmentation in dogs: A pilot study. J Oral Rehabil 2019; 46:756-764. [PMID: 30993704 PMCID: PMC6852005 DOI: 10.1111/joor.12800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/26/2019] [Accepted: 04/10/2019] [Indexed: 12/02/2022]
Abstract
Objectives The purpose of this study was to investigate whether a novel in situ interdental bone elevation method could achieve vertical bone augmentation around natural teeth. Methods Horizontal periodontal bone defects were created at nine quadrants of mandibles in five dogs. Six weeks later, one of the nine quadrants was randomly chosen as the model control. The remaining mandibles were allocated into two experimental groups: cortical bone removing (CBR) or interdental bone elevation (IBE). For the IBE group, four millimetres of interdental bone blocks were separated and elevated from the base of alveolar bone. Then bone xenografts were implanted beneath the elevated alveolar blocks. Animals were euthanised 12 weeks post‐operation. Cone beam computed tomography (CBCT) examination and histological analysis were performed to evaluate the surgical outcomes. Results Enhanced soft tissue profiles were observed in the two experimental groups as compared to the model control group. CBCT images showed that the height of alveolar bone was significantly higher in the IBE group with bone blocks seated near the cementoenamel junction. Significantly larger area of bone tissues with the highest coronal level of new bone was observed in the IBE group. New bone was observed around the elevated bone blocks with bone remodelling and neovascularisation inside the elevated blocks. Conclusions Vertical bone augmentation at interdental sites may be performed through in situ interdental bone elevation for patients with horizontal alveolar bone resorption.
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Affiliation(s)
- Lili Li
- Department of Periodontology, Nangjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China.,Central laboratory of Stomatology, Nangjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wenqi Su
- Department of Periodontology, Nangjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China.,Central laboratory of Stomatology, Nangjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiaoting Xie
- Department of Periodontology, Nangjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China.,Central laboratory of Stomatology, Nangjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Lang Lei
- Central laboratory of Stomatology, Nangjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China.,Department of Orthodontics, Nangjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jun Bao
- Department of Periodontology, Nangjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China.,Central laboratory of Stomatology, Nangjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Shasha He
- Department of Periodontology, Nangjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China.,Central laboratory of Stomatology, Nangjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Sheng Chen
- Department of Pathology, Nangjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yan Yang
- Department of Pathology, Nangjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Fuhua Yan
- Department of Periodontology, Nangjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China.,Central laboratory of Stomatology, Nangjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Houxuan Li
- Department of Periodontology, Nangjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China.,Central laboratory of Stomatology, Nangjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
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