Autologous dental pulp mesenchymal stem cells for inferior third molar post-extraction socket healing: A split-mouth randomised clinical trial

Abstract

BackgroundSince the discovery of adult mesenchymal stem cells extensive research has been conducted to determine their mechanisms of differentiation and effectiveness in cell therapy and regenerative medicine.Material and MethodsTo assess the efficacy of autologous dental pulp mesenchymal stem cells delivered in a collagen matrix for post-extraction socket healing, a single-centre, double-blind, randomised, split-mouth, controlled clinical trial was performed. Both impacted mandibular third molars were extracted from 32 patients. Dental pulp was collected and dissociated; the resulting cell suspension, obtained by centrifugation, was incorporated into a resorbable collagen matrix and implanted in 32 experimental post-extraction sockets. Collagen matrices alone were implanted in 32 contralateral, control post-extraction sockets. Two neuroradiologists independently assessed the extent of bone repair at 6 months after the extractions. Computed tomography (CT, Philips Brilliance) and an advanced display platform (IntelliSpace Portal) was used to record extraction socket density, expressed as Hounsfield units (HU) and height (mm) of the distal interdental bone septum of the second molar. Measurements at 6 months post-extraction were compared with measurements obtained immediately after extraction. Data were analysed with the statistical program STATA 14.ResultsTwo patients dropped out of the study. The final sample consisted of 22 women and 8 men (mean age, 23 years; range: 18–30 years). Clinical, radiological, and surgical characteristics of impacted third molars of the control and experimental groups were homogeneous. Measurements obtained by the two neuroradiologists showed agreement. No significant differences were found in the extent of bone repair during analyses of density (p=0.4203 neuroradiologist 1; p=0.2525 neuroradiologist 2) or interdental septum height (p=0.2280 neuroradiologist 1; p=0.4784 neuroradiologist 2).ConclusionsIn our clinical trial, we were unable to demonstrate that autologous dental pulp mesenchymal stem cells reduce socket bone resorption after inferior third molar extraction. Key words:Clinical trial, autologous, pulpal stem cells, extraction socket healing.

Dental Stem Cell Banking and Applications of Dental Stem Cells for Regenerative Medicine

“…All three studies conclude that the application of DPSC to bone periodontal disease shows significant improvement in a clinical setting with no observed adverse effects. Barbier et al, however, observed no significant difference in mandibular post extraction socket healing resulting from use of DPSC [54]. Also in this study, bone density nor interdental septum height were found to be significantly increased by the addition of DPSC [54].…”

Induced Periosteum-Mimicking Membrane with Cell Barrier and Multipotential Stromal Cell (MSC) Homing Functionalities

“…Furthermore, investigation into the natural opening of pores following in vivo degradation is needed to ascertain the changes in porosity over time. ‘Minimally manipulated’ MSC sources should be examined, where BMA, the current surgical gold standard, or periosteum micrografts, MSCs released from macerated tissue, could be combined with PCL3%-E [ 67 , 68 , 69 ]. Additionally, future in vivo studies are required to not only detail membrane degradation in vivo, but also to characterise the membranes influence on bone regeneration [ 70 ].…”

Sinking Our Teeth in Getting Dental Stem Cells to Clinics for Bone Regeneration

“…A total number of seven publication reported on the clinical use of dentals stem cells or the use of dental stem cells as an intervention (Figure 7) [496][497][498][499][500][501][502]. The majority of the identified publications focus on dentistry; in detail, publications evaluated the role of dental stem cells in third molar post-extraction socket healing [496], the role of autologous periodontal ligament stem cells' periodontal intrabony defects using [497], the role of dental stem cells in human intrabony defects [498], and the regeneration dental pulp after implantation into injured teeth [501], respectively. One publication on the clinical uses in dentistry was a case report reporting the grafting of mesenchymal stem cells from dental pulp for the retrieval of a periodontally compromised tooth by allogeneic [500].…”

“…Two of the trials were investigating the role of DPSCs to treat COVID-19 [502] (ClinicalTrials.gov Identifier: NCT04336254, NCT04302519), one was investigating the role of DPSCs in a trial for osteoarthritis in the knee (NCT04130100), another was investigating the role of human dental pulp mesenchymal stem cells ischemic stroke (NCT04608838), and one was investigating the role of dental pulp cells for the treatment of diabetes (NCT03912480). Even with the high number of publications about dental stem cells, a low number of publications clinically using dental stem cells were identified [496][497][498][499][500][501][502]. While the in vitro and animal in vivo experiments with DSCs seem promising, there is still plenty left to investigate whether it was concerning cellular behavior, culturing techniques, or choice of scaffolds approaches in order to better the translation of these techniques into clinical settings.…”