Cellular therapy in periodontal regeneration

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.

Exosomes derived from P2X7 receptor gene-modified cells rescue inflammation-compromised periodontal ligament stem cells from dysfunction

“…Multiple studies have proven that the inflammatory microenvironment in defective periodontal sites hinders stem cell-based periodontal tissue regeneration. 4,6 Further elucidation of the underlying mechanism that occurs when stem cells encounter an inflammatory microenvironment will definitely benefit stem cell-based regeneration therapy. The P2X7 receptor (P2X7R) belongs to the adrenergic receptor family 19 and plays important physiological and pathological roles in vivo, [20][21][22] including in periodontitis.…”

“…Novello et al, 3 and Nunez et al, 4 ; eg, see Reference 5). One reason for the lack of success in clinical practice is that PDLSCs are functionally compromised when they are placed in an inflammatory intrabony periodontal defect.…”

“…One reason for the lack of success in clinical practice is that PDLSCs are functionally compromised when they are placed in an inflammatory intrabony periodontal defect. 4,6 Due to incomplete knowledge of the underlying mechanism, [7][8][9] therapeutic approaches that protect PDLSCs from inflammation-induced dysfunction (eg, reduced stemness and aberrant differentiation) following transplantation are still in their infancy. 10,11 In our previous study, we identified the role of P2X7 receptor (P2X7R) in inflammation-compromised osteogenic differentiation of PDLSCs, and most importantly, we found that the cell impairment could be reversed by P2X7R gene modification.…”

Prospects of Advanced Therapy Medicinal Products–Based Therapies in Regenerative Dentistry: Current Status, Comparison with Global Trends in Medicine, and Future Perspectives

“…Very few clinical trials have been published on periodontal tissue reconstruction and have been systematically reviewed 76,77 . Among these, only 3 RCTs 78-80 and 1 phase I/ II clinical trial 81 provide higher levels of evidence.…”

Treatment trends in periodontics

“…Stem cells may form the basis for more successful periodontal tissue engineering. Nuñez et al discuss animal studies performed in vitro and in vivo to investigate the role of cellular therapy in periodontal regeneration. After pointing out the limited capacity of periodontal tissues for self‐regeneration, the authors evaluate the potential role of enamel matrix proteins in differentiation of cementoblasts and in attaining new cementum formation.…”