Localized delivery of growth factors for periodontal tissue regeneration: Role, strategies, and perspectives

Abstract

Difficulties associated with achieving predictable periodontal regeneration, means that novel techniques need to be developed in order to regenerate the extensive soft and hard tissue destruction that results from periodontitis. Localized delivery of growth factors to the periodontium is an emerging and versatile therapeutic approach, with the potential to become a powerful tool in future regenerative periodontal therapy. Optimized delivery regimes and well-defined release kinetics appear to be logical prerequisites for safe and efficacious clinical application of growth factors and to avoid unwanted side effects and toxicity. While adequate concentrations of growth factor(s) need to be appropriately localized, delivery vehicles are also expected to possess properties such as protein protection, precision in controlled release, biocompatibility and biodegradability, self-regulated therapeutic activity, potential for multiple delivery, and good cell/tissue penetration. Here, current knowledge, recent advances, and future possibilities of growth factor delivery strategies are outlined for periodontal regeneration. First, the role of those growth factors that have been implicated in the periodontal healing/regeneration process, general requirements for their delivery, and the different material types available are described. A detailed discussion follows of current strategies for the selection of devices for localized growth factor delivery, with particular emphasis placed upon their advantages and disadvantages and future prospects for ongoing studies in reconstructing the tooth supporting apparatus.

Peri̇odontal Doku Mühendi̇sli̇ği̇nde Kullanilan İskele Yapilari

“…Bunun dışında, bu polimerleri in vivo aşırı inflamatuvar cevap, zayıf salınım özelliği ve polimerlerin yüksek moleküler ağırlığına bağlı kronik inflamasyon gibi yan etkileri bulunmaktadır. 31,[39][40][41] PLA iskeleler, çapraz bağlantılı fiber sistemi oluşturulabilen bu yapının kullanımıyla hücre proliferasyonu için yeterli ve düzenli poroziteyi sağlayabil-mektedir. 40 Poli-Laktit Glikolik Asit (PLGA), iyi biyouyumluluk, biyobozunabilirlik ve mekanik dayanıklılık gibi olumlu özellikleri nedeniyle dikkat çekmiştir.…”

“…Böylelikle, daha üstün özelliklere sahip kompozit biyomateryallerin eldesi gerçekleştirilmeye çalışılmaktadır. 31 Hidroksil apatit ile PLA, PLGA, kollajen, jelatin ve kitosan gibi doğal ve sentetik materyaller kombine kullanılarak kompozit iskeleler elde edilmiştir. Böylece, porözite, biyobozunum ve mekanik özellikler gibi parametrelerin geliştirilmesi sağlanmıştır.…”

Biological approaches toward dental pulp regeneration by tissue engineering

“…While the application of recombinant growth factors to induce dentine and pulp regeneration has been widely investigated (Tziafas et al, 2000;Nakashima and Reddi, 2003;Nakashima, 2005), there are very few data about the effects of endogenous growth factors in vital pulp therapy, and the data are still often controversial. The localized delivery of growth factors for regenerative therapy is today hampered by the need for a safe and efficient delivery vehicle that can provide sustained therapeutic action without cytotoxicity or unwanted side effects (Chen et al, 2009b(Chen et al, , 2009cChen and Jin, 2010). Periodontal therapy using a formation of platelet-rich plasma (PRP) has been suggested as a modality to enhance the outcome of regenerative surgery, which points to a great interest in the use of PRP for potential pulp regeneration (Bashutski and Wang, 2008).…”

“…In vitro studies suggest that growth factors released by platelets recruit reparative cells and may augment soft-tissue repair. Although minimal clinical evidence is currently available to support the hypothesis that PRP might be a promising agent for pulp regeneration, the use of PRP across bone reconstruction to periodontal healing has increased because of its safety and the availability of new devices for outpatient preparation and delivery (Bashutski and Wang, 2008;Chen et al, 2009c;Intini, 2009). In addition, the use of PRP in conjugation with hydroxyapatite (HA) as a pulp capping material for the root was recently investigated (Danilović et al, 2008).…”

“…One of the most remarkable advantages is that regeneration of only a small amount of tissue can be highly beneficial to the patient, particularly in the tooth and periodontium areas (Nakashima and Akamine, 2005;Murray et al, 2007;Chen et al, 2009bChen et al, , 2009cScheller et al, 2009;Chen and Jin, 2010). Based on this principle, one potential approach for pulp regeneration would possibly involve some combination of disinfection or debridement of infected root canal systems, with apical enlargement to permit revascularization and the use and integration of tissue-specific stem cells and extracellular matrix (ECM) molecules Goldberg et al, 2008b).…”