Regeneration of periodontal bone defects with mesenchymal stem cells in animal models. Systematic review and meta-analysis

Abstract

The aim of this study was to evaluate the efficacy of mesenchymal stem cells (MSCs) in the regeneration of periodontal bone defects in animal models. A systematic review and meta-analysis were conducted following the PRISMA guidelines, and the study was recorded in PROSPERO under reference number CDR42021247462. The PICO question was: is periodontal regeneration (cementum, periodontal ligament and alveolar bone) with MSCs more effective than other techniques? Three groups were considered: Group 1: MSCs alone or mixed with regenerative materials. Group 2: only regenerative materials. Group 3: no regenerative material nor MSCs. The search was conducted using MeSH with a total of 18 articles for qualitative analysis and 5 for quantitative analysis. For the meta-analysis, a modification of the effect size algorithm was developed, which considered a comparison of means between treatments using the Student's t sample distribution. When comparing the effect size between Group 1 and Group 2, the effect size for the new cementum was 2.83 mm with an estimated confidence interval of 95% (CI 95%) between 0.48 and 5.17 mm. When considering the fit to a random-effects model, the combined variance (τ2) was 6.1573 mm, with a standard deviation (SD) of 5.6008 mm and a percentage of total heterogeneity I2 of 92.33% (p < 0.0001). For new bone, the effect size was 0.88 mm, CI 95% − 0.25 to 2.01 mm, τ2 = 1.3108 mm (SD = 1.2021 mm) and I2 = 80.46%, p = 0.0004). With regard to the new periodontal ligament, it was not possible for the meta-analysis to be performed. MSCs have a greater capacity for tissue regeneration in root cementum than in alveolar bone compared to other regenerative materials.

Orally Derived Stem Cell-Based Therapy in Periodontal Regeneration: A Systematic Review and Meta-Analysis of Randomized Clinical Studies

“…In virtue of their self-renewal, multipotentiality, immunomodulation, and tissue regeneration capacities, MSCs can promote the growth of various periodontal tissues, like alveolar bones, root cementum, and periodontal ligaments, even in situations with low intrinsic potential [23,[37][38][39][40][41]. A recent study assessed periodontal regenerative approaches in animal models, observing that mesenchymal stem cells used alone or mixed with other biomaterials, such as bovine bone, beta-tricalcium phosphate, or platelet-rich plasma, offered better regenerative outcomes than those of the group with biomaterials alone [42]. Most preclinical studies have indeed supported the biological rationale of employing MSCs to promote osteoinduction and tenogenesis, while simultaneously decreasing inflammation [26,[43][44][45].…”