A new direction in managing avulsed teeth: stem cell-based de novo PDL regeneration

Hacer Aksel,Adham A Azim,Philippe Gauthier,Xiaofei Zhu,George T.-J Huang,Wenjing Zhang

doi:10.1186/s13287-022-02700-x

Abstract

Management of avulsed teeth after replantation often leads to an unfavorable outcome. Damage to the thin and vulnerable periodontal ligament is the key reason for failure. Cell- or stem cell-based regenerative medicine has emerged in the past two decades as a promising clinical treatment modality to improve treatment outcomes. This concept has also been tested for the management of avulsed teeth in animal models. This review focuses on the discussion of limitation of current management protocols for avulsed teeth, cell-based therapy for periodontal ligament (PDL) regeneration in small and large animals, the challenges of de novo regeneration of PDL on denuded root in the edentulous region using a mini-swine model, and establishing a prospective new clinical protocol to manage avulsed teeth based on the current progress of cell-based PDL regeneration studies.

Highlights

In the field of traumatic dental injury, especially the management of avulsed teeth, it has been a lack of significant breakthrough in the past many decades
Cell‐based periodontal ligament (PDL) regeneration for avulsed teeth A recent systematic review investigated the outcomes of cell-based approaches for the tooth replantation using animal models and reported that the replacement root resorption and ankylosis ranged from 20.8 to 100% in the cell-free control group and 0 to 38.4% in the cell-based groups suggesting the potential of cell-based approach for the management of avulsed teeth [41]
This study shows the importance of extracellular matrix (ECM) proteins and the local microenvironment for regenerative properties of Periodontal ligament stem cells (PDLSCs)

Summary

Introduction

In the field of traumatic dental injury, especially the management of avulsed teeth, it has been a lack of significant breakthrough in the past many decades. Utilizing periodontal ligament stem cells (PDLSCs) to regenerate PDL could theoretically prevent or lower the incidence of resorption following tooth replantation, especially when there is extended extraoral time. Cell‐based PDL regeneration for avulsed teeth A recent systematic review investigated the outcomes of cell-based approaches for the tooth replantation using animal models and reported that the replacement root resorption and ankylosis ranged from 20.8 to 100% in the cell-free control group and 0 to 38.4% in the cell-based groups suggesting the potential of cell-based approach for the management of avulsed teeth [41].

Results

Conclusion