Abstract
A dental implant is used to replace a missing tooth. Fixing the implant in its natural position requires the engineering of a substantial amount of conformal bone growth inside the implant socket, osseointegration. However, this conventional implant attachment does not include the periodontal ligament (PDL), which has a fundamental role in cushioning high mechanical loads. As a result, tooth implants have a shorter lifetime than the natural tooth and have a high chance of infections. We have engineered a “bio-implant” that provides a living PDL connection for titanium implants. The bio-implant consists of a hydroxyapatite coated titanium screw, ensheathed in cell sheets made from immortalized human periodontal cells. Bio-implants were transplanted into the upper first molar region of a tooth-extraction mouse model. Within 8 weeks the bio-implant generated fibrous connective tissue, a localised blood vessel network and new bone growth fused into the alveolar bone socket. The study presents a bio-implant engineered with human cells, specialised for the root connection, and resulted in the partial reconstruction of a naturalised tooth attachment complex (periodontium), consisting of all the principal tissue types, cementum, PDL and alveolar bone.
Highlights
Dental implants are the most improved treatment for teeth that have been either extracted or have been ejected as a result of periodontal disease
We demonstrated that immortalized human cells, human umbilical vein endothelial cells (HUVECs) and epithelial cell rests of Malassez (ERM) cells could be sustained in situ, and engineer an attachment between the fixture and alveolar bone
After the alveolar bone healed, the fixture was wrapped with a cell sheet and implanted into a tooth-extracted region of a nude mouse
Summary
Dental implants are the most improved treatment for teeth that have been either extracted or have been ejected as a result of periodontal disease. Since dental implants are secured only by osseointegration, they are more susceptible to infections This arises because without the existence of periodontal sensory mechanisms, including proprioception, pain perception is absent when periodontal diseases, including peri-implantitis arise and undermining shape bone resorption occurs. A similar bio-hybrid implant trial, incorporated living bone tissue as a substitute for cementum, was reported[6]. The transplanted PDL cell sheets induced periodontal regeneration with a cementum layer and Sharpey’s fibres[9]. A tri-layered PDL cell sheet derived from canine PDL tissue was transplanted into artificial 3-wall infrabony defects with complete cementum removal in canine models, and periodontal regeneration was observed[10]. Another study reported that cell sheet fragments of canine PDL stem cells and platelet-rich fibrin granules enhanced periodontal healing in avulsed tooth re-implantation in a canine model[11]. Knowing that cell sheets alone can integrate and regenerate compound periodontal tissues we explored the idea of marrying them to the base of dental implants to generate a proper biological attachment
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