Abstract
Periodontal tissue engineering involves a multi-disciplinary approach towards the regeneration of periodontal ligament, cementum and alveolar bone surrounding teeth, whereas bone regeneration specifically applies to ridge reconstruction in preparation for future implant placement, sinus floor augmentation and regeneration of peri-implant osseous defects. Successful periodontal regeneration is based on verifiable cementogenesis on the root surface, oblique insertion of periodontal ligament fibers and formation of new and vital supporting bone. Ultimately, regenerated periodontal and peri-implant support must be able to interface with surrounding host tissues in an integrated manner, withstand biomechanical forces resulting from mastication, and restore normal function and structure. Current regenerative approaches utilized in everyday clinical practice are mainly guided tissue/bone regeneration-based. Although these approaches have shown positive outcomes for small and medium-sized defects, predictability of clinical outcomes is heavily dependent on the defect morphology and clinical case selection. In many cases, it is still challenging to achieve predictable regenerative outcomes utilizing current approaches. Periodontal tissue engineering and bone regeneration (PTEBR) aims to improve the state of patient care by promoting reconstitution of damaged and lost tissues through the use of growth factors and signaling molecules, scaffolds, cells and gene therapy. The present narrative review discusses key advancements in PTEBR including current and future trends in preclinical and clinical research, as well as the potential for clinical translatability.
Highlights
The management of periodontal and peri-implant diseases constitutes a significant healthcare burden with the potential to greatly improve the quality of life of affected patients[1]
In order to tackle the complexity of regenerating the periodontium which is composed of numerous cell types and tissue interfaces, therapeutic approaches in tissue engineering/regenerative medicine (TE/RM) must draw from many fields of research spanning both the basic science and clinical realms
The present review provides an overview of important advancements in Periodontal tissue engineering and bone regeneration (PTEBR) from the perspective of recent preclinical and clinical trials, discussing their implementation and clinical translatability
Summary
The management of periodontal and peri-implant diseases constitutes a significant healthcare burden with the potential to greatly improve the quality of life of affected patients[1]. This section aims to provide the reader with an overview of mechanisms of action, indications, as well as preclinical and clinical evidence supporting the implementation of growth factors and signalling molecules in periodontal and peri-implant tissue engineering-based treatment approaches [Table 1]. A review of both pre-clinical and clinical evidence by Lee and Wikesjö[89] found that GDF-5 is a safe and effective candidate for periodontal regeneration and alveolar ridge augmentation, with one canine study showing greater alveolar bone and cementum regeneration compared to rh-PDGF for the treatment of intrabony defects[90]. Clinical studies are needed to validate regenerative outcomes for pro-resolving lipid mediators As of this writing, no human clinical trials have been conducted utilizing these mediators for periodontal tissue engineering and bone regeneration. Considering the complex structure of the periodontium and the interactions between multiple soft and hard tissues, Ivanovski et al.[104] summarized key considerations in the design of multiphasic scaffolds for periodontal tissue engineering: (1) the compartmentalization of bone and periodontal attachment tissue formation that is integrated over time; (2) the promotion of cementum formation on the root surface; and (3) the
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