Abstract
BackgroundThe main objective is to evaluate the way to graft the dental pulp stem cells (DPSC) in periodontal defects that best regenerate periodontal tissues. Numerous procedures have been done to promote periodontal regeneration. Bone grafts show good gains clinically and radiographically but histologically seem to have minimal osteoinductive capacity. Another option that exceeds conventional surgery in reducing probing depth and increasing insertion is guided tissue regeneration and tissue engineering that could be an alternative approach to help in the regeneration of living functional bone and peri-dental structures.Material and MethodsA search was carried out in Cochrane, PubMed-MEDLINE and Scopus databases with keywords: “dental pulp stem cells”, “periodontal regeneration”, “guided tissue regeneration, periodontal”, “tissue regeneration”, “periodontal bone defects”, “periodontal tissue engineering” and “periodontal defect”. Inclusion criteria were articles in English, maximum 10 years old, in which DPSC were used to regenerate a periodontal defect. Exclusion criteria were studies not published in English, case reports, case series, literature reviews, and studies in which periodontal defect was caused by dental extraction.ResultsOut of the 185 articles identified, 101 after excluding duplicates, of which 94 were discarded when reading the title and abstract. 7 articles were obtained for the full text reading: a case report and a case series were eliminated. The systematic review is performed with 5 animal testing studies in vivo. The DPSC sheets regenerate a greater amount of bone than the injection. If HGF (hepatocyte growth factor) is added, the maximum bone volume regenerated (69.3 ± 3.9 mm3; p<0.01) is achieved. Similar results were obtained in all carriers tested except in the controls. The periodontal ligament stem cells (PDLSC) formed more new bone, compared to DPSC (p<0.001). The presence of new cementum and periodontal ligament induced by CMLPs, was detected histologically but DPSC cannot achieve it alone.ConclusionsCementum or PDL regeneration does not depend only on DPSC but on other unknown factors. PDLSC has better periodontal regeneration than DPSC. DPSC significantly favours the regeneration of periodontal bone tissue but has few advantages over other grafts. It is necessary to study which growth factors or matrices can enhance their capacity for periodontal regeneration. Key words:Dental pulp, stem cells, periodontal guided tissue regeneration, periodontal bone loss.
Highlights
Periodontitis is one of the main causes of dental loss in adults (1)
dental pulp stem cells (DPSC) significantly favours the regeneration of periodontal bone tissue but has few advantages over other grafts
If a scaffold is not used to graft, the therapeutic option that has shown the best results in terms of bone regeneration, according to the computed tomography (CT), is the hepatocyte growth factor (HGF)-DPSC sheet despite the stem cells were from different species. New periodontal ligament formation In Cao et al study (22) the new Sharpey fibers penetrates the regenerated bone tissue in all groups except for the DPSC injection and control
Summary
Periodontitis is one of the main causes of dental loss in adults (1). Non-surgical and surgical therapies are the basis of treatment, the way to treat patients currently is different, due to the greater pathology understanding (2). Bone grafts show good gains clinically and radiographically but histologically seem to have minimal osteoinductive capacity (3,4) Another option is guided tissue regeneration (GTR) that exceeds conventional surgery in reducing probing depth and increasing insertion (5). The author’s main objective is to evaluate which is the carrier that allow the best results when grafting the DPSCs to regenerate periodontal bone loss (not caused by the extraction of an adjacent tooth). The main objective is to evaluate the way to graft the dental pulp stem cells (DPSC) in periodontal defects that best regenerate periodontal tissues. Bone grafts show good gains clinically and radiographically but histologically seem to have minimal osteoinductive capacity Another option that exceeds conventional surgery in reducing probing depth and increasing insertion is guided tissue regeneration and tissue engineering that could be an alternative approach to help in the regeneration of living functional bone and peri-dental structures.
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