Abstract
BackgroundPeriodontal tissue regeneration (PTR) is the ultimate goal of periodontal therapy. Currently, stem cell therapy is considered a promising strategy for achieving PTR. However, there is still no conclusive comparison that distinguishes clear hierarchies among different kinds of stem cells.MethodsA systematic review and network meta-analysis (NMA) was performed using MEDLINE (via PubMed), EMBASE, and Web of Science up to February 2020. Preclinical studies assessing five types of stem cells for PTR were included; the five types of stem cells included periodontal ligament-derived stem cells (PDLSCs), bone marrow-derived stem cells (BMSCs), adipose tissue-derived stem cells (ADSCs), dental pulp-derived stem cells (DPSCs), and gingival-derived stem cells (GMSCs). The primary outcomes were three histological indicators with continuous variables: newly formed alveolar bone (NB), newly formed cementum (NC), and newly formed periodontal ligament (NPDL). We performed pairwise meta-analyses using a random-effects model and then performed a random-effects NMA using a multivariate meta-analysis model.ResultsSixty preclinical studies assessing five different stem cell-based therapies were identified. The NMA showed that in terms of NB, PDLSCs (standardized mean difference 1.87, 95% credible interval 1.24 to 2.51), BMSCs (1.88, 1.17 to 2.59), and DPSCs (1.69, 0.64 to 2.75) were statistically more efficacious than cell carriers (CCs). In addition, PDLSCs were superior to GMSCs (1.49, 0.04 to 2.94). For NC, PDLSCs (2.18, 1.48 to 2.87), BMSCs (2.11, 1.28 to 2.94), and ADSCs (1.55, 0.18 to 2.91) were superior to CCs. For NPDL, PDLSCs (1.69, 0.92 to 2.47) and BMSCs (1.41, 0.56 to 2.26) were more efficacious than CCs, and PDLSCs (1.26, 0.11 to 2.42) were superior to GMSCs. The results of treatment hierarchies also demonstrated that the two highest-ranked interventions were PDLSCs and BMSCs.ConclusionPDLSCs and BMSCs were the most effective and well-documented stem cells for PTR among the five kinds of stem cells evaluated in this study, and there was no statistical significance between them. To translate the stem cell therapies for PTR successfully in the clinic, future studies should utilize robust experimental designs and reports.
Highlights
IntroductionPeriodontitis is a chronic bacteriological disease characterized by a series of tooth-supporting structures (gingiva, periodontal ligament, cementum, and alveolar bone) in a state of inflammation, resulting in progressive damage, such as gingival atrophy, alveolar bone resorption, and tooth loss [1]
Periodontitis is a chronic bacteriological disease characterized by a series of tooth-supporting structures in a state of inflammation, resulting in progressive damage, such as gingival atrophy, alveolar bone resorption, and tooth loss [1]
In terms of newly formed cementum (NC), periodontal ligament-derived stem cells (PDLS Cs) (SMD 2.05, 95% credible intervals (CI) 1.36 to 2.74), bone marrowderived stem cells (BMSCs) (SMD 2.20, 95% CI 1.37 to 3.04), adipose tissue-derived stem cells (ADSCs) (SMD 1.62, 95% CI 0.98 to 2.26), and Dental pulp-derived stem cells (DPSCs) (SMD 1.04, 95% CI 0.10 to 1.98) were statistically more efficacious than cell carriers (CCs); periodontal ligament-derived stem cells (PDLSCs) were superior to Gingival-derived stem cells (GMSCs) (SMD 1.75, 95% CI 0.24 to 3.26) and BMSCs (SMD 2.01, 95% CI 0.82 to 3.20)
Summary
Periodontitis is a chronic bacteriological disease characterized by a series of tooth-supporting structures (gingiva, periodontal ligament, cementum, and alveolar bone) in a state of inflammation, resulting in progressive damage, such as gingival atrophy, alveolar bone resorption, and tooth loss [1]. Various therapeutic interventions are utilized clinically to treat periodontitis, including removing plaque and calculus by scaling and root planning or removing the necrotic tissues and initiating guided tissue regeneration (GTR) by periodontal surgery [5] It seems that these therapies can only delay tooth loss with a small amount of PTR, which is unsatisfactory for both patients and dentists [6]. The exploration of new PTR therapies includes bone transplantation, allogeneic materials, GTR, and various growth factor-based treatments [6,7,8] These strategies still cannot reliably regenerate intact periodontal tissue damaged by severe periodontitis [9]. There is still no conclusive comparison that distinguishes clear hierarchies among different kinds of stem cells
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