Cementum protein 1 gene-modified adipose-derived mesenchymal stem cell sheets enhance periodontal regeneration in osteoporosis rat

A narrative review on the role of adipose-derived stem cells in periodontal regeneration

OBJECTIVES

Recent research suggests that periodontal regeneration (PR) through the application of adipose-derived stem cells (ADSCs) has depicted some encouraging outcomes. They have the benefit of convenient access and are harvested through minimally invasive and inexpensive procedures. This review aimed to explore the role of ADSCs in PR.

DATA AND SOURCES

The recommendation from the Scale for the Assessment of Narrative Review Articles (SANRA) was utilised to conduct this review. It was carried out by extensively searching the literature for evidence on PR using ADSCs by electronic search through PubMed and Google Scholar databases.

STUDY SELECTION

The search terms included "adipose-derived stem cells" OR "ADSCs" AND "periodontal regeneration" OR "alveolar bone regeneration". A literature review was established to include articles related to the use of ADSCs in PR, after refining the inclusion criteria.

CONCLUSION

The relevant studies demonstrated that ADSCs have a significant regenerative and therapeutic potential in periodontal tissues. Specifically, ADSCs were shown to differentiate into periodontal structures. However, the data is scarce for assessing their effectiveness in human models. Consequently, further research is required, including randomised controlled trials on human and animal models to further verify their regenerative capability in periodontal restoration.

CLINICAL SIGNIFICANCE

Adipose-derived stem cells exhibited their capability to differentiate into key periodontal structures and enhance tissue repair indicating their potential as a novel therapeutic method for improving clinical results in periodontal treatment.

Progress in Basic Research and Clinical Strategies for Cementum Regeneration

Periodontitis is a chronic inflammatory disease that inflicts damage to periodontal tissues, leading to loss of teeth, and affects systemic health. Traditional treatments can delay inflammation, whereas regeneration of the periodontal complex (periodontal ligament, cementum, and alveolar bone) can better restore periodontal tissue function. In recent years, the regeneration of alveolar bone and the periodontal ligament has been widely reviewed although cementum has received less attention. As an avascular mineralised structure around the tooth, cementum can anchor periodontal ligament fibres to the root surface, thereby connecting teeth to alveolar bone. The supporting and stabilizing effects of cementum make its regeneration vital for restoring the functionality of the periodontal tissues. In this review, we discuss advancements in basic and clinical research appertaining to cementum regeneration. We describe the molecular mechanisms that contribute to cementum regeneration thereby providing a foundation for further basic research. Finally we summarise the clinical strategies employed for cementum regeneration, including regenerative surgery and utilisation of growth factors and stem cells.

Orally Derived Stem Cell-Based Therapy in Periodontal Regeneration: A Systematic Review and Meta-Analysis of Randomized Clinical Studies

The present systematic review was performed to assess the application of orally derived stem cells in periodontal regenerative therapy, and because of this, the following PICO question was proposed: "In patients with periodontitis, can the adjunctive use of orally derived stem cells provide additional clinical and radiographic benefits for periodontal regeneration?". Randomized clinical studies were electronically and manually searched up until December 2023. Quantitative analyses were performed with the aim of evaluating the mean differences (MDs) between the treatment and control groups in terms of clinical attachment level (CAL) gain, probing pocket depth (PPD) reduction, gingival recession (GR), and radiographic bone gain (RBG) using random effect models. A total of seven studies were selected for the systematic review. Meta-analyses excluding studies with a high risk of bias highlighted a non-statistically significant result for the use of stem cells when compared to the control groups in terms of CAL gain [MD = 1.05; 95% CI (-0.88, 2.97) p = 0.29] and PPD reduction [MD = 1.32; 95% CI (-0.25, 2.88) p = 0.10]. The same also applied to GR [MD = -0.08; 95% CI (-0.79, 0.63) p = 0.83] and RBG [MD = 0.50; 95% CI (-0.88, 1.88) p = 0.48]. Based on the high heterogeneity, there is not enough evidence to consider the adjunctive application of orally derived mesenchymal stem cells as a preferential approach for periodontal regenerative treatment, as compared to standard procedures.

Insights and Advancements in Periodontal Tissue Engineering and Bone Regeneration

The regeneration of periodontal bone defects continues to be an essential therapeutic concern in dental biomaterials. Numerous biomaterials have been utilized in this sector so far. However, the immune response and vascularity in defect regions may be disregarded when evaluating the effectiveness of biomaterials for bone repair. Among several regenerative treatments, the most recent technique of in situ tissue engineering stands out for its ability to replicate endogenous restorative processes by combining scaffold with particular growth factors. Regenerative medicine solutions that combine biomaterials/scaffolds, cells, and bioactive substances have attracted significant interest, particularly for bone repair and regeneration. Dental stem cells (DSCs) share the same progenitor and immunomodulatory properties as other types of MSCs, and because they are easily isolable, they are regarded as desirable therapeutic agents in regenerative dentistry. Recent research has demonstrated that DSCs sown on newly designed synthetic bio-material scaffolds preserve their proliferative capacity while exhibiting increased differentiation and immuno-suppressive capabilities. As researchers discovered how short peptide sequences modify the adhesion and proliferative capacities of scaffolds by activating or inhibiting conventional osteogenic pathways, the scaffolds became more effective at priming MSCs. In this review, the many components of tissue engineering applied to bone engineering will be examined, and the impact of biomaterials on periodontal regeneration and bone cellular biology/molecular genetics will be addressed and updated.

From Basic Science to Clinical Practice: A Review of Current Periodontal/Mucogingival Regenerative Biomaterials

Periodontitis is a dysbiosis-driven inflammatory disease affecting the tooth-supporting tissues, characterized by their progressive resorption, which can ultimately lead to tooth loss. A step-wise therapeutic approach is employed for periodontitis. After an initial behavioral and non-surgical phase, intra-bony or furcation defects may be amenable to regenerative procedures. This review discusses the regenerative technologies employed for periodontal regeneration, highlighting the current limitations and future research areas. The search, performed on the MEDLINE database, has identified the available biomaterials, including biologicals (autologous platelet concentrates, hydrogels), bone grafts (pure or putty), and membranes. Biologicals and bone grafts have been critically analyzed in terms of composition, mechanism of action, and clinical applications. Although a certain degree of periodontal regeneration is predictable in intra-bony and class II furcation defects, complete defect closure is hardly achieved. Moreover, treating class III furcation defects remains challenging. The key properties required for functional regeneration are discussed, and none of the commercially available biomaterials possess all the ideal characteristics. Therefore, research is needed to promote the advancement of more effective and targeted regenerative therapies for periodontitis. Lastly, improving the design and reporting of clinical studies is suggested by strictly adhering to the Consolidated Standards of Reporting Trials (CONSORT) 2010 statement.

Tailoring cell sheets for biomedical applications

Cell sheet technology has emerged as a novel scaffold-free approach for cell-based therapies in regenerative medicine. Techniques for harvesting cell sheets are essential to preserve the integrity of living cell sheets. This review provides an overview of fundamental technologies to fabricate cell sheets and recent advances in cell sheet-based tissue engineering. In addition to the commonly used temperature-responsive systems, we introduce alternative approaches, such as ROS-induced, magnetic-controlled, and light-induced cell sheet technologies. Moreover, we discuss the modification of the cell sheet to improve its function, including stacking, genetic modification, and vascularization. With the significant advances in cell sheet technology, cell sheets have been widely applied in various tissues and organs, including but not limited to the lung, cornea, cartilage, periodontium, heart, and liver. This review further describes both the preclinical and clinical applications of cell sheets. We believe that the progress in cell sheet technology would further propel its biomedical applications.