Regenerative medicine, tissue engineering for periodontal

Dental Tribune International

Mon. 16. December 2024

save

TAIPEI, Taiwan: Conventional periodontal therapies, while effective to a degree, often fall short of fully restoring the complex architecture and function of the periodontal tissue. A new review by researchers in Taiwan offers clinicians a well-rounded look into cutting-edge interdisciplinary approaches to periodontal regeneration which could revolutionise dental treatment. This summary of the review highlights a range of advanced biomaterials, therapies and innovative technologies that hold promise for achieving superior tissue engineering and patient outcomes.

The challenge of periodontal regeneration

Conventional periodontal treatment modalities are typically unable to replicate the intricate multi-tissue structure of the periodontium, often leading to incomplete regeneration. To address these limitations, the authors shared that contemporary research is pivoting towards regenerative medicine and tissue engineering in particular, focusing on multidisciplinary techniques to overcome biological and mechanical barriers in periodontal repair.

Stem cell therapies

Stem cell therapy has emerged as a cornerstone of periodontal regeneration owing to the multipotentiality of periodontal ligament stem cells. Because they can differentiate into a variety of cell types critical for forming new cementum and collagen fibres, including cementoblast-like cells and fibroblasts, these cells are uniquely suited for reconstruction of periodontal tissue.

Clinical trials have demonstrated that autologous periodontal ligament stem cell transplants achieve substantial regeneration in periodontal defects. For example, acute furcation defects have shown a 58% mean regeneration with this therapy. However, the extraction of stem cells often necessitates tooth extraction, limiting its widespread application.

Allogeneic mesenchymal stem cells offer a solution by eliminating the need for tooth extraction and reducing immune rejection risks. Preclinical studies have reported successful regeneration of periodontal tissue using allogeneic stem cells combined with deproteinised bovine bone mineral scaffolds, highlighting their therapeutic potential.

Gene therapies

As the authors summarised, gene therapy is a revolutionary modality that directly targets the molecular pathways involved in tissue repair and regeneration. By introducing engineered genetic material, this approach enhances the endogenous production of growth and differentiation factors, significantly amplifying the regenerative capacity of periodontal tissue.

Enamel matrix derivatives, primarily composed of amelogenins, play a critical role in promoting cementum formation and periodontal ligament regeneration. When combined with bone grafts, they create a synergistic effect, producing significant clinical improvements in severe periodontal defects.

The utilisation of growth factors integral to bone formation, bone morphogenetic proteins (BMPs), particularly BMP-2 and BMP-7, has shown remarkable efficacy in stimulating osteogenesis and cementogenesis. BMP-2 has shown success in regenerating bone in surgically induced defects. Combining BMPs with gene therapy holds the potential to amplify their osteoinductive properties, making them highly effective in periodontal reconstruction.

A solution derived from the patient’s own blood, platelet-rich plasma contains a high concentration of growth factors, such as platelet-derived growth factor and transforming growth factor beta. These proteins enhance cell proliferation and differentiation, as well as angiogenesis, which are all vital for periodontal regeneration. Gene therapy can augment platelet-rich plasma’s effects by upregulating receptor expression on target cells, thereby enhancing their response to growth factors.

Scaffolding technologies

Scaffolds are a critical component of tissue engineering, providing structural support and guiding cellular growth to regenerate periodontal tissue. Recent innovations have focused on creating scaffolds that closely replicate the natural environment of the periodontium.

Fibre-guiding scaffolds feature micro-grooved topographies that orient collagen fibres, mimicking the structure of the periodontal ligament. Studies have shown superior outcomes in ligament functionality and maturity when fibre-guiding scaffolds are used compared with random-porous scaffolds.

A useful, biocompatible material for periodontal regeneration is injectable calcium phosphate cement. It has demonstrated effective bone and cementum formation without adverse reactions, such as inflammation or ankylosis. Its injectable nature makes it a minimally invasive alternative to conventional grafting techniques.

According to the review, combining alginate and fibrin, alginate–fibrinogen microfibres provide a dynamic environment for cell encapsulation and delivery. When loaded with human bone marrow mesenchymal stem cells, they significantly enhance bone regeneration in defect models, showcasing their potential in complex periodontal repairs.

3D-printing solutions

3D printing has revolutionised scaffold fabrication, enabling the creation of constructs with precise geometries and tailored properties. Using biocompatible materials such as gelatine methacryloyl, customised 3D-printed scaffolds can mimic the extracellular matrix and support cellular attachment, proliferation and differentiation. This ensures a high degree of structural and functional integration with native tissue.

Bioprinting techniques like fused deposition modelling and direct ink writing have advanced the production of scaffolds that not only replicate periodontal structures but also guide the growth of specific tissue types. These innovations hold great promise for regenerating complex multi-tissue interfaces such as the periodontal ligament–bone complex.

Conclusion

The review concluded that the integration of interdisciplinary approaches in periodontal regeneration represents a significant leap forwards in dental science. By leveraging stem cell therapy, gene therapy, advanced scaffolding technologies and 3D printing, these strategies provide clinicians with tools to achieve functional and aesthetic restoration of periodontal tissue. For clinicians, adopting these innovations offers not only enhanced patient outcomes but also an opportunity to redefine the standards of periodontal therapy.

The study, titled “Unlocking the future of periodontal regeneration: An interdisciplinary approach to tissue engineering and advanced therapeutics”, was published online on 14 May 2024 in Biomedicines.

Topics:

Restorative Dentistry

Tags:

3D printing Dental stem cells Gene therapy Periodontal regeneration

To post a reply please login or register

Current and future regenerative possibilities: A review of 3D bioprinting applications

WARDHA, India: While the majority of dental clinicians are already familiar with the capabilities of 3D printing for producing models, appliances, surgical ...

GC hosts successful symposium on biomaterials for periodontal regeneration

GENEVA, Switzerland: Last week, GC International held the Symposium on Innovation in Biomaterials for Periodontal Regeneration as part of the CED/NOF-IADR ...

Macrolide-based molecules drive bone regeneration

NIIGATA, Japan/PHILADELPHIA, US: Ageing is known to increase people’s susceptibility to chronic inflammatory bone loss disorders, including periodontal ...

The future of regenerative dentistry: “Cells alone are not proving to be enough to provide lasting, curative treatments”

Being able to not only customise treatment plans but provide bioidentical implants to patients is a dream that may not be too far off considering the ...

CBCT data could help create patient-specific scaffolds for periodontal tissue regeneration

ATHENS, Greece: Leveraging advancements in 3D printing, researchers in Greece have outlined a methodology for designing patient-specific 3D scaffolds for ...