A new direction in managing avulsed teeth: stem cell-based de novo PDL regeneration

Abstract

Management of avulsed teeth after replantation often leads to an unfavorable outcome. Damage to the thin and vulnerable periodontal ligament is the key reason for failure. Cell- or stem cell-based regenerative medicine has emerged in the past two decades as a promising clinical treatment modality to improve treatment outcomes. This concept has also been tested for the management of avulsed teeth in animal models. This review focuses on the discussion of limitation of current management protocols for avulsed teeth, cell-based therapy for periodontal ligament (PDL) regeneration in small and large animals, the challenges of de novo regeneration of PDL on denuded root in the edentulous region using a mini-swine model, and establishing a prospective new clinical protocol to manage avulsed teeth based on the current progress of cell-based PDL regeneration studies.

Successful outcome of permanent maxillary incisor reimplanted after 30 hours of extra‐oral time—a case report with 5‐year follow‐up

“…The risk of ankylosis remains a critical factor influencing the ultimate long‐term outcome after similar delayed replantations 27,29 . Investigated therapeutic modalities to delay ankylosis have evolved from simple scrapping of root surface, to root surface treatments and most recently the use of stem cells for the regeneration of the lost PDL cells 34,35 . However, none of these is considered as a strict recommendation by IADT 2012 and even recently modified 2020 guidelines due to the presence of insufficient clinical trials 1,2 .…”

“…27,29 Investigated therapeutic modalities to delay ankylosis have evolved from simple scrapping of root surface, to root surface treatments and most recently the use of stem cells for the regeneration of the lost PDL cells. 34,35 However, none of these is considered as a strict recommendation by IADT 2012 and even recently modified 2020 guidelines due to the presence of insufficient clinical trials. 1,2 Moreover, it might not be possible to practice them consistently due to the limited availability of resources.…”

Perspective Chapter: Update and Making-Decisions in Dental Traumatology

“…Then, once in the clinical area, we must wash the patient's face and thoroughly clean the injured areas with saline solution and gauze pads, using 5-ml syringes for areas that are difficult to access, such as the back of the vestibule. Often once this cleaning has been carried out, the diagnosis is nothing more than the most banal of injuries, despite the initial appearance of the blow (Figure 2) [32][33][34][35][36][37][38][39][40].…”

Effect of icariin surface treatment on the resorption of denuded roots after replantation in rat

“…Currently, the aim of anti‐resorptive regenerative treatments (ART) in unfavourable rescue cases is to promote PDL regeneration and to limit the incidence of root surface resorption by inhibiting differentiation to form root‐resorbing cells, buffering locally produced acids or enhancing surface resistance to acid attacks (Panzarini et al, 2008; Souza et al, 2018). Although local application of stem cell sheets and growth factors to regenerate and promote PDL reattachment has recently been proposed as a promising regenerative treatment modality, the medico‐legal concerns and unsuitability of the urgency are delaying this strategy's transition from research to a clinical setting (Aksel et al, 2022; Chen et al, 2021). Thus, antiresorptive surface treatments remain an important clinical modality to retain the teeth function and aesthetics and improve the prognosis of delayed replantations after traumatic avulsions (Panzarini et al, 2008).…”