Current and future trends in periodontal tissue engineering and bone regeneration

Abstract

Periodontal tissue engineering involves a multi-disciplinary approach towards the regeneration of periodontal ligament, cementum and alveolar bone surrounding teeth, whereas bone regeneration specifically applies to ridge reconstruction in preparation for future implant placement, sinus floor augmentation and regeneration of peri-implant osseous defects. Successful periodontal regeneration is based on verifiable cementogenesis on the root surface, oblique insertion of periodontal ligament fibers and formation of new and vital supporting bone. Ultimately, regenerated periodontal and peri-implant support must be able to interface with surrounding host tissues in an integrated manner, withstand biomechanical forces resulting from mastication, and restore normal function and structure. Current regenerative approaches utilized in everyday clinical practice are mainly guided tissue/bone regeneration-based. Although these approaches have shown positive outcomes for small and medium-sized defects, predictability of clinical outcomes is heavily dependent on the defect morphology and clinical case selection. In many cases, it is still challenging to achieve predictable regenerative outcomes utilizing current approaches. Periodontal tissue engineering and bone regeneration (PTEBR) aims to improve the state of patient care by promoting reconstitution of damaged and lost tissues through the use of growth factors and signaling molecules, scaffolds, cells and gene therapy. The present narrative review discusses key advancements in PTEBR including current and future trends in preclinical and clinical research, as well as the potential for clinical translatability.

A comparison between anorganic bone and collagen-preserving bone xenografts for alveolar ridge preservation: systematic review and future perspectives

“…As an aid for alveolar ridge preservation, the use of barrier membranes in combination with bone grafts during ARP procedures was demonstrated to prevent epithelial downgrowth into the alveolar socket, whereas the graft material avoids membrane collapse and promotes bone formation through osteoconduction and/or osteoinduction processes [ 87 ]. Resorbable collagen matrices are the membranes of choice to cover ABXs-grafted sockets, with conflicting outcomes reported by clinical trials which demonstrated both (a) the effective reduction of horizontal ridge changes, with significant preservation of vertical height at mid crest [ 73 ] and (b) failure to limit the loss of horizontal/vertical ridge dimensions in comparison with the application of collagen membrane without ABXs [ 74 ].…”

SBA-15 Mesoporous Silica as Delivery Vehicle for rhBMP-2 Bone Morphogenic Protein for Dental Applications

“…In other studies using spray-dried mesoporous bioactive glass microspheres [ 41 ] or pure mesoporous silicate nanoparticles [ 42 ], the protein amount was significantly higher in relation to MSN mass, thus yielding higher loading capacity. However, the exact dose of rhBMP-2 that can promote bone regeneration in different clinical applications without adverse effects has yet to be discovered, as different studies have reported controversial findings [ 43 , 44 , 45 ], increasing the reluctance and insecurity of clinicians to apply it [ 46 , 47 ]. It has not been proven that a high dose of rhBMP-2 can increase its efficacy [ 48 ], instead it can lead to increased inflammation [ 49 , 50 ], abnormal bone formation [ 51 ], root resorption [ 52 ], ankyloses [ 53 ], ectopic bone formation [ 50 ], gingival swelling [ 54 ], etc.…”

Novel approaches for periodontal tissue engineering

“…Although multiphasic scaffold strategies seem to be well-suited for periodontal tissue engineering and regeneration in terms of their ability to stimulate coordinated responses in both soft and hard tissues, there is a scarcity of work and apparent limitations. First, as most of the multiphasic constructs were made solely from (Galli et al, 2021).…”

“…The specific spatial or temporal delivery of signaling molecules, such as growth factors, can be challenging. To overcome those limitations, various gene therapies have been developed specifically for periodontal diseases, allowing for sustained synthesis and secretion of one or multiple growth factors by genetically modifying cells (Figure 4 ) (Galli et al, 2021 ).…”

“…The goal of tissue engineering and regenerative medicine is to repair and replace damaged tissues in the course of the disease, to restore physiologic function (Hoffman, Khademhosseini, & Langer, 2019 ; Langer & Vacanti, 1993 , 2016 ). In the case of periodontal tissues, the field of periodontology has made significant progress in translating periodontal regeneration techniques to the patient care (Galli, Yao, Giannobile, & Wang, 2021 ; Giannobile & McClain, 2015 ; Menicanin, Hynes, Han, Gronthos, & Bartold, 2015 ). While considerable progress has been made in areas of alveolar bone and gingival soft tissue regeneration, these treatments have had limited success in recapitulating a regenerated periodontal ligament's (PDL) structural and functional aspects.…”