Direct application of autologous periodontal ligament stem cell niche in treatment of periodontal osseous defects: A randomized controlled trial

Abstract

Background and Objectives:The periodontal regenerative techniques using growth factors and stem cells are gaining momentum in periodontics. However, relatively little is known about the biological process and the potential role of direct transplantation of autologous periodontal ligament stem cells (PDLSC) niche in promoting periodontal regeneration.Aim:The aim of this is to clinically and to radiographically evaluate the effects of direct transplantation of autologous PDLSC niche (A-PDLSc Ni) in intrabony defects.Materials and Methods:Among 28 patients, 14 sites in test group were treated with open flap debridement (OFD) followed by direct transplantation of A-PDLSc Ni and other 14 sites in control group were treated with OFD. Clinical and radiographic assessment was done for each site before surgical therapy and at intervals of 3, 6, 9, and 12 months using radiovisiography. For clinical and radiographic parameters, intragroup comparison was made by paired t-test and unpaired t-test for intergroup comparisons.Results:The result showed that significant reduction (P < 0.05) of clinical parameters in both the OFD and A-PDLSc Ni groups. Radiographic parameters such as alveolar crest changes, defect area resolution were not statistically significant in both the OFD and A-PDLSc Ni groups whereas improvement in defect density was statistically significant (P < 0.05) only in the autologous periodontal ligament stem cell niche group.Conclusion:In the present study, treatment of intrabony defect by direct transplantation of autologous periodontal ligament stem cells niche in comparison with OFD showed a significant reduction in probing pocket depth (PPD), gain in clinical attachment level, and there was no gingival recession seen owing to thick gingiva. Radiographically, there was alveolar crest improvement, decrease in defect area, and increase in defect density in A-PDLSC Ni group.

A 3D-printed vanperio educative dental model – A review report of its chairside evaluation

“…The simulation of a novel regeneration technique termed, stem cell assistance in periodontal regeneration technique[ 3 ] has also been demonstrated on the Vanperio model and is depicted in Figure 13a - j .…”

Pharmacological Approaches and Regeneration of Bone Defects with Dental Pulp Stem Cells

“…Clinical application of autologous implantation of hPDLSCs was evaluated by Shalini et al They implanted hPDLSCs along with its niche, and no additional bone graft material was used in healing intrabony defects. A significant reduction in probing depth together with growth in clinical attachment levels was reported compared to controls treated with open flap debridement with no graft or implantation at all [ 39 ]. Periodontal regeneration with autologous periodontal ligament-derived stem cell sheets was assessed in ten patients' study by Iwata et al They verified the safety and efficacy of PDL-derived cell sheets isolated from extracted wisdom teeth in patients with chronic periodontitis.…”

Periodontal bioengineering with mesenchymal stem cells

“…This strategy is based on transplanting samples of autologous tissue, mainly from autologous periodontal ligament [80,122,123] and dental pulp of permanent teeth [83,[124][125][126] , with minimal manipulation and without ex vivo expansion [76] . Two different approaches of whole tissue fractions containing stem cells should be distinguished.…”

“…Two different approaches of whole tissue fractions containing stem cells should be distinguished. In one, the tissue sample, immediately after its harvesting and isolation, is directly introduced into the periodontal defect without any manipulation [80,122,123] . On the other hand, the tissue samples once isolated, are mechanically disaggregated with special devices to attain a so-called "micrografts containing different cell fractions, with MSCs among them" [83,[124][125][126] .…”

“…When compared at six months with the control group using only coronally advanced flaps, the test group exhibited a greater CAL gain and probing pocket depth reduction (P < 0.05). A similar protocol, but, combining PDL scraped from the root surface and the socket walls and mixed a gelatin sponge, the so-called "Autologous Stem Cell Assistance in Periodontal Regeneration (SAI-PRT)" was tested in a 12-month RCT, using as control group OFD in the treatment of intrabony defects [122,123] . This study also reported significant probing pocket depth reductions and CAL gains in the test group [123] .…”