Periodontal Tissue Engineering and Regeneration: Current Approaches and Expanding Opportunities

Abstract

The management of periodontal tissue defects that result from periodontitis represents a medical and socioeconomic challenge. Concerted efforts have been and still are being made to accelerate and augment periodontal tissue and bone regeneration, including a range of regenerative surgical procedures, the development of a variety of grafting materials, and the use of recombinant growth factors. More recently, tissue-engineering strategies, including new cell- and/or matrix-based dimensions, are also being developed, analyzed, and employed for periodontal regenerative therapies. Tissue engineering in periodontology applies the principles of engineering and life sciences toward the development of biological techniques that can restore lost alveolar bone, periodontal ligament, and root cementum. It is based on an understanding of the role of periodontal formation and aims to grow new functional tissues rather than to build new replacements of periodontium. Although tissue engineering has merged to create more opportunities for predictable and optimal periodontal tissue regeneration, the technique and design for preclinical and clinical studies remain in their early stages. To date, the reconstruction of small- to moderate-sized periodontal bone defects using engineered cell-scaffold constructs is technically feasible, and some of the currently developed concepts may represent alternatives for certain ideal clinical scenarios. However, the predictable reconstruction of the normal structure and functionality of a tooth-supporting apparatus remains challenging. This review summarizes current regenerative procedures for periodontal healing and regeneration and explores their progress and difficulties in clinical practice, with particular emphasis placed upon current challenges and future possibilities associated with tissue-engineering strategies in periodontal regenerative medicine.

Morinda citrifolia leaves enhance osteogenic differentiation and mineralization of human periodontal ligament cells

“…Bone and periodontal tissue regeneration is a process that depends upon a sequence of biological events including cell proliferation, osteogenic differentiation, attachment to extracellular matrix components, organic matrix formation, and matrix mineralization 26,27) . The ability to grow and manipulate stem cells within the periodontal ligament is of considerable clinical significance, especially for developing novel mechanisms to achieve bone and periodontal tissue regeneration 28) .…”

Electrospinned bioactive glass/nano hydroxyapatite reinforced polycaprolactone GTR/GBR membranes in periodontics- A review

“…PCL does not produce a local acidic environment during the degradation procedure compared with PLA and PLGA. 33,34 One of the limitations of membranes fabricated with PCL is their poor cell-scaffold interactions due to the inherent hydrophobic nature. This may lead to poor cell adhesion, migration, proliferation, and differentiation during cell culture.…”

Biological approaches toward dental pulp regeneration by tissue engineering

“…While the application of recombinant growth factors to induce dentine and pulp regeneration has been widely investigated (Tziafas et al, 2000;Nakashima and Reddi, 2003;Nakashima, 2005), there are very few data about the effects of endogenous growth factors in vital pulp therapy, and the data are still often controversial. The localized delivery of growth factors for regenerative therapy is today hampered by the need for a safe and efficient delivery vehicle that can provide sustained therapeutic action without cytotoxicity or unwanted side effects (Chen et al, 2009b(Chen et al, , 2009cChen and Jin, 2010). Periodontal therapy using a formation of platelet-rich plasma (PRP) has been suggested as a modality to enhance the outcome of regenerative surgery, which points to a great interest in the use of PRP for potential pulp regeneration (Bashutski and Wang, 2008).…”

“…One of the most remarkable advantages is that regeneration of only a small amount of tissue can be highly beneficial to the patient, particularly in the tooth and periodontium areas (Nakashima and Akamine, 2005;Murray et al, 2007;Chen et al, 2009bChen et al, , 2009cScheller et al, 2009;Chen and Jin, 2010). Based on this principle, one potential approach for pulp regeneration would possibly involve some combination of disinfection or debridement of infected root canal systems, with apical enlargement to permit revascularization and the use and integration of tissue-specific stem cells and extracellular matrix (ECM) molecules Goldberg et al, 2008b).…”