Future dentistry: Cell therapy meets tooth and periodontal repair and regeneration

Clinical and Diagnostic Sciences, Dental Institute, King's College London, London, UK.
Journal of Cellular and Molecular Medicine (Impact Factor: 4.01). 12/2010; 15(5):1054-65. DOI: 10.1111/j.1582-4934.2010.01251.x
Source: PubMed


Cell-based tissue repair of the tooth and - tooth-supporting - periodontal ligament (PDL) is a new attractive approach that complements traditional restorative or surgical techniques for replacement of injured or pathologically damaged tissues. In such therapeutic approaches, stem cells and/or progenitor cells are manipulated in vitro and administered to patients as living and dynamic biological agents. In this review, we discuss the clonogenic potential of human dental and periodontal tissues such as the dental pulp and the PDL and their potential for tooth and periodontal repair and/or regeneration. We propose novel therapeutic approaches using stem cells or progenitor cells, which are targeted to regenerate the lost dental or periodontal tissue.

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    • "Traumatic injuries, periodontal disease and caries are mainly responsible for pathologies affecting teeth and their surrounding tissues (Caton et al., 2011). These pathologies remain a major clinical challenge, due mainly to the limited self-healing capability of dental tissues. "
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    ABSTRACT: Repair of dental pulp and periodontal lesions remains a major clinical challenge. Classical dental treatments require the use of specialised tissue-adapted materials with still questionable efficacy and durability. Stem cell-based therapeutic approaches could offer an attractive alternative in dentistry since they can promise physiologically improved structural and functional outcomes. These therapies necessitate a sufficient number of specific stem cell populations for implantation. Dental mesenchymal stem cells can be easily isolated and are amenable to in vitro expansion while retaining their stemness. In vivo studies realised in small and large animals have evidenced the potential of dental mesenchymal stem cells to promote pulp and periodontal regeneration, but have also underlined new important challenges. The homogeneity of stem cell populations and their quality control, the delivery method, the quality of the regenerated dental tissues and their integration to the host tissue are some of the key challenges. The use of bioactive scaffolds that can elicit effective tissue repair response, through activation and mobilisation of endogenous stem cell populations, constitutes another emerging therapeutic strategy. Finally, the use of stem cells and induced pluripotent cells for the regeneration of entire teeth represents a novel promising alternative to dental implant treatment after tooth loss. In this mini-review, we present the currently applied techniques in restorative dentistry and the various attempts that are made to bridge gaps in knowledge regarding treatment strategies by translating basic stem cell research into the dental practice.
    Full-text · Article · Nov 2015 · European cells & materials
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    • "However, in a diseased periodontal environment, the lack of robust stem cells renders the use of ex vivo expanded/manipulated stem cells a necessity [5] [13]. In this context, periodontal cell therapy involves the treatment of periodontitis by transferring new cells into a defect site with the goal of improving the regeneration process [14]. The transplanted cells may participate in the repair of damaged periodontium, serving as building blocks by differentiating into multiple cell types, or regulate repair via secretion of growth or cellular signals, instead of, or in addition to, directly participating in regeneration of the tissue [15]. "
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    ABSTRACT: Periodontitis leading to the progressive destruction of tooth-supporting tissues (including periodontal ligament, alveolar bone and cementum) is the major cause of tooth loss in adults. Currently available therapies for periodontal morbidities are clearly inadequate, with significant limitations in the predictable regeneration of the multiple lost/damaged periodontal tissues and the reconstruction of their complex structures. Recent scientific advances, however, have facilitated the identification of a wide variety of stem cells that may serve as novel ‘tools’ for cellular replenishment and tissue regeneration. Meanwhile, great progress has been made in developing biomaterials to support transplanted cells and to act as templates for the growth of new tissue. Furthermore, these biomaterials are routinely being designed to display and deliver regulatory signals in a precise and near-physiological fashion, which may orchestrate wound healing and regeneration. The concept of tissue engineering has been integrated into research and applications which attempt to regenerate the damaged periodontium by selective combination of stem cells, growth factors and such materials systems. This chapter provides an overview of the components involved in the established and proposed periodontal bioengineering strategies. Certain fundamental issues and design endeavors in relation to the cell-free and cell-based approaches that are being actively pursued to address specific demands are evaluated and illustrated. Future development highlights the importance of translational research to create a clinically feasible treatment regimen that may improve health care for patients.
    Full-text · Chapter · Jun 2014
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    • "Therefore, exogenous regenerative 'tools' such as ex vivo expanded/manipulated stem cells will be needed to replenish the host cell niche and facilitate tissue regeneration [4]. In such therapeutic approaches, stem cells and/or progenitor cells are manipulated in vitro and administered to patients as living and dynamic biological agents [14]. The transplanted cells may participate in the repair of damaged or diseased tissue, serving as or producing building blocks, or regulate regeneration via secretion of trophic factors, instead or in addition to directly participating in regeneration of the tissue [15]. "
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    ABSTRACT: Periodontitis, an inflammatory disease, is the most common cause of tooth loss in adults. Attempts to regenerate the complex system of tooth-supporting apparatus (i.e., the periodontal ligament, alveolar bone and root cementum) after loss/damage due to periodontitis have made some progress recently and provide a useful experimental model for the evaluation of future regenerative therapies. Concentrated efforts have now moved from the use of guided tissue/bone regeneration technology, a variety of growth factors and various bone grafts/substitutes toward the design and practice of endogenous regenerative technology by recruitment of host cells (cell homing) or stem cell-based therapeutics by transplantation of outside cells to enhance periodontal tissue regeneration and its biomechanical integration. This shift is driven by the general inability of conventional therapies to deliver satisfactory outcomes, particularly in cases where the disease has caused large tissue defects in the periodontium. Cell homing and cell transplantation are both scientifically meritorious approaches that show promise to completely and reliably reconstitute all tissue and connections damaged through periodontal disease, and hence research into both directions should continue. In view of periodontal regeneration by paradigms that unlock the body's innate regenerative potential has been reviewed elsewhere, this paper specifically explores and analyses the stem cell types and cell delivery strategies that have been or have the potential to be used as therapeutics in periodontal regenerative medicine, with particular emphasis placed on the efficacy and safety concerns of current stem cell-based periodontal therapies that may eventually enter into the clinic.
    Full-text · Article · Jun 2012 · Biomaterials
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