Periodontitis is a dental disease affecting most adults, which can result in the loss of teeth in severe conditions. It involves the loss of dental supporting structures like root cementum, periodontal ligament, and the alveolar bone along with an inflammatory microenvironment. This condition suppresses the dental immune system. The main cause of this disease is a microbial attack on the gums. Aerobic microorganisms like Proteobacteria, Spirochaetes, Bacteroidetes, etc. weaken the immune system, promoting each other's growth and disrupting the normal balance of the microorganisms in the gums. Periodontitis can be a risk factor for people with compromised immune systems such as those with cardiovascular defects, diabetes, rheumatoid arthritis, etc. (3)
How do they manipulate the immune system?
They avoid the attacks of the neutrophils by forming biofilms, evasion of phagocytosis, and inhibiting chemotaxis among other methods.
New regeneration strategies have been proven challenging but tissue regeneration, using stem cells appears promising. Bone marrow mesenchymal stem cells (BMMSCs), periodontal ligament stem cells (PDLSCs), and dental pulp stem cells (DPSCs) have shown good results in animal models so far. The main objective of periodontal tissue regeneration is to reduce inflammation and restore the periodontium function to restore the teeth. (3)
What you need to know about dental stem cells
Stem cells in general have remarkable properties of proliferation, immunomodulatory potential migration, and multilineage differentiation. Thus, they can help with damaged tissue repair and inflammation reduction.
Dental stem cells (DSC) are the ideal candidates for periodontal tissue regeneration because they are self-renewing and multipotent and can easily be isolated from humans belonging to any age group making them accessible. Dental pulp stem cells (DPSC), among the first DSCs isolated, can be easily harvested from the dental pulp of extracted teeth such as third molars and periodontally compromised or inflamed teeth. (2)
Medbound times reached out to Dr Amingold MJ, BDS graduate, Diploma in Clinical Research and Pharmacovigilance for his opinion on this matter.
Recent studies based on the article published by the dental departments of Grigore T. Popa University of Medicine and Pharmacy, "The Role and Involvement of Stem Cells in Periodontology" show that stem cells like mesenchymal stem cells, dental pulp stem cells, etc. can be used for periodontal regeneration.
Dr Amingold MJ, BDS, Diploma in Clinical Research and Pharmacovigilance
So how is this regenerative technique performed?
Dental pulp stem cells, in combination with scaffold materials and growth factors, are used to facilitate this process. The primary use of scaffolds is to provide a three-dimensional temporary environment to support tissue regeneration. They should be biodegradable and contain porous structures to help with nutrient exchange, waste products, and oxygen. The rate of scaffold degradation must match the rate of new tissue formation so that, as the tissue regenerates, the scaffold is gradually replaced by the native extracellular matrix. Scaffolds can be made from various materials, including biologically derived polymers like collagen and chitosan, or synthetic materials like hydroxyapatite and polylactide-co-glycoside. Growth factors like bone morphogenic proteins (BMPs) and enamel matrix derivative (EMD) help enhance cell proliferation and differentiation, which helps in guiding the formation of specific tissue types. (1)
Although animal studies have proven effective, more human trials must be conducted in the future. (2)
Medbound Times reached out to Dr. Nirainila Joseph, BDS, MS, Junior Dentist, Amala Dental Care, Tirunelveli, Tamil Nadu, India, to give her opinion on why periodontal regeneration is a challenging task without stem cells.
Gayatri Prakasan: Why is periodontal Regeneration a challenging task without stem cells?
Dr. Nirainila Joseph: Nonsurgical and surgical treatments, such as oral hygiene instruction and full-mouth scaling and root planning, can control infections and halt the progression of periodontal disease by removing pathogens and necrotic tissues. However, these methods do not achieve complete regeneration of periodontal tissues. Techniques like guided tissue regeneration (GTR) for periodontal surgery can restore alveolar bone and soft tissues to some extent, but the results are often unpredictable. Although new biomaterials and growth factors have improved methods for managing periodontal defects, their effectiveness remains debatable, and achieving full structural and functional regeneration of lost periodontal tissues is still a challenge.
Mesenchymal stem cells, which can be sourced from various tissues, exhibit significant therapeutic potential due to their ability to self-renew and differentiate into multiple cell types. This regenerative potential, combined with their immunomodulatory capabilities, makes them highly effective for periodontal treatment. Stem cell therapy is now a widely accepted approach for periodontal regeneration, focusing on the complete reconstruction of the periodontal complex. This includes rebuilding alveolar bone, promoting cementum formation on root surfaces, and ensuring the proper insertion of newly formed periodontal ligament (PDL) tissue. Among the various options, dental stem cells (DSCs) are considered the most promising for treating periodontal disease.
References
Ashri, Nahid Y., Sumaiah A. Ajlan, and Abdullah M. Aldahmash. "Dental pulp stem cells: Biology and use for periodontal tissue engineering." Saudi medical journal 36, no. 12 (2015): 1391. (Cited on 11/07/24)
Citterio, Filippo, Giacomo Gualini, Ludovica Fierravanti, and Mario Aimetti. "Stem cells and periodontal regeneration: present and future." Plastic and Aesthetic Research 7 (2020): N-A. (Cited on 11/07/24)
Goriuc, Ancuta, Liliana Foia, Karina Cojocaru, Diana Diaconu-Popa, Darius Sandu, and Ionut Luchian. "The role and involvement of stem cells in periodontology." Biomedicines 11, no. 2 (2023): 387.(Cited on 11/07/24)
