Dental Tissue Regeneration – A Mini-Review

Advanced Healthcare Materials, 2018

the mechanical forces experienced during mastication. Periodontitis is a chronic inflammatory disease initiated by an oral bacterial biofilm, which results in periodontal hard and soft tissues destruction and can lead to tooth loss. It affects 30-40% of the population [1] and the large impact and burden of this disease on individuals and the community is well recognized not only in terms of compromised quality of life, but also overall health and systemic well-being. [2] 1.1. The Unique Challenges Faced in Achieving Periodontal Regeneration The ultimate objective of periodontal treatment is regeneration of the lost tissues of the periodontium, which involves the functional reattachment of the periodontal ligament onto newly formed cementum and alveolar bone. This requires a highly coordinated spatiotemporal healing response, including cementogenesis concomitant with periodontal ligament fiber reattachment to the previously contaminated root surface, as well as bone formation within the periodontal defect (Figure 1). In addition to the challenges posed by the complex architecture of the periodontium, healing is further complicated by the avascular nature of the tooth surface, which means that all periodontal wound healing occurs by secondary intention. Furthermore, The periodontium, consisting of gingiva, periodontal ligament, cementum, and alveolar bone, is a hierarchically organized tissue whose primary role is to provide physical and mechanical support to the teeth. Severe cases of periodontitis, an inflammatory condition initiated by an oral bacterial biofilm, can lead to significant destruction of soft and hard tissues of the periodontium and result in compromised dental function and aesthetics. Although current treatment approaches can limit the progression of the disease by controlling the inflammatory aspect, complete periodontal regeneration cannot be predictably achieved. Various tissue engineering approaches are investigated for their ability to control the critical temporospatial wound healing events that are essential for achieving periodontal regeneration. This paper reviews recent progress in the field of periodontal tissue engineering with an emphasis on advanced 3D multiphasic tissue engineering constructs (TECs) and provides a critical analysis of their regenerative potential and limitations. The review also elaborates on the future of periodontal tissue engineering, including scaffold customization for individual periodontal defects, TEC's functionalization strategies for imparting enhanced bioactivity, periodontal ligament fiber guidance, and the utilization of chair-side regenerative solutions that can facilitate clinical translation.

Journal of Tissue Engineering and Regenerative Medicine, 2018

More than two thirds of the global population suffers from tooth decay, which results in cavities with various levels of lesion severity. Clinical interventions to treat tooth decay range from simple coronal fillings to invasive root canal treatment. Pulp capping is the only available clinical option to maintain the pulp vitality in deep lesions, but irreversible pulp inflammation and reinfection are frequent outcomes for this treatment. When affected pulp involvement is beyond repair, the dentist has to perform endodontic therapy leaving the tooth non-vital and brittle. Ongoing research strategies have failed to overcome the limitations of existing pulp capping materials so that healthy and progressive regeneration of the injured tissues is attained. Preserving pulp vitality is crucial for tooth homeostasis and durability, and thus, there is a critical need for clinical interventions that enable regeneration of the dentin-pulp complex to rescue millions of teeth annually. The identification and development of appropriate biomaterials for dentin-pulp scaffolds are necessary to optimize clinical approaches to regenerate these hybrid dental tissues. Likewise, a deep understanding of the interactions between the micro-environment, growth factors, and progenitor cells will provide design basis for the most fitting scaffolds for this purpose. In this review, we first introduce the long-lasting clinical dental problem of rescuing diseased tooth vitality, the limitations of current clinical therapies and interventions to restore the damaged tissues, and the need for new strategies to fully revitalize the tooth. Then, we comprehensively report on the characteristics of the main materials of naturally-derived and synthetically-engineered polymers, ceramics, and composite scaffolds as well as their use in dentin-pulp complex regeneration strategies. Finally, we present a series of innovative smart polymeric biomaterials with potential to overcome dentin-pulp complex regeneration challenges.

Bioactive materials, 2021

The periodontium is an integrated, functional unit of multiple tissues surrounding and supporting the tooth, including but not limited to cementum (CM), periodontal ligament (PDL) and alveolar bone (AB). Periodontal tissues can be destructed by chronic periodontal disease, which can lead to tooth loss. In support of the treatment for periodontally diseased tooth, various biomaterials have been applied starting as a contact inhibition membrane in the guided tissue regeneration (GTR) that is the current gold standard in dental clinic. Recently, various biomaterials have been prepared in a form of tissue engineering scaffold to facilitate the regeneration of damaged periodontal tissues. From a physical substrate to support healing of a single type of periodontal tissue to multiphase/bioactive scaffold system to guide an integrated regeneration of periodontium, technologies for scaffold fabrication have emerged in last years. This review covers the recent advancements in development of scaffolds designed for periodontal tissue regeneration and their efficacy tested in vitro and in vivo. Pros and Cons of different biomaterials and design parameters implemented for periodontal tissue regeneration are also discussed, including future perspectives.

Materials

The reconstruction or repair of oral and maxillofacial functionalities and aesthetics is a priority for patients affected by tooth loss, congenital defects, trauma deformities, or various dental diseases. Therefore, in dental medicine, tissue reconstruction represents a major interest in oral and maxillofacial surgery, periodontics, orthodontics, endodontics, and even daily clinical practice. The current clinical approaches involve a vast array of techniques ranging from the traditional use of tissue grafts to the most innovative regenerative procedures, such as tissue engineering. In recent decades, a wide range of both artificial and natural biomaterials and scaffolds, genes, stem cells isolated from the mouth area (dental follicle, deciduous teeth, periodontal ligament, dental pulp, salivary glands, and adipose tissue), and various growth factors have been tested in tissue engineering approaches in dentistry, with many being proven successful. However, to fully eliminate the prob...

https://www.ijrrjournal.com/IJRR_Vol.6_Issue.2_Feb2019/Abstract_IJRR0026.html, 2019

Three-dimensional (3D)-printing nowadays is commonly applied in tissue engineering. This brief review provides importance of 3D printing techniques & approaches in regenerating ligament-bone complexes by regulating spatiotemporal cell organizations. Some techniques currently being used to produce scaffolds are 3D Printing, Fused Deposition Modelling (FDM), Stereolithography and Selective Laser Sintering (SLS). These tissue engineering strategies will help in enhancing the knowledge regarding regeneration of tooth supporting structures.

Applied Sciences, 2021

Conventional root canal treatment may result in loss of tooth vitality, which can lead to unfavorable treatment outcomes. Notably, a ceased tooth development of immature permanent teeth with open apices, regeneration of periodontal ligaments (PDL), and pulp is highly expected healing process. For regeneration, the scaffold is one of the critical components that carry biological benefits. Therefore, this study evaluated a decellularized human tooth as a scaffold for the PDL and pulp tissue regeneration. A tooth scaffold was fabricated using an effective decellularization method as reported in previous studies. PDL stem cells (PDLSCs) and dental pulp stem cells (DPSCs) obtained from human permanent teeth were inoculated onto decellularized scaffolds, then cultured to transplant into immunosuppressed mouse. After 9 weeks, PDLSCs and DPSCs that were inoculated onto decellularized tooth scaffolds and cultured in an in vivo demonstrated successful differentiation. In PDLSCs, a regeneratio...

Dental update, 2009

A new direction in the field of vital pulp therapy is given by the introduction of tissue engineering as an emerging science. It aims to regenerate a functional tooth-tissue structure by the interplay of three basic key elements: stem cells, morphogens and scaffolds. It is a multidisciplinary approach that combines the principles of biology, medicine, and engineering to repair and/or regenerate a damaged tissue and/or organ. This two part article reviews and discusses the basic concept and strategies so far studied and researched for the engineering of basic dental tissues, to restore a functional tooth anatomy. This first part focuses on a detailed description of key elements used in tissue engineering and their applied clinical applications in dentistry. The second part will deal with the strategies that are being used and/or developed to regenerate the tooth tissues with the help of this scientific principle. The field of tissue engineering has recently shown promising results an...

PLOS ONE, 2019

Regenerating the periodontal ligament (PDL) is a crucial factor for periodontal tissue regeneration in the presence of traumatized and periodontally damaged teeth. Various methods have been applied for periodontal regeneration, including tissue substitutes, bioactive materials, and synthetic scaffolds. However, all of these treatments have had limited success in structural and functional periodontal tissue regeneration. To achieve the goal of complete periodontal regeneration, many studies have evaluated the effectiveness of decellularized scaffolds fabricated via tissue engineering. The aim of this study was to fabricate a decellularized periodontal scaffold of human tooth slices and determine its regeneration potential. We evaluated two different protocols applied to tooth slices obtained from human healthy third molars. The extracellular matrix scaffold decellularized using sodium dodecyl sulfate and Triton X-100, which are effective in removing nuclear components, was demonstrated to preserve an intact structure and composition. Furthermore, the decellularized scaffold could support repopulation of PDL stem cells near the cementum and expressed cementum and periodontal-ligament-related genes. These results show that decellularized PDL scaffolds of human teeth are capable of inducing the proliferation and differentiation of mesenchymal stem cells, thus having regeneration potential for use in future periodontal regenerative tissue engineering.

2015

Tissue engineering is a highly promising field of reconstructive biology that draws on recent advances in medicine, surgery, molecular and cellular biology, polymer chemistry, and physiology. The objective of using tissue engineering as therapeutic application has been to harness its ability to exploit selected and primed cells together with an appropriate mix of regulatory factors to allow growth and specialization of cells and matrix. The authors reviewed controlled clinical trials which also included histological studies that evaluated the potential of tissue engineering as a clinical tool in regeneration. PubMed/MEDLINE databases were searched for studies up to and including June 2010 to identify appropriate articles. A comprehensive search was designed, and the articles were independently screened for eligibility. Articles with authentic controls and proper randomization and pertaining specifically to their role in periodontal regeneration were included. Studies demonstrated th...

International Journal of Frontiers in Biology and Pharmacy Research

Periodontal diseases refer to periodontal ligament injury affecting all the supporting structure and, if left untreated, results in loss of the tooth. Periodontal regenerative therapies aim towards healing all the damaged periodontal tissues by not only restoring structure but also the functions. This review provides information of all the currently-used as well as advanced biomaterials for periodontal regeneration. During this advancing research, various regenerative therapies of periodontal apparatus, such as guided tissue regeneration (GTR), enamel matrix derivative, bone grafts, growth factor delivery, and the combination of cells and growth factors with matrix-based scaffolds have been implemented to restore lost tooth-supporting tissues, including periodontal ligament, alveolar bone, and cementum. This review has stated about the recent progresses of periodontal regeneration by means of tissue-engineering.