Current and future trends in periodontal tissue engineering and bone regeneration

Abstract

Periodontal tissue engineering involves a multi-disciplinary approach towards the regeneration of periodontal ligament, cementum and alveolar bone surrounding teeth, whereas bone regeneration specifically applies to ridge reconstruction in preparation for future implant placement, sinus floor augmentation and regeneration of peri-implant osseous defects. Successful periodontal regeneration is based on verifiable cementogenesis on the root surface, oblique insertion of periodontal ligament fibers and formation of new and vital supporting bone. Ultimately, regenerated periodontal and peri-implant support must be able to interface with surrounding host tissues in an integrated manner, withstand biomechanical forces resulting from mastication, and restore normal function and structure. Current regenerative approaches utilized in everyday clinical practice are mainly guided tissue/bone regeneration-based. Although these approaches have shown positive outcomes for small and medium-sized defects, predictability of clinical outcomes is heavily dependent on the defect morphology and clinical case selection. In many cases, it is still challenging to achieve predictable regenerative outcomes utilizing current approaches. Periodontal tissue engineering and bone regeneration (PTEBR) aims to improve the state of patient care by promoting reconstitution of damaged and lost tissues through the use of growth factors and signaling molecules, scaffolds, cells and gene therapy. The present narrative review discusses key advancements in PTEBR including current and future trends in preclinical and clinical research, as well as the potential for clinical translatability.

Keywords: Tissue engineering; bone regeneration; dental implants; periodontics; regenerative medicine; wound repair/healing.

Figure 1.

Apical migration of the supracrestal tissue attachment, formation of periodontal pockets, and destruction of PDL and alveolar bone are sequalae of periodontitis. After decontamination of the defect, periodontal tissue engineering-based treatment strategies can be implemented to regenerate the periodontium, and restore structure and function (A); treatment approaches in periodontal tissue engineering employ gene therapy, cell therapy, scaffolds, and growth factors/signaling molecules alone or in combination. Successful regenerative outcomes rely on controlling inflammation, and promoting vascularization and osteogenesis (B); three commonly used biomaterials in everyday clinical practice that are considered components of tissue engineering-based approaches are: collagen membranes, xenograft, and growth factors/signaling molecules (i.e., enamel matrix derivative) (C); biomaterials which may enter clinical practice in the future include multiphasic scaffolds, 3D-printed constructs and hydrogel delivery systems (D). PDL: periodontal ligament