Direct application of autologous periodontal ligament stem cell niche in treatment of periodontal osseous defects: A randomized controlled trial

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Abstract

Background and Objectives:

The periodontal regenerative techniques using growth factors and stem cells are gaining momentum in periodontics. However, relatively little is known about the biological process and the potential role of direct transplantation of autologous periodontal ligament stem cells (PDLSC) niche in promoting periodontal regeneration.

Aim:

The aim of this is to clinically and to radiographically evaluate the effects of direct transplantation of autologous PDLSC niche (A-PDLSc Ni) in intrabony defects.

Materials and Methods:

Among 28 patients, 14 sites in test group were treated with open flap debridement (OFD) followed by direct transplantation of A-PDLSc Ni and other 14 sites in control group were treated with OFD. Clinical and radiographic assessment was done for each site before surgical therapy and at intervals of 3, 6, 9, and 12 months using radiovisiography. For clinical and radiographic parameters, intragroup comparison was made by paired t-test and unpaired t-test for intergroup comparisons.

Results:

The result showed that significant reduction ( P < 0.05) of clinical parameters in both the OFD and A-PDLSc Ni groups. Radiographic parameters such as alveolar crest changes, defect area resolution were not statistically significant in both the OFD and A-PDLSc Ni groups whereas improvement in defect density was statistically significant ( P < 0.05) only in the autologous periodontal ligament stem cell niche group.

Conclusion:

In the present study, treatment of intrabony defect by direct transplantation of autologous periodontal ligament stem cells niche in comparison with OFD showed a significant reduction in probing pocket depth (PPD), gain in clinical attachment level, and there was no gingival recession seen owing to thick gingiva. Radiographically, there was alveolar crest improvement, decrease in defect area, and increase in defect density in A-PDLSC Ni group.

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Most cited references 21

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Beyond statistical significance: clinical interpretation of rehabilitation research literature.

Phil Page (2014)

Evidence-based practice requires clinicians to stay current with the scientific literature. Unfortunately, rehabilitation professionals are often faced with research literature that is difficult to interpret clinically. Clinical research data is often analyzed with traditional statistical probability (p-values), which may not give rehabilitation professionals enough information to make clinical decisions. Statistically significant differences or outcomes simply address whether to accept or reject a null or directional hypothesis, without providing information on the magnitude or direction of the difference (treatment effect). To improve the interpretation of clinical significance in the rehabilitation literature, researchers commonly include more clinically-relevant information such as confidence intervals and effect sizes. It is important for clinicians to be able to interpret confidence intervals using effect sizes, minimal clinically important differences, and magnitude-based inferences. The purpose of this commentary is to discuss the different aspects of statistical analysis and determinations of clinical relevance in the literature, including validity, significance, effect, and confidence. Understanding these aspects of research will help practitioners better utilize the evidence to improve their clinical decision-making skills.

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Treatment of periodontal intrabony defects using autologous periodontal ligament stem cells: a randomized clinical trial

Fa-Ming Chen, Li-Na Gao, Bei-Min Tian … (2016)

Background Periodontitis, which progressively destroys tooth-supporting structures, is one of the most widespread infectious diseases and the leading cause of tooth loss in adults. Evidence from preclinical trials and small-scale pilot clinical studies indicates that stem cells derived from periodontal ligament tissues are a promising therapy for the regeneration of lost/damaged periodontal tissue. This study assessed the safety and feasibility of using autologous periodontal ligament stem cells (PDLSCs) as an adjuvant to grafting materials in guided tissue regeneration (GTR) to treat periodontal intrabony defects. Our data provide primary clinical evidence for the efficacy of cell transplantation in regenerative dentistry. Methods We conducted a single-center, randomized trial that used autologous PDLSCs in combination with bovine-derived bone mineral materials to treat periodontal intrabony defects. Enrolled patients were randomly assigned to either the Cell group (treatment with GTR and PDLSC sheets in combination with Bio-oss®) or the Control group (treatment with GTR and Bio-oss® without stem cells). During a 12-month follow-up study, we evaluated the frequency and extent of adverse events. For the assessment of treatment efficacy, the primary outcome was based on the magnitude of alveolar bone regeneration following the surgical procedure. Results A total of 30 periodontitis patients aged 18 to 65 years (48 testing teeth with periodontal intrabony defects) who satisfied our inclusion and exclusion criteria were enrolled in the study and randomly assigned to the Cell group or the Control group. A total of 21 teeth were treated in the Control group and 20 teeth were treated in the Cell group. All patients received surgery and a clinical evaluation. No clinical safety problems that could be attributed to the investigational PDLSCs were identified. Each group showed a significant increase in the alveolar bone height (decrease in the bone-defect depth) over time (p 0.05). Conclusions This study demonstrates that using autologous PDLSCs to treat periodontal intrabony defects is safe and does not produce significant adverse effects. The efficacy of cell-based periodontal therapy requires further validation by multicenter, randomized controlled studies with an increased sample size. Trial Registration NCT01357785 Date registered: 18 May 2011. Electronic supplementary material The online version of this article (doi:10.1186/s13287-016-0288-1) contains supplementary material, which is available to authorized users.

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Niche heterogeneity in the bone marrow.

Alexander Birbrair, Paul S Frenette (2016)

In adult mammals, hematopoietic stem cells (HSCs) are defined by their abilities to self-renew and to differentiate to form all blood cell lineages. These rare multipotent cells occupy specific locations in the bone marrow (BM) microenvironment. The specific microenvironment regulating HSCs, commonly referred to as the niche, comprises multiple cell types whose exact contributions are under active investigation. Understanding cellular cross talk involving HSCs in the BM microenvironment is of fundamental importance for harnessing therapies against benign and malignant blood diseases. In this review, we summarize and evaluate recent advances in our understanding of niche heterogeneity and its influence on HSC function.

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Author and article information

Journal

Journal ID (nlm-ta): J Indian Soc Periodontol

Journal ID (iso-abbrev): J Indian Soc Periodontol

Journal ID (publisher-id): JISP

Title: Journal of Indian Society of Periodontology

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 0972-124X

ISSN (Electronic): 0975-1580

Publication date (Print): Nov-Dec 2018

Volume: 22

Issue: 6

Pages: 503-512

Affiliations

[1] Department of Periodontics, College of Dental Sciences, Davangere, Karnataka, India

Author notes

Address for correspondence: Dr. Kharidhi Laxman Vandana, Department of Periodontics, College of Dental Sciences, Davangere - 577 004, Karnataka, India. E-mail: vanrajs@ 123456gmail.com

Article

Publisher ID: JISP-22-503

DOI: 10.4103/jisp.jisp_92_18

PMC ID: 6305096

PubMed ID: 30631229

SO-VID: 443538c4-6af6-443f-8bd2-22cf292eeee8

License:

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Direct application of autologous periodontal ligament stem cell niche in treatment of periodontal osseous defects: A randomized controlled trial

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Abstract

Background and Objectives:

Aim:

Materials and Methods:

Results:

Conclusion:

Related collections

Arab Journal of Forensic Sciences & Forensic Medicine (AJFSFM)

Most cited references 21

Beyond statistical significance: clinical interpretation of rehabilitation research literature.

Treatment of periodontal intrabony defects using autologous periodontal ligament stem cells: a randomized clinical trial

Niche heterogeneity in the bone marrow.

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