ISCR [(Institut des Sciences Chimiques de Rennes)] - UMR 6226, Univ Rennes, Rennes, France.
Unité de Formation et de Recherche d'Odontologie, Univ Rennes, Rennes, France.
J Periodontal Res. 2020 Jan;55(1):1-12. doi: 10.1111/jre.12684. Epub 2019 Aug 4.
To evaluate the potential efficacy of mesenchymal stem cells (MSCs) in periodontal regeneration in humans on the following main outcomes: clinical attachment level (CAL), probing depth (PD), and gingival recession (GR).
The clinical application of stem cells in periodontal regeneration has begun in recent years, but clinical practices are not yet standardized and no recommendations are available at this time.
Electronic database searches and hand searches were conducted. All types of studies, case series, and case reports were qualitatively described. Double-blind randomized controlled trials (RCTs) evaluating MSCs in periodontal regeneration were included in a meta-analysis if they compared administration of MSCs vs application of stem cell-free therapy in the control group, in healthy patients with periodontal defects, with a minimum of three mo of follow-up.
Fifteen reports were included in qualitative analysis, involving 123 patients and 158 periodontal defects. Only two small RCTs at high risk of bias, with a total of 59 patients and 70 periodontal defects, were included in the meta-analysis. A small but significant difference between test and control groups was found for CAL at three mo (-0.90 mm, 95% CI [-1.51; -0.29]), but not for PD and GR.
Low-quality evidence suggests that MSC-based therapy may have a small impact on periodontal regeneration. However, due to the monocentric character, the small sample size, and potential heterogeneity across the two included RCTs, these results must not be considered as definitive. High-quality RCTs are needed before any clinical use of MSCs in periodontal regeneration.
评估间充质干细胞（MSCs）在人类牙周再生中的潜在疗效，主要观察指标为临床附着水平（CAL）、探诊深度（PD）和牙龈退缩（GR）。
近年来，干细胞在牙周再生中的临床应用已经开始，但临床实践尚未标准化，目前尚无相关建议。
电子数据库检索和手工检索。定性描述了所有类型的研究，包括病例系列和病例报告。如果在牙周缺陷的健康患者中，将 MSC 与对照组中的无干细胞治疗进行比较，并进行了至少 3 个月的随访的 MSC 用于牙周再生的双盲随机对照试验（RCT），则将其纳入荟萃分析。
定性分析纳入了 15 项报告，涉及 123 名患者和 158 个牙周缺损。仅纳入了两项存在高偏倚风险的小型 RCT，共纳入 59 名患者和 70 个牙周缺损进行荟萃分析。在 3 个月时，试验组与对照组之间的 CAL 差异具有统计学意义（-0.90mm，95%置信区间[-1.51；-0.29]），但 PD 和 GR 差异无统计学意义。
低质量证据表明，基于 MSC 的治疗方法可能对牙周再生有一定的影响。但是，由于两项纳入的 RCT 存在中心性、样本量小和潜在的异质性，这些结果不能被认为是明确的。在将 MSC 应用于牙周再生之前，需要进行高质量的 RCT。
