Unit of Periodontology, UCL Eastman Dental Institute, London, United Kingdom.
Medical-Surgical Dentistry (OMEQUI) Research Group, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain.
Stem Cells Transl Med. 2019 Dec;8(12):1286-1295. doi: 10.1002/sctm.19-0183. Epub 2019 Nov 6.
Current regenerative strategies for alveolar bone and periodontal tissues are effective and well adopted. These are mainly based on the use of a combination of synthetic/natural scaffolds and bioactive agents, obviating the incorporation of cells. However, there are some inherent limitations associated with traditional techniques, and we hypothesized that the use of cell-based therapies as part of comprehensive regenerative protocols may help overcome these hurdles to enhance clinical outcomes. We conducted a systematic review of human controlled clinical trials investigating the clinical and/or histological effect of the use of cell-based therapies for alveolar bone and periodontal regeneration and explored the translational potential of the different cell-based strategies identified in the included trials. A total of 16 studies (11 randomized controlled trials, 5 controlled clinical trials) were included for data synthesis and qualitative analysis with meta-analyses performed when appropriate. The results suggest a clinical benefit from the use of cell therapy. Improved outcomes were shown for alveolar ridge preservation, lateral ridge augmentation, and periodontal regeneration. However, there was insufficient evidence to identify best-performing treatment modalities amongst the different cell-based techniques. In light of the clinical and histological outcomes, we identify extraction socket and challenging lateral and vertical bone defects requiring bone block grafts as strong candidates for the adjuvant application of mesenchymal stem cells. Given the complexity, invasiveness, and costs associated with techniques that include "substantial manipulation" of tissues and cells, their additional clinical benefit when compared with "minimal manipulation" must be elucidated in future trials. Stem Cells Translational Medicine 2019;8:1286&1295.
目前，用于牙槽骨和牙周组织的再生策略是有效的，并且得到了广泛应用。这些策略主要基于合成/天然支架和生物活性物质的组合使用，避免了细胞的掺入。然而，传统技术存在一些固有的局限性，我们假设将基于细胞的治疗方法作为综合再生方案的一部分使用，可能有助于克服这些障碍，提高临床效果。我们对人类对照临床试验进行了系统回顾，这些临床试验调查了基于细胞的治疗方法用于牙槽骨和牙周再生的临床和/或组织学效果，并探讨了纳入试验中确定的不同基于细胞的策略的转化潜力。共有 16 项研究（11 项随机对照试验，5 项对照临床试验）被纳入数据综合和定性分析，适当情况下进行了荟萃分析。结果表明，细胞治疗具有临床益处。牙槽嵴保存、侧壁牙槽嵴扩增和牙周再生的结果得到了改善。然而，没有足够的证据来确定不同基于细胞的技术中表现最佳的治疗方式。鉴于临床和组织学结果，我们确定拔牙窝和需要骨块移植的具有挑战性的侧壁和垂直骨缺损是间充质干细胞辅助应用的有力候选者。鉴于包括“大量组织和细胞操作”在内的技术的复杂性、侵入性和成本，在未来的试验中必须阐明其与“最小操作”相比的额外临床益处。干细胞转化医学 2019;8:1286&1295。
