Liu Guanqi, Xue Junlong, Zhou Xuan, Gui Mixiao, Xia Ruidi, Zhang Yanshu, Cai Yihua, Li Shuhua, Shi Songtao, Mao Xueli, Chen Zetao
Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, and Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, 510055, China.
Guangdong Research Center for Dental and Cranial Rehabilitation and Material Engineering, Guangzhou, 510055, China.
Bioact Mater. 2025 Mar 18;49:418-436. doi: 10.1016/j.bioactmat.2025.03.009. eCollection 2025 Jul.
Ideal periodontal regeneration requires the integration of alveolar bone, periodontal ligament, and cementum, along with Sharpey's fibers for occlusal force resistance. However, physiological regeneration remains rare due to its intricate structure, making clinical regeneration a challenge. Periodontal ligament stem cells (PDLSCs), first isolated in 2004, hold the key to multi-directional differentiation into cementoblasts, fibroblasts, and osteoblasts. While traditional therapies like guided tissue regeneration (GTR) aim to activate PDLSCs, clinical outcomes are inconsistent, suggesting the need for additional strategies to enhance PDLSCs' functions. Advancements in molecular biotechnology have introduced the use of recombinant growth factors for tissue regeneration. However, maintaining their efficacy requires high doses, posing cost and safety issues. Multi-layered scaffolds combined with cell sheet technology offer new insights, but face production, ethical, and survival challenges. Immune regulation plays a crucial role in PDLSC-mediated regeneration. The concept of "coagulo-immunomodulation" has emerged, emphasizing the coupling of blood coagulation and immune responses for periodontal regeneration. Despite its potential, the clinical translation of immune-based strategies remains elusive. The "developmental engineering" approach, which mimics developmental events using embryonic-stage cells and microenvironments, shows promise. Our research group has made initial strides, indicating its potential as a viable solution for periodontal complex regeneration. However, further clinical trials and considerations are needed for successful clinical application. This review aims to summarize the strategic transitions in the development of periodontal regenerative materials and to propose prospective avenues for future development.
理想的牙周组织再生需要牙槽骨、牙周膜和牙骨质整合在一起，同时还需要沙比纤维来抵抗咬合力量。然而，由于其结构复杂，生理性再生仍然很少见，这使得临床再生成为一项挑战。牙周膜干细胞（PDLSCs）于2004年首次分离出来，是多向分化为成牙骨质细胞、成纤维细胞和成骨细胞的关键。虽然像引导组织再生（GTR）这样的传统疗法旨在激活PDLSCs，但临床结果并不一致，这表明需要额外的策略来增强PDLSCs的功能。分子生物技术的进步引入了重组生长因子用于组织再生。然而，维持其疗效需要高剂量，这带来了成本和安全问题。多层支架与细胞片技术相结合提供了新的思路，但面临生产、伦理和存活方面的挑战。免疫调节在PDLSC介导的再生中起着关键作用。“凝血-免疫调节”的概念已经出现，强调凝血和免疫反应的耦合以促进牙周组织再生。尽管具有潜力，但基于免疫的策略在临床转化方面仍然难以实现。“发育工程”方法，即利用胚胎期细胞和微环境模拟发育事件，显示出前景。我们的研究小组已经取得了初步进展，表明其作为牙周组织复杂再生可行解决方案的潜力。然而，要成功应用于临床还需要进一步的临床试验和考虑。本综述旨在总结牙周再生材料开发中的战略转变，并提出未来发展的前瞻性途径。
