Current regenerative approaches to the treatment of generalized periodontitis in young people (literature review)

O.V Kopchak; I.V. Kovach; Y.V. Litvinova; K.A. Yanishevsky; N.S.  Marchenko

doi:10.26641/2307-0404.2024.1.300786

Authors

O.V Kopchak Kyiv Medical University, Boryspilska str., 2, Kyiv, 02099, Ukraine https://orcid.org/0000-0003-3244-2041
I.V. Kovach Dnipro State Medical University, Volodymyra Vernadskoho str., 9, Dnipro, 49044, Ukraine https://orcid.org/0000-0002-5887-4136
Y.V. Litvinova Kyiv Medical University, Boryspilska str., 2, Kyiv, 02099, Ukraine https://orcid.org/0000-0003-2673-9295
K.A. Yanishevsky Kyiv Medical University, Boryspilska str., 2, Kyiv, 02099, Ukraine https://orcid.org/0009-0000-6394-615X
N.S. Marchenko Kyiv Medical University, Boryspilska str., 2, Kyiv, 02099, Ukraine https://orcid.org/0000-0001-8885-5529

DOI:

https://doi.org/10.26641/2307-0404.2024.1.300786

Keywords:

generalized periodontitis, regenerative technologies, stem cells, platelet-rich plasma

Abstract

Periodontal diseases are a component of the global burden of chronic morbidity worldwide. The prevalence of periodontitis increases with age, reaching a high at the age of 40, which has increased medical and social importance. In Ukraine the prevalence of periodontal diseases among people aged 19-24 reaches 30%, 25-30 years – more than 60%, and in the age group 35-44 years and older – varies from 92 to 98%. With the generalized form of periodontitis in young people, considerable degradation of periodontal tissues occurs, while treatment measures are mainly ineffective, with a temporary therapeutic effect that only stabilizes the course of disease. The goal of this literature review was to identify innovative approaches to the reparation and regeneration of affected periodontal tissues that could be used as non-invasive treatment modes. The conducted analysis included studies whose findings were published in 52 English- and Ukrainian-language information sources for the period 1985-2022. The literature search was carried out in the PubMed, Scopus, Google Scholar databases and in the electronic catalog of the National Scientific Medical Library of Ukraine. The results of the literature review confirm the considerable potential of cell therapy supplemented with platelet-rich plasma for the formation of new periodontal tissues, which supported their use to promote the regenerative process. In combination with stem cells, platelet-rich plasma provides a considerable increase in the effectiveness of periodontal disease treatment in young people. The literature search was carried out in PubMed databases (327 sources), Scopus (121 sources), Google Academy (16 articles) and in the electronic catalog of the National Scientific Medical Library of Ukraine (89 records). Out of 537, 52 sources were selected for review. Periodontal tissue disease is an actual problem today. According to the data of the analyzed literature, the use of stem cells in dentistry is actively studied, but there are no recommendations and protocols for their use in periodontology. The analyzed scientific sources, the results of which were published in English- and Ukrainian-language sources, aimed at tissue regeneration, have a significant impact on the creation of new approaches to the treatment of generalized periodontitis. The world experience of using cellular technologies with using stem cells demonstrates the significant potential and positive results of their application to promote the regenerative process in the comprehensive treatment of periodontal diseases. The combination of stem cells and platelet-enriched plasma significantly increases the effectiveness of treatment of periodontal tissue diseases, in particular generalized periodontitis in young people. The use of stem cells and growth factors, which contains platelet-rich plasma, allows you to significantly increase the effectiveness of periodontal disease treatment.

References

Wu L, Zhang SQ, Zhao L, Ren ZH, Hu CY. Global, regional, and national burden of periodontitis from 1990 to 2019: Results from the Global Burden of Disease study 2019. J Periodontol. 2022 Oct;93(10):1445-54. doi: https://doi.org/10.1002/JPER.21-0469

Borysenko AV, Mialkivskyi KO. [Prevalence of periodontal diseases in young people]. Sovremennaia stomatolohyia. 2018;4:85. Ukrainian.

Kholodniak OV. [Prevalence and structure of periodontal disease in young aged adults]. Klinichna ta eksperymentalna patolohiia. 2015;14(3):159-62. Ukrainian.

Voronenko YuV, Mazur IP, Pavlenko OV, editors. [Dental care in Ukraine: analysis of the main activity indicators for 2018]. Kropyvnytskyi: Polium; 2019. 175 р. Ukrainian.

Kwon T, Lamster IB, Levin L. Current concepts in the management of periodontitis. Int Dent J. 2021 Dec;71(6):462-76. doi: https://doi.org/10.1111/idj.12630

Bourgeois D, Bravo M, Llodra JC, Inquimbert C, Viennot S, Dussart C, et al. Calibrated interdental brushing for the prevention of periodontal pathogens infection in young adults – a randomized controlled clinical trial. Sci Rep. 2019 Oct 22;9(1):15127. doi: https://doi.org/10.1038/s41598-019-51938-8

Kopchak O, Marchenko N, Kaniura O, Savosko S, Yanishevsky K, Makarenko O, et al. The effect of hyalu¬ronic acid on the periodontium in spontaneous perio¬dontitis in rats. Int J Morphol. 2021;39(4):1028-35. doi: https://doi.org/10.1902/jop.2015.130685

Kopchak O, Yakovenko L, Marchenko N, Кovach I, Pavlenko E, Nimenko O, et al. Levels of Hsp60 in periodontal tissue of rats: influence of injections of hyaluronic acid. Medicni perspektivi. 2021;26(2):12-8. doi: https://doi.org/10.26641/2307-0404.2021.2.234382

Liu Y, Guo L, Li X, Liu S, Du J, Xu J, et al. Challenges and tissue engineering strategies of periodontal-guided tissue regeneration. Tissue Eng Part C Methods. 2022 Aug;28(8):405-19. doi: https://doi.org/10.1089/ten.TEC.2022.0106

Zhang Y, Zhao W, Jia L, Xu N, Xiao Y, Li Q. The application of stem cells in tissue engineering for the regeneration of periodontal defects in randomized controlled trial: a systematic review and meta-analysis. J Evid Based Dent Pract. 2022 Jun;22(2):101713. doi: https://doi.org/10.1016/j.jebdp.2022.101713

Novello S, Debouche A, Philippe M, Naudet F, Jeanne S. Clinical application of mesenchymal stem cells in periodontal regeneration: A systematic review and meta-analysis. J Periodontal Res. 2020 Jan;55(1):1-12. doi: https://doi.org/10.1111/jre.12684

Citterio F, Gualini G, Fierravanti L, Aimetti M. Stem cells and periodontal regeneration: present and future. Plast Aesthet Res. 2020;7:41. doi: https://doi.org/10.20517/2347-9264.2020.29

Seo BM, Miura M, Gronthos S, Bartold PM, Batouli S, Brahim J, et al. Investigation of multipotent post-natal stem cells from human periodontal ligament. Lancet. 2004;364(9429):149-55. doi: https://doi.org/10.1016/S0140-6736(04)16627-0

Melcher AH. Cells of periodontium: Their role in the healing of wounds. Ann R Coll Surg Engl. 1985;67:130-1.

Huang GT, Gronthos S, Shi S. Mesenchymal stem cells derived from dental tissues vs. those from other sources: their biology and role in regenerative medicine. J Dent Res. 2009 Sep;88(9):792-806. doi: https://doi.org/10.1177/0022034509340867

Ouchi T, Nakagawa T. Mesenchymal stem cell-based tissue regeneration therapies for periodontitis. Regen Ther. 2020 Jan 15;14:72-8. doi: https://doi.org/10.1016/j.reth.2019.12.011

Onizuka S, Iwata T. Application of periodontal ligament-derived multipotent mesenchymal stromal cell sheets for periodontal regeneration. Int J Mol Sci. 2019 Jun 7;20(11):2796. doi: https://doi.org/10.3390/ijms20112796

Hernández-Monjaraz B, Santiago-Osorio E, Monroy-García A, Ledesma-Martínez E, Mendoza-Núñez VM. Mesenchymal stem cells of dental origin for inducing tissue regeneration in periodontitis: A mini-review. Int J Mol Sci. 2018 Mar 22;19(4):944. doi: https://doi.org/10.3390/ijms19040944

Monterubbianesi R, Bencun M, Pagella P, Woloszyk A, Orsini G, Mitsiadis TA. A comparative in vitro study of the osteogenic and adipogenic potential of human dental pulp stem cells, gingival fibroblasts and foreskin fibroblasts. Sci Rep. 2019 Feb 11;9(1):1761. doi: https://doi.org/10.1038/s41598-018-37981-x

Tassi SA, Sergio NZ, Misawa MYO, Villar CC. Efficacy of stem cells on periodontal regeneration: Systematic review of pre-clinical studies. J Periodontal Res. 2017 Oct;52(5):793-812. doi: https://doi.org/10.1111/jre.12455

Zhou LL, Liu W, Wu YM, Sun WL, Dörfer CE, Fawzy El-Sayed KM. Oral mesenchymal stem/progenitor cells: the immunomodulatory masters. Stem Cells Int. 2020;2020:1327405. doi: https://doi.org/10.1155/2020/1327405

Ferrarotti F, Romano F, Gamba MN, Quirico A, Giraudi M, Audagna M, et al. Human intrabony defect regeneration with micrografts containing dental pulp stem cells: A randomized controlled clinical trial. J Clin Periodontol. 2018;45(7):841-50. doi: https://doi.org/10.1111/jcpe.12931

Seo Y, Shin TH, Kim HS. Current strategies to enhance adipose stem cell function: an update. Int J Mol Sci. 2019 Aug 5;20(15):3827. doi: https://doi.org/10.3390/ijms20153827

Zuk PA, Zhu M, Mizuno H, Huang J, Futrell JW, Katz AJ, et al. Multilineage cells from human adipose tissue: implications for cell-based therapies. Tissue Eng. 2001;7(2):211‐28. doi: https://doi.org/10.1089/107632701300062859

Argentati C, Morena F, Bazzucchi M, Armentano I, Emiliani C, Martino S. Adipose stem cell translational applications: from bench-to-bedside. Int J Mol Sci. 2018 Nov 5;19(11):3475. doi: https://doi.org/10.3390/ijms19113475

Goriuc A, Foia L, Cojocaru K, Diaconu-Popa D, Sandu D, Luchian I. The role and involvement of stem cells in periodontology. Biomedicines. 2023 Jan 28;11(2):387. doi: https://doi.org/10.3390/biomedicines11020387

Palumbo P, Lombardi F, Siragusa G, Cifone MG, Cinque B, Giuliani M. Methods of isolation, characterization and expansion of human adipose-derived stem cells (ASCs): An overview. Int J Mol Sci. 2018 Jun 28;19(7):1897. doi: https://doi.org/10.3390/ijms19071897

Si Z, Wang X, Sun C, Kang Y, Xu J, Wang X, et al. Adipose-derived stem cells: Sources, potency, and implications for regenerative therapies. Biomed Phar-macother. 2019 Jun;114:108765. doi: https://doi.org/10.1016/j.biopha.2019.108765

Romano IR, D'Angeli F, Vicario N, Russo C, Ge-novese C, Lo Furno D, et al. Adipose-derived mesen-chymal stromal cells: A tool for bone and cartilage repair. Biomedicines. 2023 Jun 21;11(7):1781. doi: https://doi.org/10.3390/biomedicines11071781

Ayanoğlu FB, Elçin AE, Elçin YM. Evaluation of the stability of standard reference genes of adipose-derived mesenchymal stem cells during in vitro proliferation and differentiation. Mol Biol Rep. 2020;47(3):2109‐22. doi: https://doi.org/10.1007/s11033-020-05311-y

Cho YD, Kim KH, Ryoo HM, Lee YM, Ku Y, Seol YJ. Recent advances of useful cell sources in the periodontal regeneration. Curr Stem Cell Res Ther. 2019;14(1):3-8. doi: https://doi.org/10.2174/1574888X13666180816113456

Mannino G, Russo C, Maugeri G, Musumeci G, Vicario N, Tibullo D, et al. Adult stem cell niches for tissue homeostasis. J Cell Physiol. 2022 Jan;237(1):239-57. doi: https://doi.org/10.1002/jcp.30562

Marx RE. Platelet-rich plasma (PRP): what is PRP and what is not PRP? Implant Dent. 2001;10(4):225-8. doi: https://doi.org/10.1097/00008505-200110000-00002

Al-Hamed FS, Mahri M, Al-Waeli H, Torres J, Badran Z, Tamimi F. Regenerative effect of platelet concentrates in oral and craniofacial regeneration. Front Cardiovasc Med. 2019 Sep 3;6:126. doi: https://doi.org/10.3389/fcvm.2019.00126

Xu J, Gou L, Zhang P, Li H, Qiu S. Platelet-rich plasma and regenerative dentistry. Aust Dent J. 2020 Jun;65(2):131-42. doi: https://doi.org/10.1111/adj.12754

Kovach IV, Hutarova NV. [Microcirculation in periodontal tissues after the use of platelet-rich plasma in patients with chronic catarrhal gingivitis in the dynamics of orthodontic treatment]. Colloquium-journal. 2020;24:15-9. Ukrainian.

Jeong W, Kim YS, Roh TS, Kang EH, Jung BK, Yun IS. The effect of combination therapy on critical-size bone defects using platelet-rich plasma and adipose-derived stem cells. Childs Nerv Syst. 2020 Jan;36(1):145-51. doi: https://doi.org/10.1007/s00381-019-04109-z

Harrison TE, Bowler J, Levins TN, Reeves KD, Cheng AL. Platelet-rich plasma centrifugation changes leukocyte ratios. Cureus. 2021 Apr 13;13(4):e14470. doi: https://doi.org/10.7759/cureus.14470

Oudelaar BW, Peerbooms JC, Huis In 't Veld R, Vochteloo AJH. Concentrations of blood components in commercial platelet-rich plasma separation systems: A review of the literature. Am J Sports Med. 2019 Feb;47(2):479-87. doi: https://doi.org/10.1177/0363546517746112

Tey RV, Haldankar P, Joshi VR, Raj R, Maradi R. Variability in platelet-rich plasma preparations used in regenerative medicine: A comparative analysis. Stem Cells Int. 2022 Oct 20;2022:3852898. doi: https://doi.org/10.1155/2022/3852898

Samadi P, Sheykhhasan M, Khoshinani HM. The use of platelet-rich plasma in aesthetic and regenerative medicine: A comprehensive review. Aesthetic Plast Surg. 2019 Jun;43(3):803-14. doi: https://doi.org/10.1007/s00266-018-1293-9

Liebig BE, Kisiday JD, Bahney CS, Ehrhart NP, Goodrich LR. The platelet-rich plasma and mesenchymal stem cell milieu: A review of therapeutic effects on bone healing. J Orthop Res. 2020 Dec;38(12):2539-50. doi: https://doi.org/10.1002/jor.24786

Guida A, Cecoro G, Rullo R, Laino L, Del Fabbro M, Annunziata M. A systematic critical appraisal of the methodological quality of systematic reviews on the effect of autologous platelet concentrates in the treatment of periodontal intraosseous defects. Materials (Basel). 2020 Sep 20;13(18):4180. doi: https://doi.org/10.3390/ma13184180

Tatsis D, Vasalou V, Kotidis E, Anestiadou E, Grivas I, Cheva A, et al. The combined use of platelet-rich plasma and adipose-derived mesenchymal stem cells promotes healing. A review of experimental models and future perspectives. Biomolecules. 2021 Sep 24;11(10):1403. doi: https://doi.org/0.3390/biom11101403

Mohan SP, Jaishangar N, Devy S, Narayanan A, Cherian D, Madhavan SS. Platelet-rich plasma and plateletrich fibrin in periodontal regeneration: a review. J Pharm Bioallied Sci. 2019 May;11(Suppl 2):S126-30. doi: https://doi.org/10.4103/JPBS.JPBS_41_19

Yamada Y, Ueda M, Hibi H, Baba S. A novel approach to periodontal tissue regeneration with mesen-chymal stem cells and platelet-rich plasma using tissue engineering technology: A clinical case report. Int J Periodontics Restorative Dent. 2006;26(4):363-9.

Yamada Y, Nakamura S, Ito K, Umemura E, Hara K, Nagasaka T, et al. Injectable bone tissue engineering using expanded mesenchymal stem cells. Stem Cells. 2013 Mar;31(3):572-80. doi: https://doi.org/10.1002/stem.1300

Tobita M, Uysal CA, Guo X, Hyakusoku H, Mizuno H. Periodontal tissue regeneration by combined implantation of adipose tissue-derived stem cells and platelet-rich plasma in a canine model. Cytotherapy. 2013 Dec;15(12):1517-26. doi: https://doi.org/10.1016/j.jcyt.2013.05.007

Tobita M, Masubuchi Y, Ogata Y, Mitani A, Kikuchi T, Toriumi T, et al. Study protocol for periodontal tissue regeneration with a mixture of autologous adipose-derived stem cells and platelet rich plasma: A multicenter, randomized, open-label clinical trial. Regen Ther. 2022 Oct 12;21:436-41. doi: https://doi.org/10.1016/j.reth.2022.09.008

Yamakawa J, Hashimoto J, Takano M, Takagi M. The Bone Regeneration Using Bone Marrow Stromal Cells with Moderate Concentration Platelet-Rich Plasma in Femo¬ral Segmental Defect of Rats. Open Orthop J. 2017;11:1‐11. doi: https://doi.org/10.2174/1874325001711010001

Nguyen ATM, Tran HLB, Pham TAV. In vitro evaluation of proliferation and migration behaviour of human bone marrow-derived mesenchymal stem cells in presence of plateletrich plasma. Int J Dent. 2019 Apr 9;2019:9639820. doi: https://doi.org/10.1155/2019/9639820

Wang K, Li Z, Li J, Liao W, Qin Y, Zhang N, et al. Optimization of the plateletrich plasma concentration for mesenchymal stem cell applications. Tissue Eng Part A. 2019 Mar;25(5-6):333-51. doi: https://doi.org/10.1089/ten.TEA.2018.0091