Regeneration of Intrabony Defects Utilizing Stem Cells Allograft
Regeneration of intrabony defects remains an important goal in the treatment of periodontitis. Clinical and histologic evidence of periodontal regeneration has been shown for multiple regenerative approaches, including bone replacement grafts, guided tiss
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Regeneration of Intrabony Defects Utilizing Stem Cells Allograft Richard T. Kao and Mark C. Fagan
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Introduction
Periodontitis is commonly characterized by the formation of intrabony defects. Pioneering research on the use of autogenous bone grafts of both extra- and intraoral sources has been used successfully for periodontal regeneration [1]. This has been accepted as the gold standard for grafting materials. However, critical limitations for autogenous bone use include limited supply and possible need for multiple donor sites, and donor site morbidity can make this therapeutic approach less than desirable. Several surgical approaches shown to be effective in improving clinical and radiographic parameters such as clinical attachment level (CAL) and defect depth utilizing bone replacement grafts and/or guided tissue regeneration (GTR) are well documented in the literature [2–5]. However, these approaches have limitations in the predictability and effectiveness of regenerative therapy, inability to achieve vertical bone growth beyond the existing bony walls and therapeutic inconsistencies. This has resulted in the search for alternative regenerative strategies. More recently, tissue engineering approaches for periodontal regeneration involving grafting with scaffolding material (i.e., demineralized or mineralized freeze-dried bone allograft materials (DFDBA, FDBA) or tricalcium phosphate (TCP)), grafting and/or recruitment of mesenchymal stem cells (MSCs, also known as multipotential stromal cells), and the use of signaling molecules (i.e., growth factors such as recombinant human platelet-derived growth factor (rhPDGF), recombinant human fibroblast growth factor (rhFGF), and enamel matrix derivative R. T. Kao (*) Division of Periodontology, University of California, San Francisco, San Francisco, CA, USA Cupertino, CA, USA e-mail: [email protected] M. C. Fagan San Jose, CA, USA e-mail: [email protected] © Springer Nature Switzerland AG 2020 S. Nares (ed.), Advances in Periodontal Surgery, https://doi.org/10.1007/978-3-030-12310-9_7
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(EMD)) have been proposed to potentially overcome some of these limitations [6]. This has resulted in the extensive study of the use of biologics, like enamel matrix derivative (EMD) and recombinant human platelet-derived growth factor-BB plus β-tricalcium phosphate (rhPDGF-TCP) [7–12]. The past 15 years of studies have concluded that these biologic agents generally enhanced periodontal regeneration with comparable results similar to DFDBA and GTR. Additionally, it has been shown that these methods are superior to open flap debridement procedures in improving clinical parameters [13]. Long-term studies indicate that the improvements are maintainable up to 10 years, even in severely compromised teeth, consistent with a favorable, long-term prognosis. In search of improved healing response in advanced compromised periodontal intrabony defects, we have explored if augmentation of all three components of tissue engineering variables, namel
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