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Katie Ferguson and Amanda Means

Mrs. Lori Rogers
Dental Hygiene 2015
April 17, 2014
Regeneration of the Periodontium Using Dental Stem Cells
Bone and tooth loss has always been irreversible at least until now. Studies have shown
that stem cells have the ability to regenerate bone in the orofacial region. Caries, periodontal
disease, and fractures are just a few forms of bone and tooth loss that can now be repaired with
stem cells. When we hear the term stem cells, the majority of us probably assume that there is
only one entity that stem cells come from: embryos. The truth is stem cells can be found almost
anywhere in the human body including the periodontium. The periodontium is a complex tissue
composed mainly of two soft tissues and two hard tissues; the former includes the periodontal
ligament (PDL) tissue and gingival tissue, and the latter includes alveolar bone and cementum
covering the tooth root (Maeda, Tomokiyo, Fujii, Wda, Akamine). Today we will be discussing
the different types of stem cells, the benefits of using dental stem cells, and the storage of your
own dental stem cells.
Tooth loss or absence is a frequent situation that results from numerous pathologies such
as periodontal disease, dental caries, fractures, injuries, or even genetic alterations (Shilpa,
Kaul, Sultana, and Bhat 149-154). As mentioned earlier, the loss of bone is irreversible. Up
until now treatment for any form of bone and tooth loss such as caries and fractures has entailed
replacing the missing tooth structure with synthetic material, the patients own tissue, or metallic
alloy to name a few. Certain synthetic materials such as implants will only work if there is
enough bone structure to support it. Therefore, treatment can result in failure. Stem cells
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however, have been able to produce orofacial bone structures which reduce the loss of a tooth
structure.
Stem cells are master cells that generate tissue and organs following trauma or disease
(Mao, 173). Stem cells are classified as embryonic stem cells or adult stem cells. Embryonic
stem cells are derived from embryos; however, to obtain the embryonic stem cells the embryo is
destroyed. This leads to technical and ethical problems. Embryonic stem cells can develop into
almost any tissue, ranging from neurons to muscles to perhaps teeth (Shilpa, Kaul, Sultana, and
Bhat 149-154). Embryonic stem cells can be difficult to grow and unless controlled excessive
growth can cause tumor formation. Adult stem cells have less of an ethical concern. Adult stem
cells have restricted ability to proliferate and are theoretically found in every type of tissue,
such as bone marrow, adipose tissue, umbilical cord, and teeth (Shilpa, Kaul, Sultana, and Bhat
149-154). Though stem cells have a great regenerative ability, their application in dental therapy
is still problematic (Eleuterio, Trubiani, Sulpizio, Giuseppe, Pierdomenico, Marchisio,
Giancola, Giammaria, Miscia, Caputi, Ilio, and Angelucc 1-10). A newer classification of adult
stem cells is dental stem cells. Human dental stem cells have high proliferative potential for
self-renewal that is important to the regenerative capacity of the tissue (Navabazam , Nodoshan,
Sheikhhan , Miresmaeili, Soeimani , and Fesahar 235-241).
To date 5 different human dental stem cells have been described in literature: dental
pulp stem cells, stem cells from exfoliated deciduous teeth, periodontal ligament stem cells, stem
cells from apical papilla, and dental follicle stem cells (Eleuterio, Trubiani, Sulpizio, Giuseppe,
Pierdomenico, Marchisio, Giancola, Giammaria, Miscia, Caputi, Ilio, and Angelucc 1-10).
Dental pulp stem cells generate a dentin, pulp like complex (Shilpa, Kaul, Sultana, and Bhat
149-154). Stem cells from exfoliated deciduous teeth, also known as SHED, have a higher
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proliferation rate compared to permanent teeth (Shilpa, Kaul, Sultana, and Bhat 149-154).
SHED has the ability to transform into odontoblast-like cells which influence dentin formation.
Periodontal ligament stem cells are isolated from root surface of extracted teeth and
differentiate into cells or tissues very similar to periodontium (Shilpa, Kaul, Sultana, and Bhat
149-154). Stem cells from the apical papilla can be collected from the root apex of human teeth.
Stem cells from the apical part of the papilla can only be isolated at a certain stage of tooth
development, but have a greater capacity from dentin regeneration than dental pulp because the
dental papilla contains a higher number of adult stem cells compared to the mature dental pulp
(Shilpa, Kaul, Sultana, and Bhat 149-154). Due to rapid growth of stem cells from the apical part
of the papilla they are acceptable for producing root structure. Dental follicle stem cells have the
capability to produce bone, periodontal ligament, and cementum. These five forms of dental stem
cells have all proven to regenerate tissue in the orofacial region.
Currently dental stem cell research focuses on regeneration of dentine, pulp and teeth;
alveolar bone; regeneration of the periodontal ligament after periodontal disease; salivary gland
regeneration after radiation therapy; repair craniofacial defects; and in the treatment of lichen
planus (Shilpa, Kaul, Sultana, and Bhat 149-154). Dental tissue stem cells reproduce some
dental tissues when treating tooth loss or tooth defects. Researchers are focused on regenerating
a whole tooth by transplanting artificial tooth germ and allowing it to develop in the adult oral
environment (Shilpa, Kaul, Sultana, and Bhat 149-154). Using periodontal ligament stem cells
from human teeth that have been extracted and dental follicle stem cells, a new technique has
been discovered for transplanting those cells, which could mean another cell source for therapy
of periodontal regeneration. Periodontal ligament stem cells have shown to regenerate collagen
fibers and cementum/periodontal ligament like structures (Shilpa, Kaul, Sultana, and Bhat 149-
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154). Head and neck cancer that involves radiation treatment can cause hyposalivation.
According to studies, stem cell therapy could reduce hyposalivation that is caused by radiation,
which means that the patients quality of life would improve. Due to major improvement in stem
cell research, there is a great possibility of xerostomic conditions being treated by stem cell
therapy. As of now autologous bone grafts is the best route for craniofacial repair, but the use of
dental and skeletal stem cells could in the future repair craniofacial bone. This means a
promising approach for reconstruction of craniofacial defects (Shilpa, Kaul, Sultana, and Bhat
149-154). Treating oral lichen planus is a challenge as of today. Studies have shown that
mesenchymal stem cells can be used to treat patients with oral lichen planus. This is done by
local application or systemic infusion. Since studies have proven to produce results using stem
cells in the orofacial region, the next step is retrieving and storing the patients stem cells.
Dentists and hygienists must stay current with the developing research of stem cells being
used to treat the orofacial region so they can educate patients on the advantages and
disadvantages of stem cell storage. However, the ultimate decision should be the patients own
when it comes to storing their stem cells. If the patient chooses to store their dental pulp stem
cells, the pulp chamber of the extracted or deciduous tooth that has been exfoliated would be
opened to remove the cells. The isolated cells are then stored under ultra-low temperature to
induce the arrest of cellular activities (Mao, 173). There are storage banks that will store the
patients stem cells; however, it can be costly to do so. Therefore, the patient should weigh the
risk over benefit and make the ultimate decision.
The hope of a time when people no longer have to suffer from bone and tooth loss is
within our grasp and dental stem cells are making this vision a very near reality. Knowledge of
stem cells has created promising techniques for regenerative dentistry....and will replace
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damaged teeth or metal implants in the future. (Navabazam , Nodoshan, Sheikhhan ,
Miresmaeili, Soeimani , and Fesahar 235-241). We as dental professionals are in an ever
changing and evolving career. It is our responsibility to continually expand our education to
better improve the care and quality of life for our patients. A profession that fails to advance
itself by new knowledge is not a profession that lasts (Mao, 173).




















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Works Cited

Eleuterio, Enrica, Oriana Trubiani, Marilisa Sulpizio, Fabrizio Di Giuseppe, Laura
Pierdomenico, Marco Marchisio, Raffaella Giancola, Gianluigi Giammaria, Sebastiano
Miscia, Sergio Caputi, Carmine Di Ilio, and Stefanni Angelucci. "Proteome of Human
Stem Cells from Periodontal Ligament and Dental Pulp." PLOS ONE 8.8 (2013): 1-10.
Web. 12 Nov. 2013.
<http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0071101>.

Maeda, Hidefumi, Atsushi Tomokiyo, Shinsuke Fujii, Naohisa Wada, and Akifumi Akamine.
"Promise of Periodontal Ligament Stem Cells in Regeneration of Periodontium." Stem
Cell Research & Therapy 2.4 (2011): N. pag. Web. 12 Nov. 2013.
<http://stemcellres.com/content/2/4/33>.
Mao, Jeremy. "Stem Cells and Dentistry." The Journal of Dental Hygiene 83.4 (2009): 173. Web.
12 Nov. 2013. <http://jdh.adha.org/content/83/4/175.full.pdf>.

Navabazam M.D., Ali Reza, Fatemeh Sadeghian Nodoshan M.Sc., Mohammad Hasan Sheikhhan
M.D. Ph.D., Sayyed Mohsen Miresmaeili M.Sc., Mehrdad Soeimani B.Sc., and Farzaneh
Fesahar M.Sc.. "Charaterization of Mesenchymal Stem Cells from Human Dental Pulp,
Periapical Follicle and Periodontal Ligament." Iranian Journal of Reproductive Medicine
11.3 (2013): 235-241. Web. 12 Nov. 2013. <http://www.bioline.org.br/pdf?rm13031>.


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Shilpa, P.S., Rachna Kaul, Nishat Sultana, and Surakasha Bhat. "Stem Cells: Boon to Dentistry
and Medicine." Dental Research Journal 10.2 (2013): 149-154. Web. 30 Mar. 2014.
<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3731952/>.