줄기세포 기반의 치주조직재생
Stem cell based periodontal regeneration
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초록
Periodontium is complex tissue composed of cementum, periodontal ligament and alveolar bone which holds the tooth in the bone. periodontitis is main cause of tooth loss leads to loss of attachment of connective tissue and irreversible bony destruction. So periodontitis has been one of the main concern to dentist, patient and oral health system. For recent years the main purpose of periodontics is regeneration of damaged peroidontium on shape, structure and function. In periodontal regeneration, new connective tissue fibers should be inserted in the cementum and bone, and construct the complex cementum-ligament-bone interfaces and provide a functional connection between a tooth and the surrounding jaw. Recently, many surgical, nonsurgical therapies and bone substitutes are using, but the clinical outcomes are still limiting. Bone transplantation or bone substitutes like guided bone regeneration, guided tissue regeneration don't have the capacity to regenerate destructed connective tissue. With cell based therapy, numerous growth factors and modulating agents have used but it made limited success. Stem cell based therapy is the most active researching field in medical and dental area. However, when diseased periodontal condition, tissue repair does not occur naturally because of the lack of sound stem cells. So exogenous regenerative tools such as ex vivo expanded/ manipulated stem cells will be needed to replenish the host cell niche and facililtate tissue regeneration. As the increasing success of regenerating other tissues(skin, cartilage, bone, cardiovascular component, pancreas), stem cell based periodontal regeneration with tissue engineering approach can be new field of treatment. Comparing stem cells from other sites of adult body, dental stem cells have advantage that is easy access to gaining site and have characteristics like proliferation, differentiation, and flexiblity. Some kind of reviewed stem cells, dental pulp stem cells (DPSCs), Stem cells from exfoliated deciduous teeth (SHED), PDL stem cells (PDLSCs), Stem cells from apical papilla, apical papilla stem cells (SCAP), Dental follicle cells (DFCs), and MSCs are most actively studied for stem cell based periodontal regeneration. However, safety problems are not completely examined, and the difficulty of ex vivo proliferation is still recognized to limiatation of stem cells. With effective stem cell delivery strategy, research to overcome these limitations should be continued. With recent advancement of stem cell based periodontal tissue engineering and periodontal regeneration, next step of research should be concentrated to clinical application of this advanced therapeutic method. Accordingly, further studies are required to develop new methods to identify and maintain multipotent stem cells in vitro and to determine the long term safety and efficacy of ex vivo expanded stem cells to repair periodontal defects in large animal models. With partial regeneration of tooth, whole tooth regeneration has been actively studied. When whole tooth regeneration succeed, regenerating periodontal ligament and contact of tooth-periodontium are needed to transplant regenerated tooth. So periodontal regeneration is essential step to achieve whole tooth regeneration and replantation.
Abstract
Periodontium is complex tissue composed of cementum, periodontal ligament and alveolar bone which holds the tooth in the bone. periodontitis is main cause of tooth loss leads to loss of attachment of connective tissue and irreversible bony destruction. So periodontitis has been one of the main concern to dentist, patient and oral health system. For recent years the main purpose of periodontics is regeneration of damaged peroidontium on shape, structure and function. In periodontal regeneration, new connective tissue fibers should be inserted in the cementum and bone, and construct the complex cementum-ligament-bone interfaces and provide a functional connection between a tooth and the surrounding jaw. Recently, many surgical, nonsurgical therapies and bone substitutes are using, but the clinical outcomes are still limiting. Bone transplantation or bone substitutes like guided bone regeneration, guided tissue regeneration don't have the capacity to regenerate destructed connective tissue. With cell based therapy, numerous growth factors and modulating agents have used but it made limited success. Stem cell based therapy is the most active researching field in medical and dental area. However, when diseased periodontal condition, tissue repair does not occur naturally because of the lack of sound stem cells. So exogenous regenerative tools such as ex vivo expanded/ manipulated stem cells will be needed to replenish the host cell niche and facililtate tissue regeneration. As the increasing success of regenerating other tissues(skin, cartilage, bone, cardiovascular component, pancreas), stem cell based periodontal regeneration with tissue engineering approach can be new field of treatment. Comparing stem cells from other sites of adult body, dental stem cells have advantage that is easy access to gaining site and have characteristics like proliferation, differentiation, and flexiblity. Some kind of reviewed stem cells, dental pulp stem cells (DPSCs), Stem cells from exfoliated deciduous teeth (SHED), PDL stem cells (PDLSCs), Stem cells from apical papilla, apical papilla stem cells (SCAP), Dental follicle cells (DFCs), and MSCs are most actively studied for stem cell based periodontal regeneration. However, safety problems are not completely examined, and the difficulty of ex vivo proliferation is still recognized to limiatation of stem cells. With effective stem cell delivery strategy, research to overcome these limitations should be continued. With recent advancement of stem cell based periodontal tissue engineering and periodontal regeneration, next step of research should be concentrated to clinical application of this advanced therapeutic method. Accordingly, further studies are required to develop new methods to identify and maintain multipotent stem cells in vitro and to determine the long term safety and efficacy of ex vivo expanded stem cells to repair periodontal defects in large animal models. With partial regeneration of tooth, whole tooth regeneration has been actively studied. When whole tooth regeneration succeed, regenerating periodontal ligament and contact of tooth-periodontium are needed to transplant regenerated tooth. So periodontal regeneration is essential step to achieve whole tooth regeneration and replantation.
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