Comparative evaluation of efficacy of stem cells in combination with PLA/PGA membrane versus sub-epithelial connective tissue for the treatment of multiple gingival recession defects: a clinical study.

BACKGROUND: Umbilical Mesenchymal Stem Cells possess immunoregulatory capacities that have been permissive to allogenic transplantation. Recent animal studies have demonstrated histologically that bone marrow- derived mesenchymal stem cells (MSCs) may enhance the regeneration of periodontal defects in dogs by differentiating MSCs into cementoblasts, osteoblasts and periodontal fibroblasts. AIM: To compare the clinical efficacy between stem cells in combination with PLA/PGA membrane and subepithelial connective tissue graft (SCTG) in the treatment of multiple gingival recession defects. METHODS: Twenty four patients aged between 20 to 33 years (mean age 27.41 ± 1.06 years) with multiple gingival recession defects on labial or buccal surface of the teeth in the aesthetic zone either in maxilla or mandible were treated. The test group was treated using stem cells cultured on bioresorbable PLA/PGA membrane, while control group was treated using SCTG. Following parameters were assessed, Plaque Index (PI),Gingival Bleeding Point Index (GBI), Relative gingival margin level (RGML), Relative attachment level (RAL) and Probing pocket depth (PPD) Results: In the test group, mean percent defect coverage was 72.43 ± 13.55 % and the predictability was 41.17% for root coverage i.e 14 of 34 defects, while in the control group, mean percent defect coverage was 82.06 ± 10.99 % and the predictability was 50 % for root coverage i.e 15 of 30 defects. CONCLUSION: Stem cells in combination with bioresorbable PLA/PGA membrane was effective for root coverage resulted in a significant reduction in gingival recession, greater gain in CAL and WKG. Stem cells in combination with bioresorbable PLA/PGA membrane resulted in significantly higher CAL gain than SCTG.

Human periodontal ligament fibroblast response to rhPDGF-BB application on periodontally diseased root surfaces-in vitro.

The aim of the present study was to evaluate the influence of recombinant platelet derived growth factor-BB (rhPDGF-BB) on the cellular proliferation, morphology and adherence of human periodontal ligament fibroblasts (PLFs) to the root surfaces of periodontally diseased and healthy human teeth roots at two different time periods. Primary cell cultures of PLFs were obtained from clinically healthy premolar or mandibular third molar teeth. 11 scaffolds were prepared from healthy teeth for group-1 (Healthy Substrates), 33 scaffolds were prepared from periodontally diseased teeth, which were further divided in Group-2 - Periodontally diseased substrates, Group-3 - Scaled and Root planed (SRP) substrates, Group-4 - SRP + rhPDGF-BB (50 ng/ml). Groups were further subdivided into two groups (n = 5 scaffolds per subgroup) and PLFs were incubated on the scaffolds for three and seven days, topographical assessment was done on the remaining substrate. Cell morphology and counting was assessed under a scanning electron microscope at 350× on day three and seven and statistically compared with the Mann-Whitney U test and the Kruskal-Wallis test. On day three, Group 1 showed least number of cells attached, whereas maximum number of cells were attached on Group 3 (SRP only) substrates. For day 7, Group 1 and Group 4 showed increase in the number of cells from day 3 to 7, while number of cells attached/substrate reduced drastically for Group 2 and 3 substrates. Group 3 and 4 showed better adhesion and proliferation of PLFs as compared to Group 1 and 2. Group-1 and Group-4 showed predominantly spindle cells with flat appearance, Group-3 showed stellate cells and Group-2 showed predominantly distorted spindle shaped cells. The results of this in-vitro study indicates that rhPDGF-BB plays a significant role as an adjunct to periodontal therapy in influencing maturity, attachment and proliferation of PLFs.