Clinical implications of cellular biologic advances in periodontal regeneration

It is known that periodontal tissues retain the ability to regenerate; however, current therapies fail in achieving predictable and consistent regeneration. Cell and molecular biology research in periodontal regeneration hold great promise in providing improved understanding of this complex phenomenon and direct us towards new possibilities of future clinical application. This paper reviews both the cells and extracellular matrix of the periodontal ligament in addition to the cell-to-matrix and cell-to-cell interaction involved in periodontal regeneration. Results of recent studies have suggested that periodontal regeneration recapitulates the process of morphogenesis, histogenesis, and cytodifferentiation, as well as cell field migration that occurs during development of the periodontium. A small population of purported periodontal stem cells is believed to be responsible for maintaining homeostasis in the periodontal ligament. This cell, which may have its origin in late periodontal mesenchyme of the dental papilla, is advocated as a tripotential cell capable of differentiating into cementoblast, osteoblast, and periodontal fibroblast. The clinical implication of advances made in cell and molecular biology research in periodontal regeneration may include future use of biomolecules in periodontal regeneration may include future use of biomolecules to improve the regenerative healing process and use of bioactive degradable membrane barriers in guided tissue regeneration as well as seeding of periodontal stem cells into periodontal defects. If the current trend continues, clinicians can look forward to seeing periodontal wound healing being substantially enhanced to achieve predictable periodontal regeneration.