Periodontal regeneration with polypeptide growth factors

Attempts at periodontal regeneration have been plagued by inconsistent results. The failures associated with these procedures are likely due to an insufficient number of cells themselves lacking sufficient activity to produce the supporting structures of the periodontium. Molecular studies have provided insight into the regenerative process by identifying locally acting mediators expressed during healing. These mediators, termed growth factors, may stimulate a wide variety of cellular events, including chemotaxis, proliferation, differentiation, and production of extracellular matrix proteins. Thus, the use of polypeptide hormones to enhance regeneration is based on the concept that the effect of the mediators that are naturally present can be enhanced by the addition of exogenous growth factors. Based on information originally obtained from in vitro studies, investigators have recently attempted to enhance bone formation and periodontal regeneration by using growth factors. This review focuses on five growth factor families that have potential for inducing periodontal regeneration based on their ability to stimulate osteoblasts and periodontal ligament cells in vitro or in vivo. These include platelet-derived growth factor, insulin-like growth factor, transforming growth factor-beta, fibroblast growth factor, and bone morphogenetic protein.