Cell Sheet Engineering for Periodontal Regeneration - New Trends in Tissue Engineering and Regenerative Medicine - page 1

Chapter 1

Cell Sheet Engineering for Periodontal Regeneration

Takanori Iwata, Kaoru Washio, Toshiyuki Yoshida,
Isao Ishikawa, Tomohiro Ando,
Masayuki Yamato and Teruo Okano

Additional information is available at the end of the chapter

1. Introduction

Periodontitis is a world-wide infectious disease that destroys the tooth-supporting attach‐
ment apparatus, which consists of alveolar bone, cementum, and periodontal ligament. Re‐
cent studies have reported numerous associations between periodontitis and systemic
diseases, such as cardiovascular disease (de Oliveira et al., 2010) and diabetes mellitus (Lalla
and Papapanou, 2011), as well as a higher risk of preterm low birth-weight babies (Offen‐
bacher et al., 1996). Furthermore, researches have recently shown that Bisphosphonate-Re‐
lated Osteonecrosis of the Jaws (BRONJ) is also associated with severe periodontitis
(Vescovi et al., 2011). Therefore, periodontal treatment may not only contribute to oral hy‐
giene but also improvement of systemic conditions (Seymour et al., 2007). Conventional
treatments, such as scaling, root-planing, and surgical cleaning, have been performed to re‐
move the bacteria and contaminated tissue. However, these procedures frequently result in
the formation of a weak attachment, a condition termed “long junctional epithelium (LJE)”
(Caton et al., 1980), wherein the patients tend to present with a recurrence of disease with‐
out maintenance therapies (Axelsson and Lindhe, 1981). To overcome this problem, various
regenerative therapies, such as guided tissue regeneration (GTR) and enamel matrix deriva‐
tive, have been introduced in clinical practice. The use of cell-occlusive membranes for GTR
is regarded as the first generation of periodontal regeneration, whereas the development
and use of growth factors and endogenous regenerative technology for periodontal regener‐
ation is regarded as the second generation of periodontal regeneration (Ishikawa et al.,
2009). However, the outcomes of these studies were limited and associated with poor clini‐
cal predictability (Esposito et al., 2009). Therefore, stem cell-based approaches for periodon‐
tal regeneration have been studied and translated into clinical settings as the third