Stem Cells in Periodontal Regeneration: A Systematic Review

Introduction

The periodontium, the supporting tissue of teeth, is permanently damaged in periodontitis. Conventional treatments such as guided tissue regeneration and bone grafting are limited by infection risk, membrane exposure, and the need for secondary surgery. Stem cell therapy offers a potential biological alternative aimed at tissue reconstruction rather than mere repair.

Aim

To evaluate the regenerative potential of stem cells in periodontal tissue reconstruction and the current clinical evidence supporting their use.

Methods

This systematic review was conducted in accordance with PRISMA guidelines using PubMed only, acknowledged as a limitation. Search terms included combinations of "stem cells," "periodontal regeneration," and "dental pulp stem cells," restricted to human studies from 2014 to 2024. Of 5,164 articles identified, 56 were screened by title and abstract, 12 underwent full-text review, and 6 studies met inclusion criteria. No formal risk-of-bias assessment tool was applied, a further limitation.

Results

Dental pulp stem cells (DPSCs) were the most frequently studied. Evidence was mixed, drawn from both clinical trials and systematic reviews, showing improved clinical attachment level, reduced probing depth, and radiographic bone fill at treated sites, at both hard and soft tissue levels.

Conclusion

Stem cell therapy, particularly using DPSCs, appears promising for periodontal regeneration, but current evidence remains limited and heterogeneous. Further well-designed randomised controlled trials, multi-database searches, and formal risk-of-bias evaluation are required before clinical translation can be recommended.

Limitations

Single-database search, small number of included studies (n = 6), mixed study designs, and absence of formal risk-of-bias assessment limit the strength of conclusions drawn.

Keywords: Periodontal regeneration, stem cells, dental pulp stem cells (DPSCs), mesenchymal stem cells, alveolar bone regeneration, clinical attachment level, probing depth, tissue engineering, periodontitis, PRISMA, risk of bias.