Attachment formation following replantation of cultured cells into periodontal defects--a study in minipigs

Regeneration processes in the periodontium occur by the interaction of different cell populations. It is known that these cells are also capable of forming new periodontal tissue after culture in vitro. The present study investigated whether replanted cultured cells from the periodontium could contribute to attachment formation. Primary cell cultures from alveolar bone and periodontal ligament were obtained from 11 minipigs. Experimentally induced furaction and interdental defects (n = 168) were treated in groups: (a) flap surgery, replantation of alveolar bone cells, and covering of the defects with Teflon membranes (ABC group); (b) flap surgery, replantation of periodontal ligament cells and membranes (PLC group); (c) flap surgery, bone gelatin (carrier material) and membranes (BG group); (d) flap surgery and membranes (NBG group); (e) flap surgery (FS group); and (f) no treatment (NT group). The defects were clinically and histologically (polyfluorochrome labeling) assessed after 10, 30, and 90 days. In the ABC group, initial calcified tissue formation at the roots was apparent after only 8 days. Marked new formation of cementum and alveolar bone and the development of a new attachment were observed after 90 days. In the BG and the NBG groups, wound healing varied depending on membrane healing and the morphology of the defects, which led to significantly poorer and variable results. Similar results were found in the PLC group, although some defects showed extensive cementum and bone formation. Defects in the FS and the NT groups healed largely by epithelialization. The study shows that replantation of cultured alveolar bone cells leads to formation of new cementum and bone, which, in turn, leads to formation of a new attachment. It is likely that the cells stabilize the tissue formation in the defect or on the root surface in the early phase of wound healing and prevent epithelial downgrowth. Results also show that regeneration in the periodontium is determined by the availability of (precursor) cells capable of forming calcified tissues.