Periodontal Ligament Cell Sheet Engineering: A new Possible Strategy to Promote Periodontal Regeneration

Introduction: Osseointegration represents a direct structural and functional connection between ordered, living bone and the surface of a load-carrying implant without the periodontium. As a result, im-plant fracture or aggressive bone loss sometime occurs because the patient cannot feel the mechanical overloads exerted on the implant. Until now, no available method has been used to solve this problem.The hypothesis: Periodontal ligament (PDL) cells are a desirable cell population capable of regenerating a functional periodontal at-tachment apparatus. Cell sheet engineering has emerged as a novel alternative approach for periodontal tissue engineering without the disruption of both critical cell surface proteins such as ion channels, growth factor receptors and cell-to-cell junction proteins. PDL cells can be isolated from an extracted tooth and can be cultured on temperature-responsive culture dishes at 37°C. Transplantable cell sheets can be harvested by reducing the temperature to 20°C, and would be transplanted into the implant beds before insertion of the implant.Evaluation of the hypothesis: Controlling the differentiation of PDL cell sheets to different functional peri-implant periodontal tissues is very difficult. Further studies are required to determine the fate of implanted cells. Fluorescence protein-labeled cell sheets would be a good approach to investigate the fate of the grafted cell sheet.