Therapeutic efficacy of mesenchymal stem cells in periodontal regeneration: a systematic review and meta-analysis of clinical trials.

BACKGROUND

Periodontitis is a major global health problem that leads to destruction and loss of periodontal tissues. As conventional therapy has a limited capacity to restore the complex architecture of the periodontium, regenerative approaches have been explored. This meta-analysis evaluates the therapeutic efficacy of mesenchymal stem cells (MSCs) for periodontal regeneration in patients with periodontal defects.

METHODS

PubMed, Scopus, Web of Science, Dentistry & Oral Sciences Source, and the Cochrane Library were searched for clinical trials. The risk of bias was assessed using Cochrane RoB2. Random- or fixed-effects meta-analyses were used in the pooled analysis and reported as mean differences (MDs) and 95% confidence intervals (CIs). Certainty of evidence was rated using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE).

RESULTS

Ten clinical trials were included in the analysis. MSCs significantly improved probing pocket depth (MD, -0.51; 95% CI, -0.84 to -0.19; p<0.01; I2=62%), clinical attachment level (MD, -0.75; 95% CI, -0.95 to -0.54; p<0.01; I2=40%), cementoenamel junction to the base of defect (MD, -0.49; 95% CI, -0.95 to -0.02; p=0.04; I2=63%), and intrabony defect (MD, -1.09; 95% CI, -1.60 to -0.57; p<0.01; I2=71%). However, no significant improvement in gingival recession was observed (MD, -0.18; 95% CI, -0.38 to 0.01; p=0.07; I2=0%). The GRADE assessment indicated a high-to-moderate certainty.

CONCLUSION

MSCs represent a promising strategy for periodontal regeneration. Nevertheless, the limited number of studies and the observed heterogeneity warrant cautious interpretation. Larger methodologically rigorous trials are needed to clarify the true contribution of MSCs to periodontal regeneration.