In Vitro Evaluation of the Human Gingival Fibroblasts - GMSCs Dynamics Through Perforated Guided Tissue Membranes: Cell Proliferation, Migration and Membrane Stiffness Assay

Abstract

Chronic periodontitis is an inflammatory disease that causes gradual destruction of the tooth-supporting tissues including periodontal ligaments, cementum and alveolar bone (1). Regenerative periodontal therapy aims at restoration of the original pattern and function of the tooth supporting apparatus. However, it is still a challenging task with unpredictable outcome in most situations. Guided tissue regeneration (GTR) is considered the most well documented procedure for periodontal regeneration especially for intrabony defects and class II furcation defects(2). The concept of GTR was introduced in the mid-1980s by Gottlowet al. as they observed through an animal study that the placement of a membrane over denuded root surfaces favored new attachment formation compared to control roots treated by open flap debridement(3). The rationale behind GTR is that using a physical barrier over the denuded root surfaces prevents migration of gingival epithelium and connective tissue and offers selective guidance for cells originating from periodontal ligament and alveolar bone to repopulate the wound area and proliferate to reform the lost tissue compartments (2-4). Scantlebury described five essential design criteria for membranes used for guided tissue regeneration. These criteria include biocompatibility, space-provision, cell-occlusiveness, tissue integration and clinical manageability(5).Barrier membranes are classified according to their degradation rate into nonresorbable and bioabsorbable categories. Currently, the most commonly used nonresorbable material is the expanded polytetrafluoroethylene (ePTFE) membrane. Examples of bioabsorbable membranes include collagen, polylactic acid, polyurethane, polyglactin, acellular dermal matrix, dura mater, periosteum, and chitosan(2). Comparative studies have shown that resorbable collagen membranes have similar clinical effectiveness as non-resorbable membranes. When compared to open flap debridement, collagen barriers have shown better probing depth reduction, clinical attachment level (CAL) gain, and defect fill(6).Collagen membranes have the advantages of easy manipulation, and weak immunogenicity. Collagen also shows a hemostatic function, as it can aggregate platelets, facilitating early clot formation and wound stabilization. In addition, collagen possesses a chemotactic