VERY EARLY INTERVENTION THROUGH GERMECTOMY WITH PIEZOSURGERY AND RESULTING ISOLATION AND OSTEOGENIC DIFFERENTIATION OF DENTAL FOLLICLE STEM CELLS

Aim. Stem cells are defined as clonogenic cells capable of self-renewal and multi-lineage differentiation. A population of these cells has been identified in human Dental Follicle (DF). Dental Follicle Stem Cells (DFSCs) were found in pediatric unerupted wisdom teeth and have been shown to differentiate, under particular conditions, into various cell types of the mesenchymal tissues. The aim of this study was to investigate if cells, isolated from DF, can differentiate into osteoblastic phenotype and express osteoblastic markers. Materials and methods. Bone remodeling is the process maintaining bone mass and occurs during the whole life; it is regulated by osteoblast differentiation and activity and it is influenced by many pathological events that could determine bone loss. Osteoblast differentiation has been studied starting from mesenchymal stem cells of the bone marrow or periosteum. Stem cells are defined as clonogenic cells and they are capable of self-renewal and multi-lineage differentiation. To date, in human postnatal dental tissues, five different sources of MSCs have been already identified: dental pulp, periodontal ligament, exfoliated deciduous teeth, dental follicle and root apical papilla. Dental Follicle Stem Cells (DFSCs) were found in young patients wisdom teeth and they have been shown their capability to differentiate, under particular conditions, into various cell types of the mesenchymal tissues. All early germectomies were performed with Piezoelectric Bone Surgery technique, in that this technique compared to the traditional instruments, has the advantage to be less invasive, thus reducing post- operative complications and improving a positive biological response to healing. That’s why, whether it is performed in the right timing, can be more effective. We have studied the immunophenotype of DFSCs through flow cytometric analysis, the osteoblastic markers of differentiated DFSCs were assayed by histochemical methods and real-time PCR. Results. We have proved that DFSCs are easily obtained from wisdom teeth, a source of easier access than bone marrow and periosteum and succeed in differentiating into osteoblast-like cells, producing mineralized matrix nodules and expressing the typical osteoblastic markers, Alkaline Phosphatase (ALP) and Collagen I (Coll I). Conclusions. We have demonstrated with our work that DFSCs in accordance with established criteria can be defined MSCs and have a remarkable osteogenic potential. Therefore, the ability of these stem cells to differentiate into osteoblasts is certain: firstly, they are cultured in an osteogenic induction medium so that several clusters of cells adhere, assume an osteoblast-like morphology and express the typical osteoblastic marker such as ALP and Coll I. Secondly, DFSCs formed mineralized matrix nodules showing a mature osteoblast exclusive characteristic. DFSCs have a similar, if not identical, potential of BMSCs, but, by contrast, they come from a dental bug that could generate a problematic wisdom tooth and proliferate at a higher rate. Therefore, DFSCs could be used for stomatognathic bone regeneration and other systems, and represent an excellent cell source for tissue engineering therapy. In addition, DFSCs can differentiate into the other cells of the connective tissues, thus, more diversified clinical applications should be investigated. As a potential stem cell source, dental stem cell banking may be a necessary step and further progresses on establishing individualized induced pluripotent stem cells for dental tissue regeneration should be imminent.