Advances in tissue engineering strategies for periodontal and endodontic regeneration: Current therapies and future trends for disease treatment and tissue repair in the oral cavity

Tissue damage within the oral cavity caused by periodontal and endodontic diseases impart significant socioeconomic and healthcare impacts on the global population. In addition to the negative aesthetic effects, such oral diseases cause increased pain and discomfort during everyday activities and advanced forms of these diseases can ultimately result in tooth loss. This motivates the need for novel therapies aimed at regenerating tissues inside and around the tooth or, in the case of tooth extraction, to promote development of sufficient tissue volume to allow for implant placement. Tissue engineering strategies typically combine three-dimensional biomaterial scaffolds, cells and biologics in order to regenerate or replace damaged or diseased tissues. This review will focus on advances in tissue engineering applications within the oral cavity, with a particular emphasis put on periodontal and endodontic tissue regeneration. To that end, we begin by describing the aetiology and progression of the disease states that cause damage to tissues inside and surrounding the tooth and, furthermore, will describe the procedures that are currently used clinically in the treatment of these conditions. Subsequently, biomaterial-based approaches that can be leveraged to promote regeneration of periodontal and endodontic tissues are explored and, thereafter, the advances made in enhancing the efficacy of these biomaterials through the use of cells and biologics outlined. Finally, we describe the state-of-the-art technologies that are envisaged to become disruptive in the field as it moves towards the goal of functional periodontal and endodontic tissue engineering.