Evaluation of Dental Pulp Stem Cells (DPSCs) in Periodontally Accelerated Osteogenic Orthodontics (PAOO) for Enhancing Alveolar Bone Thickness and Reducing Orthodontic Treatment Duration-A Pilot Clinical Study.

INTRODUCTION: Adult orthodontic patients often require prolonged treatment and heightened periodontal risks, especially in bimaxillary protrusion with thin labial bone. Periodontally Accelerated Osteogenic Orthodontics (PAOO) has been shown to shorten treatment duration and enhance periodontal safety. This quasi-experimental pilot study evaluated the feasibility of PAOO using Freeze- Dried Demineralized Bone Allograft (FDDBA) with or without Dental Pulp Stem Cells (DPSCs) embedded in Festigel. METHODS: Thirty adults were assigned to Group I: conventional treatment (control), Group II: PAOO with FDDBA, or Group III: PAOO with FDDBA + DPSCs in a Festigel scaffold. This was a prospective, non-randomized, patient-preference quasi-experimental pilot study. DPSCs were isolated, cultured, and delivered in a Festigel scaffold during corticotomy. The primary outcome measure was orthodontic treatment duration. Secondary outcomes included alveolar bone thickness and root resorption assessed using CBCT-based qualitative grading. RESULTS: Twenty-two participants completed the study: Group I, control (n=9); Group II, PAOO with FDDBA (n=7); and Group III, PAOO with FDDBA + DPSCs (n=6). Both PAOO groups showed significantly shorter treatment duration, approximately 13.5 months, compared with the control group, 24.8 months. Qualitative CBCT-based grading showed the greatest improvement in bone thickness in the PAOO + FDDBA + DPSCs group, followed by the PAOO + FDDBA group. However, the difference between these two groups was not statistically significant. Periodontal health remained excellent throughout the study in all groups. No serious adverse events were observed during the available follow-up period. DISCUSSION: PAOO with grafting, with or without DPSCs, reduced orthodontic treatment time and helped maintain alveolar bone thickness compared with conventional orthodontics. Although the PAOO + FDDBA + DPSCs group showed a favourable trend in bone thickness, the added clinical benefit of DPSCs over graft alone was not statistically significant. CONCLUSION: This first-of-its-kind pilot clinical study using DPSCs in PAOO demonstrated that both PAOO approaches, with and without DPSCs, reduced orthodontic treatment time and maintained alveolar bone thickness compared with conventional orthodontics. However, the improvement with DPSCs was modest and statistically non-significant. Future large-scale, longer-duration clinical trials are needed to validate the DPSC-based PAOO approach for routine clinical application.