Decellularized porcine pericardium supports periodontal ligament tissue regeneration and attenuates root resorption in a tooth replantation model

Tooth replantation is often compromised by the loss of periodontal ligament (PDL) integrity, leading to inflammatory root resorption and treatment failure. In this study, we investigated the regenerative potential of decellularized porcine pericardium (DPP), manufactured by either high hydrostatic pressure or surfactant decellularization. After evaluating the structural integrity and mechanical characteristics of the DPP, it was wrapped around the roots of extracted rat teeth to observe the biological response. PDL cells migrated onto the surface of DPP, establishing connection between DPP and PDL tissue. When rat molars were replanted with DPP wrapped around the root, recellularization of DPP and restoration of PDL were observed, along with the gradual augmentation of periostin-positive area within the PDL space. Severity of root resorption and inflammation was suppressed in DPP-wrapped roots. These findings suggest that DPP supports PDL regeneration and can serve as a clinically applicable material for improving tooth replantation outcomes.