Comparative evaluation of dental pulp and periodontal ligament stem cell sheets for rescuing periodontal-like tissue formation in cryopreserved tooth autotransplantation

Autologous tooth transplantation (ATT) is a biologically based approach for the management of tooth loss, particularly among adolescents. However, its broader application is limited by challenges associated with tooth cryopreservation and stem cell-based strategies, and current solutions remain suboptimal. This study compared dental pulp stem cells (DPSCs) and periodontal ligament stem cells (PDLSCs) with respect to their multilineage differentiation potential and proliferative capacity. The structural and physiological characteristics of dental pulp stem cell sheets (DCS) and periodontal ligament stem cell sheets (PCS) were assessed using RT-qPCR, western blotting, and immunohistochemistry. A rat model of subcutaneous autogenous tooth transplantation was established to histologically evaluate the effects of PCS and DCS on periodontal-like tissue regeneration following frozen tooth transplantation. DPSCs and PDLSCs exhibited substantial similarities in both multilineage differentiation and proliferative activity. DCS and PCS share comparable structural and physiological properties; notably, DCS expresses periodontal tissue-associated proteins, including cementum attachment protein (CAP) and periodontal ligament-associated protein 1 (PLAP-1). In the rat model, both PCS and DCS significantly promoted periodontal-like tissue formation with features of cementum, periodontal ligament, and alveolar bone after transplantation of frozen teeth. DCS and PCS facilitate periodontal-like tissue regeneration in the context of cryopreserved tooth transplantation. These findings provide preliminary evidence supporting the application of periodontal tissue engineering in delayed autotransplantation and lay the groundwork for future large-animal preclinical studies. Delayed tooth autotransplantation has traditionally been limited to younger populations and immediate clinical scenarios due to its reliance on fresh PDLSCs. In this study, cell sheet technology was applied for the first time in the context of frozen tooth autotransplantation. Through cytological analyses, histological evaluation of cell sheets, and in vivo animal experiments, we preliminarily assessed the potential of PCS and DCS to support periodontal-like tissue regeneration. These findings represent a step forward in periodontal tissue engineering for transplanted teeth and may inform future strategies for the reconstruction of dentition defects—although long-term functional outcomes and clinical applicability remain to be established.