Periodontal disease is an inflammatory condition that results from a microbial biofilm on the surface of the root [1]. Characteristically, this condition involves an irreversible breakdown of connective tissue attachment and surrounding alveolar bone [2,3], which potentially possess significant negative impacts on both the appearance and function of the teeth [2,4]. Disease progression leads to an impact on the periodontal tissues [1,5]. The manual cleaning of plaque build-up enables the control of inflammatory responses, which is insufficient to facilitate the rejuvenation of the compromised periodontal structures [1,[6], [7], [8]]. For regenerating periodontium, various conventional strategies have been tested, which include surgical techniques and procedures [6,9,10], occlusive barrier membranes [11,12] bone grafts [[13], [14], [15]], and the use of osteoconductive and osteoinductive biomaterials [6,16] yet, they have numerous constraints for clinical applications [16].

Some of the moderately successful strategies are also applied for periodontal regeneration (PR), which includes guided tissue regeneration (GTR) [1,17,18] and enamel matrix derivative (EMD) [[19], [20], [21], [22]]. Recent studies have evaluated the clinical impact of local application of human recombinant growth factors, comprising platelet-derived growth factor (PDGF) [[23], [24], [25]], platelet-rich fibrin [26] and basic fibroblast growth factor (FGF)-2 on PR [27,28]. As an interdisciplinary domain, tissue engineering is shaped by three fundamental factors, including scaffold biomaterial, biochemical agents, and cell sources for PR to navigate the limitations of current strategies and to provide diverse opportunities for treating periodontal defects [16,25]. Stem cell-driven tissue engineering and regenerative medicine are regarded as innovative therapeutic approaches for PR [8,29].

The stem cells that have been most comprehensively studied include, bone marrow mesenchymal stem cells (BMSCs), adipose-derived stem cells (ADSCs), dental pulp stem cells (DPSCs), periodontal ligament stem cells (PDLSCs), gingival mesenchymal stem cells (GMSCs) and umbilical cord mesenchymal stem cells (UC-MSCs), which have undergone evaluation in various animal models for experimental PR and bone regeneration [8,[30], [31], [32], [33], [34]]. Mesenchymal stem cells (MSCs) derived from fat tissue can be collected non-invasively and more readily than from other tissues outlined above. Additionally, MSCs possess enhanced regenerative capabilities and proliferative abilities [1]. ADSCs are the type of MSCs, extracted from the adipose tissues enzymatically [35,36], possessing the ability to transform into various lineages of MSCs [36,37].

ADSCs enhance cell proliferation and promote wound healing, making them valuable for various medical treatments [38]. They have demonstrated promising outcomes in enhancing bone regeneration after post-traumatic osteomyelitis by differentiating into bone-forming cells [39]. ADSCs can stimulate cell growth, repopulate and repair cartilage [40], and support chondrocyte health. These cells have been employed in treatments for wound healing [41], 3D bioprinting of breast tissue [42], hair loss [43,44] and allografts [39]. They have also proven benefits in managing oral submucous fibrosis [45], breast cancer, pancreatic cancer, gastric cancer, and oral cancer [38]. Having said this, it is also hypothesised that ADSCs may also be beneficial for promoting the regeneration of periodontal tissues. Therefore, this narrative review objective is to find an association of PR with the application of ADSCs, through various animal models, human models and laboratory-based research.