Biomaterials for Cleft Lip and Palate Regeneration

Abstract

Craniofacial bone defect anomalies affect both soft and hard tissues and can be caused by trauma, bone recessions from tumors and cysts, or even from congenital disorders. On this note, cleft/lip palate is the most prevalent congenital craniofacial defect caused by disturbed embryonic development of soft and hard tissues around the oral cavity and face area, resulting in most cases, of severe limitations with chewing, swallowing, and talking as well as problems of insufficient space for teeth, proper breathing, and self-esteem problems as a consequence of facial appearance. Spectacular advances in regenerative medicine have arrived, giving new hope to patients that can benefit from new tissue engineering therapies based on the supportive action of 3D biomaterials together with the synergic action of osteo-inductive molecules and recruited stem cells that can be driven to the process of bone regeneration. However, few studies have focused on the application of tissue engineering to the regeneration of the cleft/lip and only a few have reported significant advances to offer real clinical solutions. This review provides an updated and deep analysis of the studies that have reported on the use of advanced biomaterials and cell therapies for the regeneration of cleft lip and palate regeneration.

Load Transfer during Magnetic Mucoperiosteal Distraction in Newborns with Complete Unilateral and Bilateral Orofacial Clefts: A Three-Dimensional Finite Element Analysis

“…However, in infants this would damage the dental follicles that are embedded in the palatal shelf ridges. Most tissue engineering studies have focused on the application of biomaterials purely for bone generation [37]. However, the palatal cleft comprises bone and two mucosal layers, which makes it a difficult target for biomaterial or tissue-engineering techniques.…”

Advances in Tissue Engineering Approaches for Craniomaxillofacial Bone Reconstruction

“…b. The scaffold should be three-dimensional, porous with highly interconnected pore structure (to guide bone in-growth, nutrient transport, metabolic waste removal, deliver bioactive agents) to act as bioreactor for growth of cells [13,22,27].…”

“…Periostium is a major source for osteoprogenitor cells whereas dura mater contains multipotent mesenchymal stem cells that facilitate skull bone healing through paracrine signaling, indicating that the indigenous surrounding tissues of the craniomaxillofacial skeleton such as dura mater, periostium, suture and bone marrow themselves play an important role in healing processes [5]. As the craniomaxillofacial region is associated with a variety of vital functions such as vision, hearing, speech, mastication, breathing and normal brain function, the injuries of this region caused due to trauma, tumor surgery or genetic defects results in critical defects which are difficult to reconstruct because of complexity of anatomical structure, variety of tissue specific requirements and restoration of esthetic facial features, seeking for facial harmony and most perfect symmetry [8,[12][13][14]. Furthermore, maxillectomy defects are more complex when critical structures such as the orbit, globe and cranial base are involved [12].…”

Extracellular Matrix Composition and Remodeling: Current Perspectives on Secondary Palate Formation, Cleft Lip/Palate, and Palatal Reconstruction

“…Bone graft options available, such as allogeneic bone (Shirani et al, 2017), xenogeneic bone (Thuaksuban et al, 2010), and alloplastic graft (Kumar et al, 2013;Seifeldin, 2016;Sharif et al, 2016), still do not promote effective palatal reconstruction, stimulating the search for better alternatives. To overcome the limitations of autologous and allogeneic bone grafts, studies have investigated the use of the association, or not, of osteoconductive biomaterials, such as hydroxyapatite and tricalcium phosphate, with autologous bone graft or growth factors, such as BMP, which is known to stimulate bone formation and repair (Horch et al, 2006;Weijs et al, 2010;Lazarou et al, 2011;Benlidayi et al, 2012;De Ruiter et al, 2015;Takemaru et al, 2016;Martín-Del-Campo et al, 2019). After the systematic review of 29 studies, just two were used for qualitative and quantitative analysis (Segura-Castillo et al, 2005;Dickinson et al, 2008).…”