Is Reconstruction of Large Mandibular Defects Using Bioengineering Materials Effective?

Melville, James C.; Tran, Huy; Bhatti, Arsalan K.; Mañón, Victoria A.; Young, Simon; Wong, Mark

doi:10.1016/j.joms.2019.11.024

Cited by 24 publications

(13 citation statements)

References 31 publications

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“…In the case of smaller defects, healthy patients and sufficient vascularization in the defect area, bone healing can be achieved with nonvascularized grafts 17 . In a retrospective case series of mandibular defect reconstructions, it is emphasized that tissue-engineered constructs represent an optimal alternative to autografts even for large defects, but only if there is an adequate vascular supply in the defect area surrounding the tissue-engineered transplant 18 . There are various methods described for introducing vascularization within clinically applied tissue-engineered constructs.…”

Section: Discussionmentioning

confidence: 99%

Personalized medicine for reconstruction of critical-size bone defects – a translational approach with customizable vascularized bone tissue

et al. 2021

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Tissue engineering principles allow the generation of functional tissues for biomedical applications. Reconstruction of large-scale bone defects with tissue-engineered bone has still not entered the clinical routine. In the present study, a bone substitute in combination with mesenchymal stem cells (MSC) and endothelial progenitor cells (EPC) with or without growth factors BMP-2 and VEGF-A was prevascularized by an arteriovenous (AV) loop and transplanted into a critical-size tibia defect in the sheep model. With 3D imaging and immunohistochemistry, we could show that this approach is a feasible and simple alternative to the current clinical therapeutic option. This study serves as proof of concept for using large-scale transplantable, vascularized, and customizable bone, generated in a living organism for the reconstruction of load-bearing bone defects, individually tailored to the patient’s needs. With this approach in personalized medicine for the reconstruction of critical-size bone defects, regeneration of parts of the human body will become possible in the near future.

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Section: Discussionmentioning

confidence: 99%

Personalized medicine for reconstruction of critical-size bone defects – a translational approach with customizable vascularized bone tissue

et al. 2021

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“…Efforts have been made in recent years to apply tissue engineering to jaw reconstruction. In the case series reported by Melville et al, mandible defects were successfully reconstructed by bone tissue engineering with a mixture of bone marrow aspirate concentrate (BMAC), bone morphogenic protein (BMP), and particulate allogeneic bone grafts, contained in a Ti mesh or resorbable membrane [ 70 ]. ( Figure 2 ) With a similar principle of bone tissue engineering, Schlund et al used fresh-frozen humeral allograft as the scaffold for the reconstruction of a posttraumatic mandibular defect [ 71 ].…”

Section: Future Perspectivesmentioning

confidence: 99%

“…The success of a tissue-engineered bone graft relies significantly on the condition of the neighboring soft tissue for satisfactory blood supply and the strict separation from the oral cavity to avoid contamination. Currently, bone tissue engineering has mostly been applied to benign mandibular defects with no significant soft tissue defect from the ablative surgery [ 70 ]. Although promising, the technique is purely dependent on the soft tissue of the host as a “bioreactor” [ 76 ].…”

Section: Future Perspectivesmentioning

confidence: 99%

Current Trends in the Reconstruction and Rehabilitation of Jaw following Ablative Surgery

Hakim

Melville

et al. 2022

Cancers

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The reconstruction and rehabilitation of jaws following ablative surgery have been transformed in recent years by the development of computer-assisted surgery and virtual surgical planning. In this narrative literature review, we aim to discuss the current state-of-the-art jaw reconstruction, and to preview the potential future developments. The application of patient-specific implants and the “jaw-in-a-day technique” have made the fast restoration of jaws’ function and aesthetics possible. The improved efficiency of primary reconstructive surgery allows for the rehabilitation of neurosensory function following ablative surgery. Currently, a great deal of research has been conducted on augmented/mixed reality, artificial intelligence, virtual surgical planning for soft tissue reconstruction, and the rehabilitation of the stomatognathic system. This will lead to an even more exciting future for the functional reconstruction and rehabilitation of the jaw following ablative surgery.

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“…Allogenic bone mixed with rhBMP-2 and bone marrow aspirate concentrate were used to restore mandibular defects in a retrospective case series that enrolled 34 patients over a 5-year period (87). The clinical success of the study was evaluated using specific criteria.…”

Section: Osteoinductive Growth Factorsmentioning

confidence: 99%

“…At the 6 month mark, CT scans and clinical exams were performed resulting in 90% success with the average height that was gained being 2.12±0.64 cm and width of 1.53±0.46 cm. The report established that although the use of autogenous graft remains the gold standard, the developing science behind clinical tissue engineering has shown clinical success for craniofacial defects with less morbidity than autogenous grafting (87).…”

Section: Osteoinductive Growth Factorsmentioning

confidence: 99%

Narrative review: craniofacial bone regeneration—where are we now?

Khazaal¹,

Helman²

2022

Front Oral Maxillofac Med

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Background and Objective: The craniofacial structures are complex and esthetically the most important component of appearance. Defects in this region lead to noticeable deformities that are physically and psychologically devastating to patients. Advances in grafting and tissue transfer techniques have improved the surgical outcomes but our ability to fully regenerate the lost or defective tissue is limited. The purpose of this narrative review is to give attention to the advances that have been made towards the development of new techniques to reconstruct craniofacial bony defects using a tissue engineering approach. The aim is to bring together up to date knowledge about biomaterials that make up an ideal scaffold; different stem cell sources and their uses; growth factors and methods of delivery to defect sites; and gene therapy techniques through different vectors.Methods: A detailed data-based search using google scholar was performed looking for articles in English with the search including the following terms: bone regeneration, tissue engineering, craniofacial reconstruction, scaffolds, osteoinductive growth factors. The search was supplemented checking references of relevant review articles.Key Content and Findings: Currently, research and clinical approaches to achieve craniofacial bone regeneration are attempting to shift to new techniques to avoid intensive surgeries. Considering new technology and biomaterials, techniques are aimed at targeting delivery of specific cellular components and factors that influence the growth of native bone. Currently no method investigated has been proven to fulfil all characteristics needed to replace autologous grafting as the new gold standard.Conclusions: Currently the gold standard for craniofacial bone regeneration is still autologous grafting, but the invasiveness and surgical morbidities involved has prompted research to explore further options. This narrative review concludes that: the incorporation of computer aided designs have advanced our ability to mimic the configurations, morphologic traits and mechanical function of the native site; the recently developed techniques to obtain and process stem cells from new sources, have potentiated our ability to regenerate bone with ease; incorporation of growth factors, show promise in their regeneration ability; innovations in gene therapy and vectors have demonstrated successful bone regenerations capabilities. With advances in all aspects, we are inching closer to discovering a new gold standard.

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Is Reconstruction of Large Mandibular Defects Using Bioengineering Materials Effective?

Cited by 24 publications

References 31 publications

Personalized medicine for reconstruction of critical-size bone defects – a translational approach with customizable vascularized bone tissue

Personalized medicine for reconstruction of critical-size bone defects – a translational approach with customizable vascularized bone tissue

Current Trends in the Reconstruction and Rehabilitation of Jaw following Ablative Surgery

Narrative review: craniofacial bone regeneration—where are we now?

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