Oral Rehabilitation of Patients Sustaining Orofacial Injuries: The UPenn Initiative

Abstract

Tissue injuries in the oral and maxillofacial structures secondary to trauma, warfare, ablative cancer, and benign tumor surgery result in significant losses of speech, masticatory and swallowing functions, aesthetic deformities, and overall psychological stressors and compromise. Optimal oral rehabilitation remains a formidable challenge and an unmet clinical need due to the influence of multiple factors related to the physiologic limitations of tissue repair, the lack of site and function-specific donor tissues and constructs, and an integrated team of multidisciplinary professionals. The advancements in stem cell biology, biomaterial science, and tissue engineering technologies, particularly the 3-dimensional bioprinting technology, together with digital imaging and computer-aided design and manufacturing technologies, have paved the path for personalized/precision regenerative medicine. At the University of Pennsylvania, we have launched the initiative to integrate multidisciplinary health professionals and translational/clinical scientists in medicine, dentistry, stem cell biology, tissue engineering, and regenerative medicine to develop a comprehensive, patient-centered approach for precision and personalized reconstruction, as well as oral rehabilitation of patients sustaining orofacial tissue injuries and defects, especially oral cancer patients.

Potential application of dental stem cells in regenerative reconstruction of oral and maxillofacial tissues: a narrative review

“…This is largely attributed to the heterogeneous in the potency and property of MSCs owing to differing intrinsic factors, such as the tissue source and donor characteristics, as well as different extrinsic factors, such as methods and technologies involved in tissue harvesting, cell isolation/ expansion, TE, and product storage/administration (42). It is thus essential to establish standard operating procedures (SOP) for all the steps in the production of dental MSCs, MSC-EVs, or MSC-based TE constructs with cGMP qualities (15). Generation of MSC-EVs presents additional technical and biological challenges (162,163).…”

“…In recent years, the development and advancement of state-of-the-art technologies and approaches, such as navigation, virtual surgical pre-planning (VSP), 3D printing technology, and microsurgical techniques have significantly advanced the field of OMF reconstruction (8,15). A successful reconstruction and functional rehabilitation of OMF defects rely on multiple factors, such as the type of defect, the health status of patients, and the treatment modality (13,15). Treatment modalities may include primary closure, healing by secondary intention, autografts, allograft, prosthesis and flaps.…”

“…However, donor site morbidity, and the inability to restore specialized tissue such as taste, sensory and periodontium pose challenges in reestablishing premorbid form and function (19). Therefore, further investigation on reconstruction surgery and functional rehabilitation techniques is requisite (13,15).…”

Advances in Precision Oral Health Research

“…In addition, novel treatment targets are identified that could enable personalized treatment strategies supporting long-term remission. The final article addressing challenges faced by oral cancer patients and others facing significant oral tissue injuries, entitled “Oral Rehabilitation of Patients Sustaining Orofacial Injuries: UPenn Initiative” (Zhang et al 2019), describes a precision regenerative medicine initiative integrating multidisciplinary health professionals and translational scientists to develop a patient-centered approach for reconstruction and rehabilitation. An additional session, entitled “Unraveling TMD and Associated Conditions—The Horizon,” is not included in this Advances in Dental Research issue but can be viewed online along with all of the other presentations made at the meeting in the IADR CE On Demand Library (IADR 2019).…”

Advances in Precision Oral Health Research: Opportunities for the Future!

“…Finally, orofacial injuries, whether from trauma, warfare, cancer, congenital defects, or other causes, pose significant reconstruction and rehabilitation challenges. A unique program at the University of Pennsylvania is described that integrates multidisciplinary health professions and translational/clinical scientists in medicine, dentistry, stem cell biology, tissue engineering, and regenerative medicine with the aim to develop comprehensive, patient-centered approaches for precision and personalized reconstruction for patients with orofacial injuries (Zhang et al 2019) Although this approach is acknowledged to be in its infancy, it certainly holds great promise.…”