Abstract
In the fields of oral and craniomaxillofacial surgery, regeneration of multiple tissue types—including bone, skin, teeth, and mucosal soft tissue—is often a desired outcome. However, limited endogenous capacity for regeneration, as well as predisposition of many tissues to fibrotic healing, may prevent recovery of normal form and function for patients. Recent basic science research has advanced our understanding of molecular and cellular pathways of repair in the oral/craniofacial region and how these are influenced by local microenvironment and embryonic origin. Here, we review the current state of knowledge in oral and craniomaxillofacial tissue repair/regeneration in four key areas: bone (in the context of calvarial defects and mandibular regeneration during distraction osteogenesis); skin (in the context of cleft lip/palate surgery); oral mucosa (in the context of minimally scarring repair of mucosal injuries); and teeth (in the context of dental disease/decay). These represent four distinct healing processes and outcomes. We will discuss both divergent and conserved pathways of repair in these contexts, with an eye toward fundamental mechanisms of regeneration vs. fibrosis as well as translational research directions. Ultimately, this knowledge can be leveraged to develop new cell-based and molecular treatment strategies to encourage bone and soft tissue regeneration in oral and craniomaxillofacial surgery.
Highlights
Oral and craniofacial tissue repair represents a clinically important topic, and a fascinating system for basic scientific research
The majority of the oral mucosal epithelium is ectoderm-derived, while the connective tissue underlying the oral mucosa is formed from the neural crest ectomesenchyme [24]
Basic science research is currently aimed at developing novel approaches for encouraging regeneration of critical-sized calvarial defects
Summary
Oral and craniofacial tissue repair represents a clinically important topic, and a fascinating system for basic scientific research. The multitude of tissue types in the oral/craniofacial region—including bone, mucosa, tooth, and skin—are defined by distinct developmental origins, cellular properties, and healing outcomes This complexity presents a clinical challenge, as injury to or congenital defects of the region often involve multiple tissue types, each of which heal differently and may face unique challenges to repair. This phenomenon is regulated by Hox gene expression, wherein underlying dermal cells inform patterning of overlying epithelium, and it has been shown that the “positional identity” of dermal fibroblasts is retained past embryonic development [23] This regional “memory” may have clinical implications, such as distinct therapeutic approaches to target skin regeneration in different regions of the body ( between the neural crest-derived facial skin and the mesoderm-derived skin of the rest of the body)
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