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Abstract
Biomaterials are widely used in guided bone regeneration (GBR) and guided tissue regeneration (GTR). After application, there is an interaction between the host immune system and the implanted biomaterial, leading to a biomaterial-specific cellular reaction. The present review focuses on cellular reactions to numerous biomaterials in vivo with consideration of different implantation models and microenvironments in different species, such as subcutaneous implantation in mice and rats, a muscle model in goats and a femur model in rabbits. Additionally, cellular reactions to different biomaterials in various clinical indications within the oro-maxillofacial surgical field were considered. Two types of cellular reactions were observed. There was a physiological reaction with the induction of only mononuclear cells and a pathological reaction with the induction of multinucleated giant cells (MNGCs). Attention was directed to the frequently observed MNGCs and consequences of their appearance within the implantation region. MNGCs have different subtypes. Therefore, the present review addresses the different morphological phenotypes observed within the biomaterial implantation bed and discusses the critical role of MNGCs, their subtypes and their precursors as well as comparing the characteristics and differences between biomaterial-related MNGCs and osteoclasts. Polymeric biomaterials that only induced mononuclear cells underwent integration and maintained their integrity, while polymeric biomaterials that induced MNGCs underwent disintegration with material breakdown and loss of integrity. Hence, there is a question regarding whether our attention should be directed to alternative biological concepts, in combination with biomaterials that induce a physiological mononuclear cellular reaction to optimize biomaterial-based tissue regeneration.
Highlights
A wide range of different biomaterials is available to support hard and soft tissue regeneration following the principles of guided bone and guided tissue regeneration (GBR/GTR)
Two types of cellular reactions towards biomaterials have been observed. They are a cellular reaction based on physiologically existing mononuclear cells, such as macrophages, lymphocytes and fibroblasts, and a foreign body reaction based on the additional presence of multinucleated giant cells [3]
Two different types of cellular reactions were observed: a physiological reaction with only mononuclear cells and a pathological reaction characterized by multinucleated giant cells (MNGCs) [3,5,6,8,59,62]
Summary
A wide range of different biomaterials is available to support hard and soft tissue regeneration following the principles of guided bone and guided tissue regeneration (GBR/GTR). In vitro models are important for studying specific cells types and their molecular interactions as an isolated cell system to better understand a particular mechanism [10,14] These models are intentionally created systems that cannot mimic the complex in vivo native environment in which MNGCs are induced and formed. Developments in immunohistochemistry permit the detection of different signaling molecules to further identify the phenotypes, the role of MNGCs within the original implantation bed and MNGC interaction with the peri-implantation region Using this platform, our group has performed several studies in different implantation models of both large and small animals as well as clinical studies focusing on the tissue response towards various biomaterials. The present review systematically outlines the in vivo cellular inflammatory response to different biomaterials, with special attention paid to the formation of MNGCs, their phenotypes and their consequences in relation to different biomaterials and implantation environments
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