Main processes of bone formation and regeneration through molecules and cells as biostimulators in buccomaxillofacial surgery: a systematic review

Abstract

Introduction: At a cellular and molecular level, tissue engineering offers numerous advantages that meet the needs of the injured tissue or organ for the bone regeneration process in buccomaxillofacial surgeries. To achieve this, it is necessary to understand the chemical, physical, and biological processes of both the biological material and the target biological niche. Objective: It was to carry out a concise systematic review of the main processes of bone formation and regeneration using molecules and cells as biostimulators in buccomaxillofacial surgeries. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from December 2023 to February 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 182 articles were found, 60 articles were evaluated in full and 36 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 12 studies with a high risk of bias and 20 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=54.7%>50%. The bone regeneration process occurs through the activation of osteoblasts and vascular control guided by PDGFs and TGF-β. These growth factors also promote matrix formation and osteoblast differentiation. Some biodegradable natural polymers (chitosan®) associated with inorganic materials such as tricalcium phosphate were tested as spongy carriers for PDGF-BB. Chitosan® has been attributed to hemostatic properties, inducing bone formation and regulating the release of bioactive agents. The use of platelet-rich plasma and mesenchymal stem cells (exosomes and microRNAs) has been indicated and used in other areas of oral and buccomaxillofacial surgery, accelerating a process of bone regeneration that normally already occurs and this process continues its path until the formation of bone mature.