Major considerations of the biological mechanisms of bone regeneration through mesenchymal stem cells, exosomes, and microRNAs in the scenario of bucco-maxillo-facial surgery: a systematic review

Abstract

Introduction: In the context of bucco-maxillo facial surgery, the development of biomaterials for use in clinical dentistry in recent years has represented a powerful therapeutic instrument in the correction of bone defects. Adult tissue stem cells (mesenchymal stem cells) mediate homeostasis and regeneration of tissues and organs. Growing evidence suggests that metabolism during quiescence, activation, and differentiation may vary between tissues, integrating signaling cues and metabolic inputs with the release of exosomes and microRNAs as important metabolic messengers. Objective: It was to carry out a systematic review to present the main considerations and scientific evidence of the cellular and molecular mechanisms of bone formation or regeneration through mesenchymal stem cells, exosomes, and microRNAs in the scenario of bucco-maxillo-facial surgery with bone graft or biomaterials. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from March to May 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases, with articles dated 2001 (gold standard) through 2022. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed accordingly, according to the Cochrane instrument. Results and Conclusion: A total of 145 articles were found, 45 articles were evaluated and 34 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 30 studies with a high risk of bias and 15 studies that did not meet GRADE. The greater potential of guided bone regeneration was associated with the graft material due to the higher grade of vital bone and the lower percentage of residual graft particles. Inorganic bovine bone and porcine bone minerals combined with autogenous maxillary cortical bone showed similar biological and radiological characteristics in terms of biomaterial resorption, osteoconduction, and osteogenesis when used for maxillary sinus floor augmentation. In this regard, three fundamental parameters in bone tissue engineering that determine the capacity for osteoinduction were evidenced, such as the presence of soluble osteoinductive signals, the viability of undifferentiated mesenchymal stem cells, having the ability to differentiate into bone-forming cells and production of adequate extracellular matrix. The exosomes that contain proteins, mRNAs, microRNAs, and DNAs stand out. Exosomes change the biochemical characteristics of recipient cells through the delivery of biomolecules and play a role in cell communication. Evidence suggests that exosomes derived from mesenchymal stem cells exhibit functions similar to mesenchymal stem cells with low immunogenicity and without tumorization.