Maxillofacial Bone Reconstruction Research Articles

Bone Volume Analysis and Associated Influencing Factors in Mandibular Distraction Osteogenesis: A Retrospective Analysis

BackgroundDistraction osteogenesis is a progressively popular technique for maxillofacial bone reconstruction, but there is a notable gap in the analysis of bone volume within the distraction segment and the exploration of associated influencing factors. PurposeThe purpose of this study was to quantitatively analyze the new bone volume and the distraction gap volume in the three-dimensional model and explore the influencing factors associated with the percentage of the new bone volume to the distraction gap volume. Study Design, Setting, and SampleThis retrospective study included patients who underwent Maxillofacial distraction osteogenesis (MDO) treatment at the West China Hospital of Stomatology between 2014 and 2022, utilizing the mandibular distractor (Cebei, Ningbo, China). Exclusion criteria encompassed individuals with incomplete clinical or radiographical records as well as those who loss to follow-up. Predictor variablesThe predictor variables were age, sex, diagnosis,consolidation period duration, distraction modality, osteotomy area, distraction gap volume, proximal bone segment volume. Outcome variablesThe outcome variable was osteogenic effect which defined as the percentage of the new bone volume to the distraction gap volume in the 3D model. CovariatesNot applicable. AnalysesT-tests were used to describe categorical variables, and Pearson correlation analysis was used to describe continuous variables. Linear regression was employed to assess the predictiveness of variables for osteogenic effect. Data are described as mean ± standard deviation, statistical significance was established at a p-value < 0.05. ResultsThe study sample contained 35 patients(11 males and 24 females) with a mean age of 21.17 ± 11.82 years (range: 5-47 years) were included. The mean osteogenic effect of all samples was 78.89±24.70 %. Multiple linear regression models confirmed that the osteogenic effect was significantly influenced by the distraction gap volume (P=0.003), proximal bone segment volume (P=0.009), osteotomy area (P=0.034), diagnosis (P=0.004), and distraction modality (P= 0.021). ConclusionThe percentage of new bone mass to simulated volume based on 3D model measurement can serve as an effective quantitative indicator for evaluating the osteogenic effect, our study demonstrates that distraction gap volume, proximal bone segment volume, osteotomy area, diagnosis, and distraction modality can statistically significant influence the osteogenic effect.

Three-dimensional printed bioresorbable scaffold for maxillofacial bone reconstruction: A Scoping Review.

This scoping review aimed to provide an overview of current advancements in virtual planning and custom-made 3D-printed bioresorbable scaffolds, and to evaluate their clinical outcomes in maxillofacial reconstructive surgeries. Electronic searches of PubMed, EMBASE, Web of Science, Scopus, and Cochrane Library databases were conducted for publications up to June 2024. Included in the review were reports evaluating patients who underwent maxillofacial bone defect reconstruction using virtual planning and custom-made 3D-printed bioresorbable scaffolds. Data on postoperative complications, new bone formation, scaffold resorption, dental implant success/survival, and patient satisfaction were collected. The electronic search found 5799 results (3438 unique citations). A total of 54 studies were evaluated for full-text reading, of which 41 were excluded based on the inclusion criteria. Thirteen studies (6 case reports, 5 case series, one prospective clinical study and one randomized clinical trial) were included. These studies assessed the effectiveness of 3D-printed scaffolds in reconstructing maxillofacial defects, bone augmentation for dental implant placement, and regeneration of periosseous defects. Most of the 3D-printed scaffolds were biocompatible and did not cause local or systemic adverse events. However, some postoperative complications were reported, including graft exposure, wound dehiscence, and local infection. Overall, the 3D-printed scaffolds demonstrated favorable dimensional compatibility with deformities, provided durable support, promoted bone formation, achieved adequate bone union with host bone tissues, and supported dental implant placement without additional guided bone regeneration. In conclusion, custom-made 3D-printed bioresorbable scaffolds, guided by virtual planning, present a promising option for maxillofacial reconstruction due to their accuracy, osteoconductivity, and biocompatible properties.

A matter of origin - identification of SEMA3A, BGLAP, SPP1 and PHEX as distinctive molecular features between bone site-specific human osteoblasts on transcription level.

In oral and maxillofacial bone reconstruction, autografts from the iliac crest represent the gold standard due to their superior clinical performance, compared to autografts derived from other extraoral regions. Thus, the aim of our study was to identify putative differences between osteoblasts derived from alveolar (hOB-A) and iliac crest (hOB-IC) bone of the same donor (nine donors) by means of their molecular properties in 2D and 3D culture. We thereby focused on the gene expression of biomarkers involved in osteogenic differentiation, matrix formation and osteoclast modulation. Furthermore, we examined the transcriptional response to Vit.D3 in hOB-A and hOB-IC. Our results revealed different modulation modes of the biomarker expression in osteoblasts, namely cell origin/bone entity-dependent, and culture configuration- and/or time-dependent modulations. SEMA3A, SPP1, BGLAP and PHEX demonstrated the strongest dependence on cell origin. With respect to Vit.D3-effects, BGLAP, SPP1 and ALPL displayed the highest Vit.D3-responsiveness. In this context we demonstrated that the transcriptional Vit.D3-response concerning SPP1 and ALPL in human osteoblasts depended on the cell origin. The results indicate a higher bone remodeling activity of iliac crest than alveolar osteoblasts and support the growing evidence that a high osteoclast activity at the host-/donor bone interface may support graft integration.

The Osteogenic Capacity of HumanAmniotic Membrane Mesenchymal Stem Cell (hAMSC) and Potential for Application in Maxillofacial Bone Reconstruction in Vitro Study

Amniotic membrane of human placenta is a source of abundant mesenchymal stem cell (hAMSC) which makes it a potential source of allogeneic multipotent cell for bone healing. However, much has to be explored about its isolation procedure and the osteogenic differentiation potential. The aims of this study are to establish the procurement procedure of human amniotic membrane, the isolation and culture of hAMSC, the MSC phenotypic characterization, and the in vitro osteogenic differentiation of hAMSC. Results of the study are as follows. The quality of human amniotic membrane would be best if procured from Caesarean operation under highly aseptic condition to avoid fungal and bacterial contamination on the culture. Isolation procedure using modified Soncini protocol yielded large amount of MSC with high proliferative capacity in culture medium. Characterization of hAMSC showed that the majority of the target cells exhibited specific MSC markers (CD10S and CD90) with a small number of these cells expressing CD45the marker of hematopoeitic cells. The in vitro osteogenic differentiation of hAMSC followed by Alizarin Red staining showed that osteoblastic differentiation was detected in a significantly high number of cells. This study concludes that hAMSCs isolated from human amniotic membrane have the capacity for in vitro osteogenesis which makes them be one of the potential allogeneic stem cells for application in maxillofacial bone reconstruction.

Technical queries of a 3D design custom-made implant made from titanium particles for maxillofacial bone reconstruction

Accurate 3D bone reconstruction is one of the most difficult tasks to achieve in maxillo-facial surgery. In the present study, a zygomatic bone defect was reconstructed with a custom made implant fabricated by selective laser melting (SLM) processing from titanium particles. 2 years follow-up revealed diplopia (double vision) resolution, as well as esthetic and functional stabile reconstruction. Technical queries regarding the fabrication process and medical reconstruction are discussed.

Reconstruction of Complex Maxillary Defects Using Patient-specific 3D-printed Biodegradable Scaffolds.

Reconstruction of maxilla defects has remained one of the most challenging problems in craniomaxillofacial reconstruction because it typically requires harvesting and grafting of autologous bone, which poses limitations related to the difficulties in accurately reconstructing the defected bone and the highly prolonged duration of surgery. We employed tissue-engineered, patient-specific, 3-dimensional (3D)-printed biodegradable scaffolds for maxillofacial bone reconstruction in patients with complex maxillary defects after surgical removal of cancer. A customized polycaprolactone (PCL) scaffold was designed and fabricated for each patient. For this purpose, we used computer-aided design and manufacturing combined with 3D printing technology. The patients implanted with the PCL scaffolds were followed up for up to 2 years with careful evaluation of morphological changes in the face. We confirmed that the patient-specific 3D-printed PCL scaffold effectively filled the maxillary defect and promoted regeneration of the deficient tissue while remaining stable in the body for a relatively long period. Employing customized tissue-engineered scaffolds built using the patient's computed tomography data and an extrusion-based 3D printing system is safe and clinically feasible, helping create and maintain improved morphological features of the face, which represents the most important aspect from the perspective of the patients.

Poly(ε-caprolactone)/Hydroxyapatite 3D Honeycomb Scaffolds for a Cellular Microenvironment Adapted to Maxillofacial Bone Reconstruction

The elaboration of biomimetic materials inspired from the specific structure of native bone is one the main goal of tissue engineering approaches. To offer the most appropriate environment for bone reconstruction, we combined electrospinning and electrospraying to elaborate an innovative scaffold composed of alternating layers of polycaprolactone (PCL) and hydroxyapatite (HA). In our approach, the electrospun PCL was shaped into a honeycomb-like structure with an inner diameter of 160 μm, capable of providing bone cells with a 3D environment while ensuring the material biomechanical strength. After 5 days of culture without any differentiation factor, the murine embryonic cell line demonstrated excellent cell viability on contact with the PCL-HA structures as well as active colonization of the scaffold. The cell differentiation, as tested by RT-qPCR, revealed a 6-fold increase in the expression of the RNA of the Bglap involved in bone mineralization as compared to a classical 2D culture. This differentiation of the cells into osteoblasts was confirmed by alkaline phosphatase staining of the scaffold cultivated with the cell lineage. Later on, organotypic cultures of embryonic bone tissues showed the high capacity of the PCL-HA honeycomb structure to guide the migration of differentiated bone cells throughout the cavities and the ridge of the biomaterial, with a colonization surface twice as big as that of the control. Taken together, our results indicate that PCL-HA honeycomb structures are biomimetic supports that promotes in vitro osteocompatibility, osteoconduction, and osteoinduction and could be suitable for being used for bone reconstruction in complex situations such as the repair of maxillofacial defects.

Functional reconstruction of critical-sized load-bearing bone defects using a Sclerostin-targeting miR-210-3p-based construct to enhance osteogenic activity

A considerable amount of research has focused on improving regenerative therapy strategies for repairing defects in load-bearing bones. The enhancement of tissue regeneration with microRNAs (miRNAs) is being developed because miRNAs can simultaneously regulate multiple signaling pathways in an endogenous manner. In this study, we developed a miR-210-based bone repair strategy. We identified a miRNA (miR-210-3p) that can simultaneously up-regulate the expression of multiple key osteogenic genes in vitro. This process resulted in enhanced bone formation in a subcutaneous mouse model with a miR-210-3p/poly-l-lactic acid (PLLA)/bone marrow-derived stem cell (BMSC) construct. Furthermore, we constructed a model of critical-sized load-bearing bone defects and implanted a miR-210-3p/β-tricalcium phosphate (β-TCP)/bone mesenchymal stem cell (BMSC) construct into the defect. We found that the load-bearing defect was almost fully repaired using the miR-210-3p construct. We also identified a new mechanism by which miR-210-3p regulates Sclerostin protein levels. This miRNA-based strategy may yield novel therapeutic methods for the treatment of regenerative defects in vital load-bearing bones by utilizing miRNA therapy for tissue engineering. Statement of SignificanceThe destroyed maxillofacial bone reconstruction is still a real challenge for maxillofacial surgeon, due to that functional bone reconstruction involved load-bearing. Base on the above problem, this paper developed a novel miR-210-3p/β-tricalcium phosphate (TCP)/bone marrow-derived stem cell (BMSC) construct (miR-210-3p/β-TCP/BMSCs), which lead to functional reconstruction of critical-size mandible bone defect. We found that the load-bearing defect was almost fully repaired using the miR-210-3p construct. In addition, we also found the mechanism of how the delivered microRNA activated the signaling pathways of endogenous stem cells, leading to the defect regeneration. This miRNA-based strategy can be used to regenerate defects in vital load-bearing bones, thus addressing a critical challenge in regenerative medicine by utilizing miRNA therapy for tissue engineering.

Decellularized Bovine Bone Graft for Zygomatic Bone Reconstruction

Reconstruction of large size maxillofacial bone defects following trauma or tumor resection still represents a challenging task for surgeons. Various types of bone materials are used as the grafts for the reconstruction of bone defect: auto, allo, xeno and alloplastic bones. In recent years, using the methods of decellularization has enabled to obtain the natural,biocompatible threedimensional xenograft for the reconstruction of bone defects. Removing DNA from the bone matrix is critical because this DNA may stimulate immune reactions by activating cytokine production and B-cell immunoglobulin secretion after transplantation. For the large maxillofacial bone reconstruction procedures, the decellularized bovine bone graft has proven to be effective, easy to handle and biocompatible, providing excellent final aesthetic and functional results. However, more animal and clinical studies are required to further assess the osteogenic activity and integration of decellularized bone grafts with the native bone.

Clinical Performance of Moldable Bioceramics and Resorbable Membrane for Bone and Mucosa Regeneration in Maxillofacial Surgery

The objectives are to present the novel concept of moldable injectable osteogenic CaP bioceramic, and the data issued from a non-interventional study to demonstrate the efficacy of an injectable bone substitute (bioceramic/hydrogel) in association with a collagen resorbable membrane and the performance to guide bone regeneration and soft tissue healing in maxillofacial surgery. Historically, dental implantology required both bone augmentation and reconstruction. However, with the aging of the population, it is also necessary to prevent the bone loss after dental extraction. To overcome the limitations associated with autografts, several bone substitutes have been developed. However, there are still numerous difficulties in the handling, reproducibility of the resorption, and bone regeneration associated with the biomaterials. Therefore, it is important to optimize new bone substitute technologies. Bioactive injectable bioceramics, particularly putties, are often used in these applications. In this preclinical and clinical study, we demonstrate the efficacy and the performance of a combined use of calcium phosphate microporous granules and hydrosoluble polymers for maxillofacial bone reconstruction and regeneration. The biomaterial was extruded into bone defects and recovered by aresorbable porcine collagen membrane, after tooth extractions in 78 patients. The clinical follow-up revealed no incidents or complications. Furthermore, infections or foreign body reactions were not reported during the 17 months of follow-up. We analyzed the drilling waste taken from 11 patients during the dental implantation sequence (at 5-10 months). Resorption and bone ingrowth were assessed using microtomography, scanning electron microscopy, light microscopy, and image analysis. We found that the highly kinetic process of resorption/absorption and bone in growth was achieved within a few months. The bone ingrowth was architectured and well vascularized.

Oral and maxillofacial bone reconstruction

Event Abstract Back to Event Oral and maxillofacial bone reconstruction John Jansen1, Jeroen Van Den Beucken1 and Sander Leeuwenburgh1 1 Radboudumc - Dentistry, Biomaterials, Netherlands Hard tissue reconstruction in the oral and maxillofacial region due to trauma, tumor surgery or congenital deformities remains a challenge for reconstructive surgeons. The current preferred treatment includes the use of vascularized bone grafts, such as pedicle grafts or microvascular free grafts. This even extends to the use of computer-assisted modeling to preoperatively design the tumor resection and contour the microvascular free flap reconstruction by using a customized template. However, the current techniques have inherent disadvantages of donor site morbidity, risk of infection or non-acceptance of the flap as well as a prolonged healing and waiting time before dental rehabilitation can begin. Bone regeneration is a well-organized but complex physiological process, in which different cell types and their activated signaling pathways are involved. In bone regeneration and remodeling processes, mesenchymal stem cells (MSCs) have a crucial role, during which their differentiation is regulated by specific signaling molecules (growth factors/cytokines and hormones) and their activated intracellular networks. Especially the utilization of this molecular machinery seems crucial to consider prior to developing bone substitute materials and cell-based constructs for bone regeneration. Regenerative medicine is using the principles of “”tissue engineering”” and holds the promise for custom-tailored constructs with the potential to regenerate tissue in the host without significant donor-site morbidity and size limitation. This lecture aims to provide an overview of the current possibilities to optimize bone regeneration for cranio-facial reconstruction. First, the function and structure of bone will be discussed as well as the interaction between its main constituents with a specific focus on the mechanisms of bone mineralization. Second, the osteogenic potential of MSCs to become a key cellular resource for such regeneration and remodeling processes and the role of the scaffold material as such or as carrier for biofactors or stem cells will be addressed (Figure 1). Third, attention will be given to the main bio-inspired strategies to mineralize synthetic bone-substituting biomaterials. Figure 1. Cellular concept to explain the osteogenicity of a scaffold surfaces: Step 1: Blood cells penetrate into damaged body tissue (monocytes differentiate into macrophages), Step 2: Blood clot is formed on the scaffold surface (including blood cells and fibrin fibers), Step 3: Platelets and macrophages are activated and secrete growth factors and cytokines, which attract osteoprogenitor cells. The adhesion and activation of platelets and macrophages is controlled by the osteogenicc properties of the used scaffold material. This work was supported by the Dutch Technology Foundation, Smartmix and the Royal Netherlands Academy of Science.; This work is also an AFIRM II project and was supported by the Army, Navy, NIH, Air Force, VA and Health Affairs to support the AFIRM II effort, under Award No. W81XWH-14-2-0004. The U.S.Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick MD 21702-5014 is the awarding and administering acquisition office. Opinions, interpretations and recommendations are those of the author and are not necessarily endorsed by the Department of Defense. Keywords: Bone Regeneration, Regenerative Medicine, Surface modification, bioactive interface Conference: 10th World Biomaterials Congress, Montréal, Canada, 17 May - 22 May, 2016. Presentation Type: New Frontier Oral Topic: Biomaterials in constructing tissue substitutes Citation: Jansen J, Van Den Beucken J and Leeuwenburgh S (2016). Oral and maxillofacial bone reconstruction. Front. Bioeng. Biotechnol. Conference Abstract: 10th World Biomaterials Congress. doi: 10.3389/conf.FBIOE.2016.01.00278 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 28 Mar 2016; Published Online: 30 Mar 2016. Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers John Jansen Jeroen Van Den Beucken Sander Leeuwenburgh Google John Jansen Jeroen Van Den Beucken Sander Leeuwenburgh Google Scholar John Jansen Jeroen Van Den Beucken Sander Leeuwenburgh PubMed John Jansen Jeroen Van Den Beucken Sander Leeuwenburgh Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. 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Bone defects of the jaws: moving from reconstruction to regeneration

Jaw reconstruction is necessary for a variety of reasons including neoplastic disease, traumatic injuries, infective/inflammatory lesions, and congenital defects. Such defects can be a significant handicap for patients leading to physiological and psychological morbidity. Maxillofacial bone reconstruction remains challenging for the reconstructive surgeon; yet it has evolved significantly over recent years. The current state of the art reconstruction is via the use of vascularized osseous flaps. Modern developments in regenerative medicine propose a future for stem cells in the regeneration of bone for jaw defects. Clinical Relevance: Knowledge of the current methods of reconstruction and advances in the field of tissue engineering is of interest to dental clinicians.

The Osteogenic Capacity of Human Amniotic Membrane Mesenchymal Stem Cell (hAMSC) and Potential for Application in Maxillofacial Bone Reconstruction &amp;lt;i&amp;gt;in Vitro&amp;lt;/i&amp;gt; Study

Amniotic membrane of human placenta is a source of abundant mesenchymal stem cell (hAMSC) which makes it a potential source of allogeneic multipotent cell for bone healing. However, much has to be explored about its isolation procedure and the osteogenic differentiation potential. The aims of this study are to establish the procurement procedure of human amniotic membrane, the isolation and culture of hAMSC, the MSC phenotypic characterization, and the in vitro osteogenic differentiation of hAMSC. Results of the study are as follows. The quality of human amniotic membrane would be best if procured from Caesarean operation under highly aseptic condition to avoid fungal and bacterial contamination on the culture. Isolation procedure using modified Soncini protocol yielded large amount of MSC with high proliferative capacity in culture medium. Characterization of hAMSC showed that the majority of the target cells exhibited specific MSC markers (CD105 and CD90) with a small number of these cells expressing CD45, the marker of hematopoeitic cells. The in vitro osteogenic differentiation of hAMSC followed by Alizarin Red staining showed that osteoblastic differentiation was detected in a significantly high number of cells. This study concludes that hAMSCs isolated from human amniotic membrane have the capacity for in vitro osteogenesis which makes them be one of the potential allogeneic stem cells for application in maxillofacial bone reconstruction.