Regenerative medicine in oral and maxillofacial surgery: is it a valuable modality?

Background and objectives: Recently tissue engineering has become available as a regenerative treatment for bone defects. Mesenchymal derived stem cells (MSCs) were applied with different kinds of bone substitute in bone defects. The purpose is to appraise the effectiveness of the MSCs with different kind of the bone substitutes in dentomaxillofacial regeneration in our previous 10 years experiences.

Methods: Eight animal experiments and three human trials have been designed to investigate the use of MSCs in bone regeneration during last 10 years. Cells were extracted from bone marrow and cultured for 3 weeks. The stemness was examined with differential potential and flowcytometeric analysis. Biphasic HA/TCP, natural bovine bone mineral (NBBM), ‘beta’-TCP, demineralized Bone mineral (DBM), freeze-dried bone allograft block, nano HA silica gel and polycaprolactone–TCP (PCL–TCP) were used as a carrier for MSCs. In all experiments cells were mixed with scaffold 24–48 h before implantation in bony defects.

Results: In all experiments scaffold seeded with MSCs showed higher amount of bone formation in comparison with scaffold alone groups. Dog circular defects and rabbit calvaria defects reached to 50% bone formation. MSCs showed more formation than PRP treated group in rat calvaria defects. HA/TCP could carry more cells and showed more bone formation than NBBM. Increasing the size of the defect in dog supracrestal critical sized defect accompanied with less amount of new bone formation (25%). PCL–TCP/MSCs blocks in supracrestal bone formation have more successful than FDBA block. In human trials MSCs in sinus environment showed more promising results than alveolar cleft defects.

Conclusion: The mixture of MSCs with bone substitute may enhance bone regeneration. But in critical sized defects there is a long way to reach to autogenous bone grafting standards.

Key words: mesenchymal stem cells; bone regeneration; MSCs

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Jan 21, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Regenerative medicine in oral and maxillofacial surgery: is it a valuable modality?
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