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Mohaghegh S, Alirezaei F, Ahmadi N, Kouhestani F, Motamedian SR. Application of chemical factors for acceleration of consolidation phase of the distraction osteogenesis: a scoping review. Oral Maxillofac Surg 2023; 27:559-579. [PMID: 35852720 DOI: 10.1007/s10006-022-01097-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE This study aimed to analyze the effect of injecting chemical factors compared to conventional distraction osteogenesis (DO) treatment on the bone formation of the distracted area of the maxillofacial region in human and animal studies. METHOD Electronic search was done in PubMed, Scopus, Embase, and Cochrane database for studies published until September 2021. The studies' risk of bias (ROB) was assessed using the Cochrane Collaborations and NIH quality assessment tools. Meta-analyses were performed to assess the difference in the amount of bone formation and maximal load tolerance. RESULTS Among a total of 58 included studies, eight studies analyzed the bone formation rate of the distracted area in human models and others in animal models. Results of the human studies showed acceptable outcomes in the case of using bone morphogenic protein-2 (BMP-2), autologous bone-platelet gel, and calcium sulfate. However, using platelet reach plasma does not increase the rate of bone formation significantly. Quantitative analyses showed that both BMP-2 (SMD = 26.57; 95% CI = 18.86 to 34.28) and neuron growth factor (NGF) (SMD = 16.19; 95% CI = 9.64 to 22.75) increase the amount of bone formation. Besides, NGF increased the amount of load tolerance significantly (SMD = 30.03; 95% CI = 19.91 to 40.16). Additionally, BMP-2 has no significant impact on the post-treatment maxillary length (SMD = 9.19; 95% CI = - 2.35 to 20.73). CONCLUSION Limited number of human studies with low quality used chemical factors to enhance osteogenesis and showed acceptable results. However, more studies with higher quality are required.
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Affiliation(s)
- Sadra Mohaghegh
- Dentofacial Deformities Research Center, Research Institute of Dental Sciences and Department of Orthodontics, Shahid Beheshti University of Medical Sciences, Tehran, 1983963113, Iran
| | - Fatemeh Alirezaei
- Department of Orthodontics, School of Dentistry, Babol University of Medical Sciences, Babol, Iran
| | - Nima Ahmadi
- Dentofacial Deformities Research Center, Research Institute of Dental Sciences and Department of Orthodontics, Shahid Beheshti University of Medical Sciences, Tehran, 1983963113, Iran
| | - Farnaz Kouhestani
- Department of Periodontics, School of Dentistry, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Saeed Reza Motamedian
- Dentofacial Deformities Research Center, Research Institute of Dental Sciences and Department of Orthodontics, Shahid Beheshti University of Medical Sciences, Tehran, 1983963113, Iran.
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Mesenchymal Stem Cells Based Treatment in Dental Medicine: A Narrative Review. Int J Mol Sci 2022; 23:ijms23031662. [PMID: 35163584 PMCID: PMC8836082 DOI: 10.3390/ijms23031662] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/29/2022] [Accepted: 01/29/2022] [Indexed: 02/01/2023] Open
Abstract
Application of mesenchymal stem cells (MSC) in regenerative therapeutic procedures is becoming an increasingly important topic in medicine. Since the first isolation of dental tissue-derived MSC, there has been an intense investigation on the characteristics and potentials of these cells in regenerative dentistry. Their multidifferentiation potential, self-renewal capacity, and easy accessibility give them a key role in stem cell-based therapy. So far, several different dental stem cell types have been discovered and their potential usage is found in most of the major dental medicine branches. These cells are also researched in multiple fields of medicine for the treatment of degenerative and inflammatory diseases. In this review, we summarized dental MSC sources and analyzed their treatment modalities with particular emphasis on temporomandibular joint osteoarthritis (TMJ OA).
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Abstract
Bone regeneration is a central focus of maxillofacial research, especially when dealing with dental implants or critical sized wound sites. While bone has great regeneration potential, exogenous delivery of growth factors can greatly enhance the speed, duration, and quality of osseointegration, making a difference in a patient’s quality of life. Bone morphogenic protein 2 (BMP-2) is a highly potent growth factor that acts as a recruiting molecule for mesenchymal stromal cells, induces a rapid differentiation of them into osteoblasts, while also maintaining their viability. Currently, the literature data shows that the liposomal direct delivery or transfection of plasmids containing BMP-2 at the bone wound site often results in the overexpression of osteogenic markers and result in enhanced mineralization with formation of new bone matrix. We reviewed the literature on the scientific data regarding BMP-2 delivery with the help of liposomes. This may provide the ground for a future new bone regeneration strategy with real chances of reaching clinical practice.
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Hatefi S, Alizargar J, Le Roux F, Hatefi K, Etemadi Sh M, Davids H, Hsieh NC, Smith F, Abou-El-Hossein K. Review of physical stimulation techniques for assisting distraction osteogenesis in maxillofacial reconstruction applications. Med Eng Phys 2021; 91:28-38. [PMID: 34074463 DOI: 10.1016/j.medengphy.2021.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 02/17/2021] [Accepted: 03/24/2021] [Indexed: 01/24/2023]
Abstract
Distraction Osteogenesis (DO) is an emerging limb lengthening method for the reconstruction of the hard tissue and the surrounding soft tissue, in different human body zones. DO plays an important role in treating bone defects in Maxillofacial Reconstruction Applications (MRA) due to reduced side effects and better formed bone tissue compared to conventional reconstruction methods i.e. autologous bone graft, and alloplast implantation. Recently, varying techniques have been evaluated to enhance the characteristics of the newly formed tissues and process parameters. Promising results have been shown in assisting DO treatments while benefiting bone formation mechanisms by using physical stimulation techniques, including photonic, electromagnetic, electrical, and mechanical stimulation technique. Using assisted DO techniques has provided superior results in the outcome of the DO procedure compared to a standard DO procedure. However, DO methods, as well as assisting technologies applied during the DO procedure, are still emerging. Studies and experiments on developed solutions related to this field have been limited to animal and clinical trials. In this review paper, recent advances in physical stimulation techniques and their effects on the outcome of the DO treatment in MRA are surveyed. By studying the effects of using assisting techniques during the DO treatment, enabling an ideal assisted DO technique in MRA can be possible. Although mentioned techniques have shown constructive effects during the DO procedure, there is still a need for more research and investigation to be done to fully understand the effects of assisting techniques and advanced technologies for use in an ultimate DO procedure in MRA.
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Affiliation(s)
- Shahrokh Hatefi
- Precision Engineering Laboratory, Nelson Mandela University, Port Elizabeth, South Africa.
| | - Javad Alizargar
- Research Center for Healthcare Industry Innovation, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan.
| | - Francis Le Roux
- Department of Mechatronics Engineering, Nelson Mandela University, Port Elizabeth, South Africa.
| | - Katayoun Hatefi
- Department of Electrical and Computer Engineering, Isfahan University of Technology, Isfahan, Iran.
| | - Milad Etemadi Sh
- Department of Oral and Maxillofacial Surgery, Dental Implants Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Hajierah Davids
- Department of Physiology, Nelson Mandela University, Port Elizabeth, South Africa.
| | - Nan-Chen Hsieh
- Department of Information Management, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan.
| | - Farouk Smith
- Department of Mechatronics Engineering, Nelson Mandela University, Port Elizabeth, South Africa.
| | - Khaled Abou-El-Hossein
- Precision Engineering Laboratory, Nelson Mandela University, Port Elizabeth, South Africa.
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5
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Wilkinson P, Bozo IY, Braxton T, Just P, Jones E, Deev RV, Giannoudis PV, Feichtinger GA. Systematic Review of the Preclinical Technology Readiness of Orthopedic Gene Therapy and Outlook for Clinical Translation. Front Bioeng Biotechnol 2021; 9:626315. [PMID: 33816447 PMCID: PMC8011540 DOI: 10.3389/fbioe.2021.626315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/12/2021] [Indexed: 12/09/2022] Open
Abstract
Bone defects and improper healing of fractures are an increasing public health burden, and there is an unmet clinical need in their successful repair. Gene therapy has been proposed as a possible approach to improve or augment bone healing with the potential to provide true functional regeneration. While large numbers of studies have been performed in vitro or in vivo in small animal models that support the use of gene therapy for bone repair, these systems do not recapitulate several key features of a critical or complex fracture environment. Larger animal models are therefore a key step on the path to clinical translation of the technology. Herein, the current state of orthopedic gene therapy research in preclinical large animal models was investigated based on performed large animal studies. A summary and an outlook regarding current clinical studies in this sector are provided. It was found that the results found in the current research literature were generally positive but highly methodologically inconsistent, rendering a comparison difficult. Additionally, factors vital for translation have not been thoroughly addressed in these model systems, and the risk of bias was high in all reviewed publications. These limitations directly impact clinical translation of gene therapeutic approaches due to lack of comparability, inability to demonstrate non-inferiority or equivalence compared with current clinical standards, and lack of safety data. This review therefore aims to provide a current overview of ongoing preclinical and clinical work, potential bottlenecks in preclinical studies and for translation, and recommendations to overcome these to enable future deployment of this promising technology to the clinical setting.
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Affiliation(s)
- Piers Wilkinson
- Division of Oral Biology, School of Dentistry, University of Leeds, Leeds, United Kingdom.,CDT Tissue Engineering and Regenerative Medicine, Institute of Medical and Biological Engineering, University of Leeds, Leeds, United Kingdom
| | - Ilya Y Bozo
- Federal Medical Biophysical Center, Federal Medical-Biological Agency of Russia, Moscow, Russia
| | - Thomas Braxton
- Division of Oral Biology, School of Dentistry, University of Leeds, Leeds, United Kingdom.,CDT Tissue Engineering and Regenerative Medicine, Institute of Medical and Biological Engineering, University of Leeds, Leeds, United Kingdom
| | - Peter Just
- Into Numbers Data Science GmbH, Vienna, Austria
| | - Elena Jones
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | | | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds General Infirmary, Leeds, United Kingdom.,NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Georg A Feichtinger
- Division of Oral Biology, School of Dentistry, University of Leeds, Leeds, United Kingdom
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Applications of Bone Morphogenetic Proteins in Dentistry: A Bibliometric Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5971268. [PMID: 33163536 PMCID: PMC7604587 DOI: 10.1155/2020/5971268] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 10/06/2020] [Accepted: 10/12/2020] [Indexed: 12/12/2022]
Abstract
Background Many articles on bone morphogenetic proteins (BMPs) have been published. Bibliometric analysis is helpful to determine the most influential studies in a specific field. This bibliometric analysis is aimed at identifying and analyzing the top 50 most-cited articles on the dental applications of BMPs. Methods An electronic search was conducted using the Web of Science (WoS) “All Databases” without any restriction of language, study design, or publication year. Of 1341 publications, the top 50 were included based on their citation count. After downloading the full texts, their bibliometric data including publication title, authorship, citation count, current citation index 2019, citation density, year of publication, country and institution of origin, journal of publication, type of BMP, study design, evidence level of publication, and keywords were extracted and analyzed. Results The citation counts for the top 50 publications ranged from 81 to 557 (median 113.5). The most prolific year was 1997 (n = 7). Wikesjö UM (n = 12) and Wozney JM (n = 11) were the major contributors in this study. Most of the articles were generated primarily from the USA (n = 24), with Loma Linda University Medical Center, USA being the most prolific institution (n = 5). Majority of the articles were published in the Clinical Oral Implants Research and Journal of Periodontology, with nine publications each. Most of the publications were animal studies (n = 30) and focused on BMP-2 (n = 39). Most of the articles were within evidence level V (n = 36). The most frequently used keyword in the top articles was “bone regeneration” (n = 23). Conclusion The present study presents insights into the past and recent trends in the applications of BMPs in dentistry. A statistically significant association was observed between citation count, citation density, and age of publication.
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7
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BMP-2 Gene Delivery-Based Bone Regeneration in Dentistry. Pharmaceutics 2019; 11:pharmaceutics11080393. [PMID: 31387267 PMCID: PMC6723260 DOI: 10.3390/pharmaceutics11080393] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/22/2019] [Accepted: 08/02/2019] [Indexed: 02/06/2023] Open
Abstract
Bone morphogenetic protein-2 (BMP-2) is a potent growth factor affecting bone formation. While recombinant human BMP-2 (rhBMP-2) has been commercially available in cases of non-union fracture and spinal fusion in orthopaedics, it has also been applied to improve bone regeneration in challenging cases requiring dental implant treatment. However, complications related to an initially high dosage for maintaining an effective physiological concentration at the defect site have been reported, although an effective and safe rhBMP-2 dosage for bone regeneration has not yet been determined. In contrast to protein delivery, BMP-2 gene transfer into the defect site induces BMP-2 synthesis in vivo and leads to secretion for weeks to months, depending on the vector, at a concentration of nanograms per milliliter. BMP-2 gene delivery is advantageous for bone wound healing process in terms of dosage and duration. However, safety concerns related to viral vectors are one of the hurdles that need to be overcome for gene delivery to be used in clinical practice. Recently, commercially available gene therapy has been introduced in orthopedics, and clinical trials in dentistry have been ongoing. This review examines the application of BMP-2 gene therapy for bone regeneration in the oral and maxillofacial regions and discusses future perspectives of BMP-2 gene therapy in dentistry.
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Ozaki M, Takayama T, Yamamoto T, Ozawa Y, Nagao M, Tanabe N, Nakajima A, Suzuki N, Maeno M, Yamano S, Sato S. A collagen membrane containing osteogenic protein-1 facilitates bone regeneration in a rat mandibular bone defect. Arch Oral Biol 2017; 84:19-28. [PMID: 28938197 DOI: 10.1016/j.archoralbio.2017.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 08/31/2017] [Accepted: 09/07/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Osteogenic protein-1 (OP-1) has shown osteoinductive activities and is useful for clinical treatments, including bone regeneration. Regenerative procedures using a bioabsorbable collagen membrane (BCM) are well established in periodontal and implant dentistry. We evaluated the subsequent effects of the BCM in combination with OP-1 on bone regeneration in a rat mandibular circular critical-sized bone defect in vivo. DESIGN We used 8 rats that received surgery in both sides of the mandible, and created the total 16 defects which were divided into 4 groups: Group 1; no treatment, as a control, Group 2; BCM alone, Group 3; BCM containing low dose 0.5μg of OP-1 (L-OP-1), and Group 4; BCM containing high dose 2.0μg of OP-1 (H-OP-1). Newly formed bone was evaluated by micro computed tomography (micro-CT) and histological analyses at 8 weeks postoperatively. In quantitative and qualitative micro-CT analyses of the volume of new bone formation, bone density, and percentage of new bone area was evaluated. RESULTS BCM with rhOP-1 significantly increased and accelerated bone volume, bone mineral density, and percentage of new bone area compared to control and BCM alone at 8 weeks after surgery; these enhancements in bone regeneration in the OP-1-treated groups were dose-dependent. CONCLUSIONS OP-1 delivered with a BCM may have effective osteoinductive potency and be a good combination for bone regeneration. The use of such a combination device for osteogenesis may result in safer and more predictable bone regenerative outcomes in the future.
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Affiliation(s)
- Manami Ozaki
- Division of Applied Oral Sciences, Nihon University Graduate School of Dentistry, Tokyo, Japan
| | - Tadahiro Takayama
- Department of Periodontology, Nihon University School of Dentistry, Tokyo, Japan; Division of Advanced Dental Treatment, Dental Research Center, Nihon University School of Dentistry, Tokyo, Japan.
| | - Takanobu Yamamoto
- Division of Applied Oral Sciences, Nihon University Graduate School of Dentistry, Tokyo, Japan
| | - Yasumasa Ozawa
- Division of Applied Oral Sciences, Nihon University Graduate School of Dentistry, Tokyo, Japan
| | - Mayu Nagao
- Department of Periodontology, Nihon University School of Dentistry, Tokyo, Japan
| | - Natsuko Tanabe
- Department of Biochemistry, Nihon University School of Dentistry, Tokyo, Japan; Division of Functional Morphology, Dental Research Center, Nihon University School of Dentistry, Tokyo, Japan
| | - Akira Nakajima
- Department of Orthodontics, Nihon University School of Dentistry, Tokyo, Japan; Division of Advanced Dental Treatment, Dental Research Center, Nihon University School of Dentistry, Tokyo, Japan
| | - Naoto Suzuki
- Department of Biochemistry, Nihon University School of Dentistry, Tokyo, Japan; Division of Functional Morphology, Dental Research Center, Nihon University School of Dentistry, Tokyo, Japan
| | - Masao Maeno
- Department of Oral Health Sciences, Nihon University School of Dentistry, Tokyo, Japan; Division of Functional Morphology, Dental Research Center, Nihon University School of Dentistry, Tokyo, Japan
| | - Seiichi Yamano
- Department of Prosthodontics, New York University College of Dentistry, NY, U.S.A
| | - Shuichi Sato
- Department of Periodontology, Nihon University School of Dentistry, Tokyo, Japan; Division of Advanced Dental Treatment, Dental Research Center, Nihon University School of Dentistry, Tokyo, Japan
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El Kassaby M, El Kader KA, Khamis N, Al Hammoud A, Talb AB, El Hadidi YN. The Effect of Bone Marrow Mesenchymal Stem Cells Application on Distracted Bone Quality during Rapid Rate of Distraction Osteogenesis. Craniomaxillofac Trauma Reconstr 2017; 11:192-198. [PMID: 30087748 DOI: 10.1055/s-0037-1604070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 04/02/2017] [Indexed: 12/15/2022] Open
Abstract
Distraction osteogenesis (DO) bone regenerate usually suffers from an inferior quality especially with rapid rate. This study was conducted to investigate the effect of mesenchymal stem cells (MSCs) application on different rates of distraction bone quality. Twenty-four goats were divided into group A with standard DO and group B with rapid distraction osteogenesis (RDO) both aided by MSCs. Group C with standard DO and group (D) with RDO were controls. Kruskal-Wallis test and Conover's post hoc analysis was used to evaluate significance ( p = 0.05). Histomorphometry showed a strongly significant (SS) increase ( p = 0.00036) in trabecular bone (TB) in group A (TB = 174.7 µm, SD = 33.5) and group B (TB = 166.8 µm, SD = 14) compared with group C (TB = 115.4 µm, SD = 19.6) and group D (TB = 86.1 µm, SD = 9.3). There was SS decrease ( p = 0.00093) in osteoid percentage (OP) in group A (OP = 13.4%, SD = 2) and group B (OP = 11.5%, SD = 6.5) compared with group C (OP = 27.3, SD = 3.5) and group D (OP = 26.2%, SD = 2.6). Energy dispersive X-ray showed a nonsignificant increase ( p = 0.11) in calcification (Ca 2+ %) in group A (Ca 2+ % = 17.6%, SD = 4.9) and group B (Ca 2+ % = 17.6%, SD = 4.3) compared with group C (Ca 2+ % = 14.2%, SD = 6.7) and group D (Ca 2+ % = 11.5%, SD = 2.4). MSCs application improved microscopic bone quality during standard DO and RDO. However, macroscopic bone quality improvement still needs further investigation.
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Affiliation(s)
- Marwa El Kassaby
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Khaled Abd El Kader
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Nahed Khamis
- Department of General Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Alaa Al Hammoud
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Alaa Ben Talb
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Yasser Nabil El Hadidi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
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Herford AS, Miller M, Signorino F. Maxillofacial Defects and the Use of Growth Factors. Oral Maxillofac Surg Clin North Am 2017; 29:75-88. [DOI: 10.1016/j.coms.2016.08.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Fliefel R, Kühnisch J, Ehrenfeld M, Otto S. Gene Therapy for Bone Defects in Oral and Maxillofacial Surgery: A Systematic Review and Meta-Analysis of Animal Studies. Stem Cells Dev 2016; 26:215-230. [PMID: 27819181 DOI: 10.1089/scd.2016.0172] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Craniofacial bone defects are challenging problems for maxillofacial surgeons over the years. With the development of cell and molecular biology, gene therapy is a breaking new technology with the aim of regenerating tissues by acting as a delivery system for therapeutic genes in the craniofacial region rather than treating genetic disorders. A systematic review was conducted summarizing the articles reporting gene therapy in maxillofacial surgery to answer the question: Was gene therapy successfully applied to regenerate bone in the maxillofacial region? Electronic searching of online databases was performed in addition to hand searching of the references of included articles. No language or time restrictions were enforced. Meta-analysis was done to assess significant bone formation after delivery of gene material in the surgically induced maxillofacial defects. The search identified 2081 articles, of which 57 were included with 1726 animals. Bone morphogenetic proteins were commonly used proteins for gene therapy. Viral vectors were the universally used vectors. Sprague-Dawley rats were the frequently used animal model in experimental studies. The quality of the articles ranged from excellent to average. Meta-analysis results performed on 21 articles showed that defects favored bone formation by gene therapy. Funnel plot showed symmetry with the absence of publication bias. Gene therapy is on the top list of innovative strategies that developed in the last 10 years with the hope of developing a simple chair-side protocol in the near future, combining improvement of gene delivery as well as knowledge of the molecular basis of oral and maxillofacial structures.
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Affiliation(s)
- Riham Fliefel
- 1 Experimental Surgery and Regenerative Medicine (ExperiMed), Ludwig-Maximilians-University , Munich, Germany .,2 Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University , Munich, Germany .,3 Department of Oral and Maxillofacial Surgery, Alexandria University , Alexandria, Egypt
| | - Jan Kühnisch
- 4 Department of Conservative Dentistry and Periodontology, Ludwig-Maximilians-University , Munich, Germany
| | - Michael Ehrenfeld
- 2 Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University , Munich, Germany
| | - Sven Otto
- 2 Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University , Munich, Germany
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12
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Tee BC, Sun Z. Mandibular distraction osteogenesis assisted by cell-based tissue engineering: a systematic review. Orthod Craniofac Res 2016; 18 Suppl 1:39-49. [PMID: 25865532 DOI: 10.1111/ocr.12087] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To review the advances and limitations of recent investigations on mandibular distraction osteogenesis (MDO) assisted by mesenchymal stem cell (MSC) transplantation. MATERIALS AND METHODS Following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines, the PubMed, Scopus, and Cochrane electronic databases were systematically searched and screened from their inception through August 2014. Searching terms included the following: 'distraction osteogenesis', 'mandible OR mandibular OR jaw', and 'cells', without any other limitations. RESULTS Nineteen studies meeting the eligibility criteria were selected from 227 published articles and used for qualitative synthesis. Fifteen of the studies used small animal models (rats or rabbits), while the other four used large animal models (dogs, pigs or sheep). Among these studies, large variations exist in MDO protocol, cell transplantation time, route and quantity, as well as methodology of outcome assessment. Additionally, all studies had certain biases. Nevertheless, the majority of studies found that MSC transplantation enhanced MDO bone regeneration. CONCLUSION Evidence from animal studies indicates that MDO may be enhanced by mesenchymal stem cell transplantation, but many questions related to animal models, MDO protocols, and cell transplantation remain to be investigated.
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Affiliation(s)
- B C Tee
- Division of Orthodontics, College of Dentistry, The Ohio State University, Columbus, OH, USA
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13
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El Hadidi YN, El Kassaby M, El Fatah Ahmed SA, Khamis NS. Effect of Mesenchymal Stem Cell Application on the Distracted Bone Microstructure: An Experimental Study. J Oral Maxillofac Surg 2016; 74:1463.e1-1463.e11. [PMID: 27109711 DOI: 10.1016/j.joms.2016.03.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 03/18/2016] [Accepted: 03/18/2016] [Indexed: 11/22/2022]
Abstract
PURPOSE Distraction osteogenesis (DO) is a surgical technique used to regenerate bone. The aim of this study was to improve bone quality and quantity during DO by the addition of mesenchymal stem cells (MSCs). MATERIALS AND METHODS The study was conducted on 12 goats assigned to a study group or a control group. In the study group, DO was aided with MSCs. Bone quality was assessed using energy dispersive x-ray (EDX), a scanning electron microscope (SEM), and histology. The histologic assessment was performed by measuring trabecular bone (TB) thickness in sections stained with hematoxylin and eosin (H&E) and by measuring osteoid bone percentage in sections stained with Masson trichrome (MT). RESULTS EDX showed an increase in calcification in the study group (mean Ca(2+), 17.58%; standard deviation [SD], 4.9%) compared with the control group (mean Ca(2+), 14.17%; SD, 6.7%). However, the increase was not statistically significant (P = .3354). Histomorphometric analysis of the H&E samples showed an increase in TB size in the study group (mean TB, 174.7 μm; SD, 33.5 μm) compared with the control group (mean TB, 115.4 μm; SD, 19.6 μm), and the increase was highly statistically significant (P = .0039). Analysis of the MT samples showed a decrease in osteoid percentage (mean osteoid percentage, 13.4%; SD, 2%) in the study group compared with the control group (mean osteoid percentage, 27.3%; SD, 3.5%). The decrease in osteoid percentage was statistically significant (P = .0001), indicating more rapid healing in the study group compared with the control group. CONCLUSION MSCs improved the bone quality of distracted bone and increased the crystal density in SEM images of the study group compared with that of the control group. MSCs showed promising results in improving the quality and quantity of distracted bone.
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Affiliation(s)
- Yasser N El Hadidi
- Associate Lecturer, Department of Oral and Maxillofacial Surgery, Ain Shams University, Cairo, Egypt.
| | - Marwa El Kassaby
- Associate Professor, Department of Oral and Maxillofacial Surgery, Ain Shams University, Cairo, Egypt
| | - Salah Abd El Fatah Ahmed
- Associate Professor, Department of Oral and Maxillofacial Surgery, Ain Shams University, Cairo, Egypt
| | - Nahed Samy Khamis
- Professor, Department of General Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Compton J, Fragomen A, Rozbruch SR. Skeletal Repair in Distraction Osteogenesis: Mechanisms and Enhancements. JBJS Rev 2015; 3:01874474-201508000-00002. [PMID: 27490473 DOI: 10.2106/jbjs.rvw.n.00107] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jocelyn Compton
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10031
| | - Austin Fragomen
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
| | - S Robert Rozbruch
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
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Interval cranioplasty with patient-specific implants and autogenous bone grafts--success and cost analysis. J Craniomaxillofac Surg 2014; 42:1948-51. [PMID: 25443869 DOI: 10.1016/j.jcms.2014.08.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 08/21/2014] [Accepted: 08/25/2014] [Indexed: 01/09/2023] Open
Abstract
UNLABELLED Different options exist for the reconstruction of craniectomy defects following interval cranioplasty. The standard procedure is still based on the re-implantation of autogenous bone specimen which can be stored in the abdominal wall or be cryopreserved. Alternatively patient-specific implants (PSIs) can be used. We conducted a retrospective study based on 50 consecutive patients with skull bone defects of 100 cm(2) or more being operated on by the same team of surgeons. Thirty-three patients agreed to take part in the study. Seventeen patients who underwent reconstruction with PSIs (titanium and polyether ether ketone, PEEK) (follow-up, 43 months [range, 3-93]) were compared with 16 control subjects who had autogenous bone grafts re-implanted (follow-up, 32 months [range, 5-92]). Criteria analyzed were the success and complication rates, operation time, duration of hospitalization and the treatment costs. Complication rate and the rate of reoperation were significantly lower, and the hospital stay was shorter in the PSI group. The treatment costs for reconstruction with autogenous bone were considerably lower than skull bone reconstruction based on PSIs (average costs: 10849.91 €/patient versus 15532.08 €/patient with PSI). Due to biological reasons some of the autogenous bone implants fail due to infection and resorption and the patients have to undergo another operation with implantation of a PSI in a secondary attempt. For those patients the highest overall treatment costs must be calculated (average costs: 26086.06 €/patient with secondary stage PSI versus 15532.08 €/patient with primary stage PSI). CONCLUSION High success rates and reliability of PSIs may change the treatment strategy in patients undergoing interval cranioplasty.
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Díaz-Sánchez RM, Yáñez-Vico RM, Fernández-Olavarría A, Mosquera-Pérez R, Iglesias-Linares A, Torres-Lagares D. Current Approaches of Bone Morphogenetic Proteins in Dentistry. J ORAL IMPLANTOL 2013; 41:337-42. [PMID: 24175931 DOI: 10.1563/aaid-joi-d-13-00012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Bone morphogenic proteins (BMPs) are a group of osteoinductive proteins obtained from nonmineralized bone matrix; they are capable of stimulating the differentiation of pluripotent mesenchymal cells to osteoprogenitor cells. They have become a likely treatment option, given their action on regeneration and remodeling of bone lesions and increasing the bone response around alloplastic materials. It may be feasible in the near future for BMPs to replace autologous and allogenic bone grafts. The application of specific growth factors for osteoinduction without using a bone graft constitutes a real impact on bone regeneration. The use of BMP is not only focused on osteogenic regeneration: There are a variety of studies investigating other properties, such as periodontal or dental regeneration from the conservative viewpoint. In this review, we will highlight the role of the BMP in bone, periodontal and dental regeneration.
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Evaluation of the presence of VEGF, BMP2 and CBFA1 proteins in autogenous bone graft: histometric and immunohistochemical analysis. J Craniomaxillofac Surg 2013; 42:333-9. [PMID: 23932545 DOI: 10.1016/j.jcms.2013.05.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Revised: 05/27/2013] [Accepted: 05/28/2013] [Indexed: 11/20/2022] Open
Abstract
AIMS The purpose of this study was to evaluate the expression of proteins that participate in the osteoinduction stage (VEGF, BMP2 and CBFA1) of the process of bone regeneration of defects created in rat calvariae and filled with autogenous bone block grafts. MATERIALS AND METHODS 10 adult male rats (Rattus norvegicus albinus, Wistar) were used, who received two bone defects measuring 5 mm each in the calvariae. The bone defects constituted two experimental groups (n = 10): Control Group (CONT) (defects filled with a coagulum); Graft Group (GR) (defects filled with autogenous bone removed from the contralateral defect). The animals were submitted to euthanasia at 7 and 30 days post-operatively. RESULTS Quantitative analysis demonstrated significantly greater bone formation in Group GR, but the presence of the studied proteins was significantly greater in the CONT Group in both time intervals of observation. CONCLUSION It was not possible in this study in cortical bone block groups to detect the osteoinductive proteins in a significant amount during the repair process.
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Faysal U, Cem SB, Atilla S. Effects of different consolidation periods on bone formation and implant success in alveolar distraction osteogenesis: A clinical study. J Craniomaxillofac Surg 2013; 41:194-7. [DOI: 10.1016/j.jcms.2012.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 08/31/2012] [Accepted: 08/31/2012] [Indexed: 11/17/2022] Open
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Jiang BJ, Wang J, Yu JW. Microenvironment for cancer stem cells. Shijie Huaren Xiaohua Zazhi 2013; 21:553-558. [DOI: 10.11569/wcjd.v21.i7.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cancer stem cells and their metastatic niche are one of hot topics for tumor study. This review introduces the definition of microenvironment (niche) for cancer stem cells, related cells and factors, characteristics and regulation of niche, premetastatic niche and tissue components. The research progress in this field can provide some clues to the metastatic mechanism of tumors and the development and improvement of chemotherapeutic drugs.
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Ramazanoglu M, Lutz R, Rusche P, Trabzon L, Kose GT, Prechtl C, Schlegel KA. Bone response to biomimetic implants delivering BMP-2 and VEGF: an immunohistochemical study. J Craniomaxillofac Surg 2013; 41:826-35. [PMID: 23434516 DOI: 10.1016/j.jcms.2013.01.037] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 12/18/2012] [Accepted: 01/15/2013] [Indexed: 10/27/2022] Open
Abstract
This animal study evaluated bone healing around titanium implant surfaces biomimetically coated with bone morphogenic protein-2 (BMP-2) and/or vascular endothelial growth factor (VEGF) by examining bone matrix proteins and mineralisation. Five different implant surfaces were established: acid-etched surface (AE), biomimetic calcium phosphate surface (CAP), BMP-2 loaded CAP surface, VEGF loaded CAP surface and dual BMP-2 + VEGF loaded CAP surface. The implants were inserted into calvariae of adult domestic pigs. For the comparison of osteoconductive capacity of each surface, bone mineral density and expression of bone matrix proteins (collagen I, BMP-2/4, osteocalcin and osteopontin) inside defined chambers around the implant were assessed using light microscopy and microradiography and immunohistochemical analysis at 1, 2 and 4 weeks. In the both groups delivering BMP-2, the bone mineral density was significantly enhanced after 2 weeks and the highest value was measured for the group BMP + VEGF. In the group VEGF, collagen I and BMP-2/4 expressions were significantly up-regulated at the first and second weeks. The percentage of BMP-2/4 positive cells in the group BMP + VEGF was significantly enhanced compared with the groups AE and CAP at the second week. Although the highest osteocalcin and osteopontin expression values were observed for the group BMP + VEGF after 2 weeks, no statistically significant difference in osteocalcin and osteopontin expressions was found between all groups at any time. It was concluded that combined delivery of BMP-2 and VEGF favoured bone mineralisation and expression of important bone matrix proteins that might explain synergistic interaction between both growth factors.
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Affiliation(s)
- Mustafa Ramazanoglu
- Department of Oral Surgery, Faculty of Dentistry, Istanbul University, Istanbul 34093, Turkey.
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Wiberg A, Magdum S, Richards PG, Jayamohan J, Wall SA, Johnson D. Posterior calvarial distraction in craniosynostosis – An evolving technique. J Craniomaxillofac Surg 2012; 40:799-806. [DOI: 10.1016/j.jcms.2012.02.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Revised: 02/16/2012] [Accepted: 02/16/2012] [Indexed: 11/16/2022] Open
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Busuttil Naudi K, Ayoub A, McMahon J, Di Silvio L, Lappin D, Hunter KD, Barbenel J. Mandibular reconstruction in the rabbit using beta-tricalcium phosphate (β-TCP) scaffolding and recombinant bone morphogenetic protein 7 (rhBMP-7) - histological, radiographic and mechanical evaluations. J Craniomaxillofac Surg 2012; 40:e461-9. [PMID: 22507295 DOI: 10.1016/j.jcms.2012.03.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 03/05/2012] [Accepted: 03/06/2012] [Indexed: 11/18/2022] Open
Abstract
This investigation assesses the histological, radiographic and mechanical properties of regenerated bone in a unilateral critical-size osteoperiosteal mandibular continuity defect in the rabbit model, following the application of beta-tricalcium phosphate (β-TCP) scaffolding and recombinant human bone morphogenetic protein 7 (rhBMP-7). The study was carried out on nine cases; in six cases the critical-size defect was filled with rhBMP-7 in the β-TCP scaffolding, and in three cases the β-TCP was used alone. The cases were sacrificed 3 months post-operatively. Histologically the overall mean of the percentage of regenerated bone volume in the cases that received rhBMP-7 was 29.41% ± 6.25%, which was considerably greater than the 6.35% ± 3.08% in the cases treated with β-TCP alone. Mechanical testing of the cases treated with rhBMP-7 gave failure moments (55 mNm-2.040 Nm) that were consistently greater than those treated with β-TCP alone (0 mNm-48 mNm). In some cases the mechanical properties of the regenerated bone were comparable to those of untreated bone. RhBMP-7 in prefabricated β-TCP scaffolding appeared, radiographically and histologically, to be an effective method for bone regeneration in mandibular critical-size defects in the rabbit model. This points towards possible future clinical applications.
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Affiliation(s)
- Kurt Busuttil Naudi
- Biotechnology & Craniofacial Sciences Research Group, Glasgow Dental Hospital, UK.
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Synergistic Enhancement of New Bone Formation by Recombinant Human Bone Morphogenetic Protein-2 and Osteoprotegerin in Trans-Sutural Distraction Osteogenesis: A Pilot Study in Dogs. J Oral Maxillofac Surg 2011; 69:e446-55. [DOI: 10.1016/j.joms.2011.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 06/07/2011] [Accepted: 07/13/2011] [Indexed: 01/04/2023]
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Jensen OT, Ringeman JL, Cottam JR, Casap N. Orthognathic and osteoperiosteal flap augmentation strategies for maxillary dental implant reconstruction. Dent Clin North Am 2011; 55:813-846. [PMID: 21933734 DOI: 10.1016/j.cden.2011.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In this article, five variations in orthognathic surgery procedures used to gain bone mass for implants are discussed: Le Fort I downgrafting, Le Fort I distraction, sub-Le Fort I interpositional sandwich grafting, segmental sandwich grafting, and the island osteoperiosteal flap approach.
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Affiliation(s)
- Ole T Jensen
- Implant Dentistry Associates of Colorado, 8200 East Belleview Avenue, Suite 520E, Greenwood Village, CO 80111, USA.
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Myon L, Ferri J, Chai F, Blanchemain N, Raoul G. [Oro-maxillofacial bone tissue engineering combining biomaterials, stem cells, and gene therapy]. ACTA ACUST UNITED AC 2011; 112:201-11. [PMID: 21798570 DOI: 10.1016/j.stomax.2011.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Improvements have been made in regenerative medicine, due to the development of tissue engineering and cellular therapy. Bone regeneration is an ambitious project, leading to many applications involving skull, maxillofacial, and orthopaedic surgery. Scaffolds, stem cells, and signals support bone tissue engineering. The scaffold physical and chemical properties promote cell invasion, guide their differentiation, and enable signal transmission. Scaffold may be inorganic or organic. Their conception was improved by the use of new techniques: self-assembled nanofibres, electrospinning, solution-phase separation, micropatterned hydrogels, bioprinting, and rapid prototyping. Cellular biology processes allow us to choose between embryonic stem cells or adult stem cells for regenerative medicine. Finally, communication between cells and their environment is essential; they use various signals to do so. The study of signals and their transmission led to the discovery and the use of Bone Morphogenetic Protein (BMP). The development of cellular therapy led to the emergence of a specific field: gene therapy. It relies on viral vectors, which include: retroviruses, adenoviruses and adeno-associated vectors (AAV). Non-viral vectors include plasmids and lipoplex. Some BMP genes have successfully been transfected. The ability to control transfected cells and the capacity to combine and transfect many genes involved in osseous healing will improve gene therapy.
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Affiliation(s)
- L Myon
- Université Lille Nord de France, UDSL, 59000 Lille, France
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Jensen OT, Ringeman JL, Cottam JR, Casap N. Orthognathic and Osteoperiosteal Flap Augmentation Strategies for Maxillary Dental Implant Reconstruction. Oral Maxillofac Surg Clin North Am 2011; 23:301-19, vi. [PMID: 21492803 DOI: 10.1016/j.coms.2011.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bone formation and degradation of a highly porous biphasic calcium phosphate ceramic in presence of BMP-7, VEGF and mesenchymal stem cells in an ectopic mouse model. J Craniomaxillofac Surg 2010; 38:423-30. [DOI: 10.1016/j.jcms.2010.01.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2009] [Revised: 01/18/2010] [Accepted: 01/19/2010] [Indexed: 11/23/2022] Open
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