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Kirmanidou Y, Chatzinikolaidou M, Michalakis K, Tsouknidas A. Clinical translation of polycaprolactone-based tissue engineering scaffolds, fabricated via additive manufacturing: A review of their craniofacial applications. BIOMATERIALS ADVANCES 2024; 162:213902. [PMID: 38823255 DOI: 10.1016/j.bioadv.2024.213902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/17/2024] [Accepted: 05/19/2024] [Indexed: 06/03/2024]
Abstract
The craniofacial region is characterized by its intricate bony anatomy and exposure to heightened functional forces presenting a unique challenge for reconstruction. Additive manufacturing has revolutionized the creation of customized scaffolds with interconnected pores and biomimetic microarchitecture, offering precise adaptation to various craniofacial defects. Within this domain, medical-grade poly(ε-caprolactone) (PCL) has been extensively used for the fabrication of 3D printed scaffolds, specifically tailored for bone regeneration. Its adoption for load-bearing applications was driven mainly by its mechanical properties, adjustable biodegradation rates, and high biocompatibility. The present review aims to consolidating current insights into the clinical translation of PCL-based constructs designed for bone regeneration. It encompasses recent advances in enhancing the mechanical properties and augmenting biodegradation rates of PCL and PCL-based composite scaffolds. Moreover, it delves into various strategies improving cell proliferation and the osteogenic potential of PCL-based materials. These strategies provide insight into the refinement of scaffold microarchitecture, composition, and surface treatments or coatings, that include certain bioactive molecules such as growth factors, proteins, and ceramic nanoparticles. The review critically examines published data on the clinical applications of PCL scaffolds in both extraoral and intraoral craniofacial reconstructions. These applications include cranioplasty, nasal and orbital floor reconstruction, maxillofacial reconstruction, and intraoral bone regeneration. Patient demographics, surgical procedures, follow-up periods, complications and failures are thoroughly discussed. Although results from extraoral applications in the craniofacial region are encouraging, intraoral applications present a high frequency of complications and related failures. Moving forward, future studies should prioritize refining the clinical performance, particularly in the domain of intraoral applications, and providing comprehensive data on the long-term outcomes of PCL-based scaffolds in bone regeneration. Future perspective and limitations regarding the transition of such constructs from bench to bedside are also discussed.
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Affiliation(s)
- Y Kirmanidou
- Laboratory for Biomaterials and Computational Mechanics, Department of Mechanical Engineering, University of Western Macedonia, University Campus ZEP, 50100 Kozani, Greece
| | - M Chatzinikolaidou
- Department of Materials Science and Engineering, University of Crete, 70013 Heraklion, Greece; Foundation for Research and Technology Hellas (FO.R.T.H), Institute of Electronic Structure and Laser (IESL), 70013 Heraklion, Greece
| | - K Michalakis
- Laboratory of Biomechanics, Department of Restorative Sciences & Biomaterials, Henry M. Goldman School of Dental Medicine, Boston University, Boston MA-02111, USA; Center for Multiscale and Translational Mechanobiology, Boston University, Boston, MA, USA
| | - A Tsouknidas
- Laboratory for Biomaterials and Computational Mechanics, Department of Mechanical Engineering, University of Western Macedonia, University Campus ZEP, 50100 Kozani, Greece; Laboratory of Biomechanics, Department of Restorative Sciences & Biomaterials, Henry M. Goldman School of Dental Medicine, Boston University, Boston MA-02111, USA.
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Li S, Rong Q, Zhou Y, Che Y, Ye Z, Liu J, Wang J, Zhou M. Osteogenically committed hUCMSCs-derived exosomes promote the recovery of critical-sized bone defects with enhanced osteogenic properties. APL Bioeng 2024; 8:016107. [PMID: 38327715 PMCID: PMC10849773 DOI: 10.1063/5.0159740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 12/18/2023] [Indexed: 02/09/2024] Open
Abstract
Low viability of seed cells and the concern about biosafety restrict the application of cell-based tissue-engineered bone (TEB). Exosomes that bear similar bioactivities to donor cells display strong stability and low immunogenicity. Human umbilical cord mesenchymal stem cells-derived exosomes (hUCMSCs-Exos) show therapeutic efficacy in various diseases. However, little is known whether hUCMSCs-Exos can be used to construct TEB to repair bone defects. Herein, PM-Exos and OM-Exos were separately harvested from hUCMSCs which were cultured in proliferation medium (PM) or osteogenic induction medium (OM). A series of in-vitro studies were performed to evaluate the bioactivities of human bone marrow mesenchymal stem cells (hBMSCs) when co-cultured with PM-Exos or OM-Exos. Differential microRNAs (miRNAs) between PM-Exos and OM-Exos were sequenced and analyzed. Furthermore, PM-Exos and OM-Exos were incorporated in 3D printed tricalcium phosphate scaffolds to build TEBs for the repair of critical-sized calvarial bone defects in rats. Results showed that PM-Exos and OM-Exos bore similar morphology and size. They expressed representative surface markers of exosomes and could be internalized by hBMSCs to promote cellular migration and proliferation. OM-Exos outweighed PM-Exos in accelerating the osteogenic differentiation of hBMSCs, which might be attributed to the differentially expressed miRNAs. Furthermore, OM-Exos sustainably released from the scaffolds, and the resultant TEB showed a better reparative outcome than that of the PM-Exos group. Our study found that exosomes isolated from osteogenically committed hUCMSCs prominently facilitated the osteogenic differentiation of hBMSCs. TEB grafts functionalized by OM-Exos bear a promising application potential for the repair of large bone defects.
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Affiliation(s)
| | | | | | - Yuejuan Che
- Department of Anesthesia, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Ziming Ye
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou 510182, China
| | - Junfang Liu
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou 510182, China
| | - Jinheng Wang
- Guangzhou Municipal and Guangdong Provincial Key Laboratory of Protein Modification and Degradation, State Key Laboratory of Respiratory Disease, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou 511436, China
| | - Miao Zhou
- Author to whom correspondence should be addressed:. Tel/Fax: +86 020 33976070
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Mulinari-Santos G, Scannavino FLF, de Avila ED, Barros-Filho LAB, Theodoro LH, Barros LAB, de Molon RS. One-Stage Approach to Rehabilitate a Hopeless Tooth in the Maxilla by Means of Immediate Dentoalveolar Restoration: Surgical and Prosthetic Considerations. Case Rep Dent 2024; 2024:5862595. [PMID: 38370389 PMCID: PMC10874294 DOI: 10.1155/2024/5862595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/06/2023] [Accepted: 01/31/2024] [Indexed: 02/20/2024] Open
Abstract
Contemporary dentistry has increased the demand for predictable functional and esthetic results in a short period of time without compromising the long-term success of rehabilitation. Recent advances in surgical techniques have provided alternatives that allow the prosthetic rehabilitation of complex implant-supported cases through minimally invasive techniques. In this context, immediate dentoalveolar restoration (IDR) was described aiming at restoring function and esthetics through the reconstruction of lost periodontal tissues followed by immediate implant placement in order to minimize treatment time and surgical morbidity in a one-stage approach. Therefore, the aim of this clinical case is to describe the reconstruction and rehabilitation of a hopeless tooth in the maxillary region in a one-stage approach by means of IDR. The proposed steps to rehabilitate the case involved atraumatic dental extraction, immediate implant placement, and hard tissue augmentation by means of cortical-medullary bone graft harvested from the maxillary tuberosity. Afterwards, a provisional restoration was manufactured and installed to the implant allowing immediate prosthesis provisionalization and function in the same operatory time. Six months after the surgical procedure, the final prosthesis was manufactured and installed. The follow-up of nine years demonstrated the preservation of hard and soft tissue without tissue alteration and a successful esthetic outcome. The surgical protocol used allowed the ideal three-dimensional placement of the implant with the restoration of the bone buccal wall, favoring the esthetic and functional outcome of the case with harmony between white and pink esthetics. In conclusion, the employed treatment validated immediate implant-supported restoration of the missing tooth with high predictability. Furthermore, this protocol resulted in fewer surgical interventions, regeneration, and preservation of peri-implant tissues reaching the patient's expectations.
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Affiliation(s)
- Gabriel Mulinari-Santos
- Department of Diagnosis and Surgery, São Paulo State University-UNESP, School of Dentistry, Aracatuba SP 16015-050, Brazil
| | - Fabio Luiz Ferreira Scannavino
- Department of Diagnosis and Surgery, São Paulo State University-UNESP, School of Dentistry, Aracatuba SP 16015-050, Brazil
| | - Erica Dorigatti de Avila
- Department of Dental Materials and Prosthodontics, São Paulo State University-UNESP, School of Dentistry, Aracatuba, SP 16015-050, Brazil
| | | | - Leticia Helena Theodoro
- Department of Diagnosis and Surgery, São Paulo State University-UNESP, School of Dentistry, Aracatuba SP 16015-050, Brazil
| | - Luiz Antonio Borelli Barros
- Department of Social Dentistry, São Paulo State University-UNESP, School of Dentistry, Araraquara, Sao Paulo 14801-930, Brazil
| | - Rafael Scaf de Molon
- Department of Diagnosis and Surgery, São Paulo State University-UNESP, School of Dentistry, Aracatuba SP 16015-050, Brazil
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Pohl S. Immediate ridge reconstruction with a composite tuberosity graft after removal of failing implants. Clin Adv Periodontics 2023; 13:227-234. [PMID: 36181713 DOI: 10.1002/cap.10228] [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: 07/21/2022] [Accepted: 09/14/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND When a dental implant is discovered to be failing, the implant must be removed, resulting in a defect. Immediate reconstruction of the defect using an autogenous composite tuberosity graft has been reported following the removal of a single implant. Ridge reconstruction after the removal of more than one failing dental implant poses an even greater challenge, given the substantial loss of hard and soft tissue. To the author's knowledge, this is the first report to describe the use of an autogenous composite tuberosity graft for the reconstruction of hard and soft tissue for multiple sites. METHODS AND RESULTS Three patients with failing implants and ridge defects received a composite tuberosity graft comprising the bone, periosteum, connective tissue, and epithelium of the maxillary tuberosity for simultaneous hard and soft tissue reconstruction. Bone from the maxillary tuberosity was positioned between the bony borders of the defect or fixed buccally to augment the ridge. Smaller bone pieces from the tuberosity were used to fill the gaps. The soft tissue portion of the graft was allowed to heal spontaneously, thus eliminating the need for further surgery to increase keratinized gingiva and vestibular depth. All sites recovered uneventfully, and the ridge dimensions were re-established. CONCLUSION For patients with sufficient tuberosity bone volume, using a one-piece composite tuberosity bone graft appears to be a promising approach for rebuilding the ridge in a single surgery. KEY POINTS Why are these cases new information? Large hard and soft tissue defects are reconstructed immediately after the removal of one or more failed implants. Keratinized gingival width and vestibular depth are improved. What are the keys to the successful management of these cases? Cone-beam computed tomography for tuberosity and defect evaluation Careful handling of tuberosity bone Proper graft shaping Composite tuberosity graft fixation Fixed provisional prosthesis for grafted area protection What are the key limitations to the success of these cases? Unavailability of tuberosity A technique-sensitive approach.
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Affiliation(s)
- Snjezana Pohl
- Department of Oral Medicine and Periodontology, University of Rijeka, Rijeka, Croatia
- Private Clinic Rident, Rijeka, Croatia
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Liu Y, Guo L, Li X, Liu S, Du J, Xu J, Hu J, Liu Y. Challenges and tissue engineering strategies of periodontal guided tissue regeneration. Tissue Eng Part C Methods 2022; 28:405-419. [PMID: 35838120 DOI: 10.1089/ten.tec.2022.0106] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Periodontitis is a chronic infectious oral disease with a high prevalence rate in the world, and is a major cause of tooth loss. Nowadays, people have realized that the local microenvironment that includes proteins, cytokines, and extracellular matrix has a key influence on the functions of host immune cells and periodontal ligament stem cells during a chronic infectious disease such as periodontitis. The above pathological process of periodontitis will lead to a defect of periodontal tissues. Through the application of biomaterials, biological agents, and stem cells therapy, guided tissue regeneration (GTR) makes it possible to reconstruct healthy periodontal ligament tissue after local inflammation control. To date, substantial advances have been made in periodontal guided tissue regeneration. However, the process of periodontal remodeling experiences complex microenvironment changes, and currently periodontium regeneration still remains to be a challenging feat. In this review, we summarized the main challenges in each stage of periodontal regeneration, and try to put forward appropriate biomaterial treatment mechanisms or potential tissue engineering strategies that provide a theoretical basis for periodontal tissue engineering regeneration research.
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Affiliation(s)
- Yitong Liu
- Laboratory of Tissue Regeneration and Immunology and Department of Periodontics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, School of Stomatology, Capital Medical University, Beijing, China;
| | - Lijia Guo
- Department of Orthodontics, School of Stomatology, Capital Medical University, Beijing, China;
| | - Xiaoyan Li
- Laboratory of Tissue Regeneration and Immunology and Department of Periodontics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, School of Stomatology, Capital Medical University, Beijing, China;
| | - Siyan Liu
- Laboratory of Tissue Regeneration and Immunology and Department of Periodontics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, School of Stomatology, Capital Medical University, Beijing, China;
| | - Juan Du
- Laboratory of Tissue Regeneration and Immunology and Department of Periodontics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, School of Stomatology, Capital Medical University, Beijing, China;
| | - Junji Xu
- Laboratory of Tissue Regeneration and Immunology and Department of Periodontics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, School of Stomatology, Capital Medical University, Beijing, China;
| | - Jingchao Hu
- Laboratory of Tissue Regeneration and Immunology and Department of Periodontics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, School of Stomatology, Capital Medical University, Beijing, China;
| | - Yi Liu
- Capital Medical University School of Stomatology, Laboratory of Tissue Regeneration and Immunology and Department of Periodontics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction,, Tian Tan Xi Li No.4, Beijing, Beijing , China, 100050;
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