Is reconstruction of large mandibular defects using bioengineering materials effective?
Melville JC, Tran HQ, Bhatti AK, Manon V, Young S, Wong ME
Many innovative tissue engineering technologies for regeneration of craniofacial bone have been proposed over the years, but the complexity of the strategies coupled with regulatory considerations often mitigates translation of the approaches to the clinic. Nevertheless, the principal elements of tissue engineering (scaffolds, cells, and biologically active factors) can be applied in clinical tissue engineering strategies to promote craniofacial bone regeneration using clinically-available materials and products. A recent article by Melville et al. reports a retrospective case series of application of a composite tissue engineered graft in mandibular defects in 34 patients over a period of 5 years. The composite tissue engineered grafts comprised allogeneic bone as a biological scaffold, bone marrow aspirate concentrate as a source of progenitor cells, and recombinant human bone morphogenetic protein-2 as an osteoinductive factor. Success of the grafts was defined in terms of bone union (as apparent via radiography) without mandibular mobility and adequate grafted bone volume to support implant placement at a median follow-up of 6 months. The study reports a high success rate across a variety of reconstructive procedures employing a range of surgical approaches. The authors conclude that the composite tissue engineered bone graft is a valid alternative to autogenous bone with myriad advantages, but they underscore that the avascular tissue engineered composite graft is particularly vulnerable to bacterial contamination and patient selection is an important consideration. Overall, the study highlights the successful application of a clinical tissue engineering approach for repair of craniofacial bone defects.