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Nelms et al. Plast Aesthet Res 2019;6:21 Plastic and
DOI: 10.20517/2347-9264.2019.40 Aesthetic Research

Review Open Access

Tissue engineering in mandibular reconstruction:
osteogenesis-inducing scaffolds

Laurel Nelms , William Jack Palmer 2
1
1 University of California Riverside School of Medicine, Riverside, CA 92521, USA.
2 Boston University School of Medicine, Boston, MA 02118, USA.

Correspondence to: Laurel Nelms, University of California Riverside School of Medicine, UC Riverside: School of Medicine
Education Bldg. 900 University Ave. Riverside, CA 92521, USA. E-mail: Laurel.Nelms@medsch.ucr.edu

How to cite this article: Nelms L, Palmer WJ. Tissue engineering in mandibular reconstruction: osteogenesis-inducing scaffolds.
Plast Aesthet Res 2019;6:21. http://dx.doi.org/10.20517/2347-9264.2019.40

Received: 22 Aug 2019 First Decision: 9 Sep 2019 Revised: 12 Sep 2019 Accepted: 18 Sep 2019 Published: 23 Sep 2019

Science Editor: Ali-Farid Safi Copy Editor: Jia-Jia Meng Production Editor: Jing Yu

Abstract

Currently, the gold standard for aesthetic and functional reconstruction of critical mandibular defects is an
autologous fibular flap; however, this carries risk of donor site morbidity, and is not a promising option in patients
with depleted donor sites due to previous surgeries. Tissue engineering presents a potential solution in the design
of a biomimetic scaffold that must be osteoconductive, osteoinductive, and support osseointegration. These
osteogenesis-inducing scaffolds are most successful when they mimic and interact with the surrounding native macro-
and micro-environment of the mandible. This is accomplished via the regeneration triad: (1) a biomimetic, bioactive
osteointegrative scaffold, most likely a resorbable composite of collagen or a synthetic polymer with collagen-like
properties combined with beta-tri calcium phosphate that is 3D printed according to defect morphology; (2) growth
factor, most frequently bone morphogenic protein 2 (BMP-2); and (3) stem cells, most commonly bone marrow
mesenchymal stem cells. Novel techniques for scaffold modification include the use of nano-hydroxyapatite, or
combining a vector with a biomaterial to create a gene activated matrix that produces proteins of interest (typically
BMP-2) to support osteogenesis. Here, we review the current literature in tissue engineering in order to discuss the
success of varying use and combinations of scaffolding materials (i.e., ceramics, biological polymers, and synthetic
polymers) with stem cells and growth factors, and will examine their success in vitro and in vivo to induce and guide
osteogenesis in mandibular defects.

Keywords: Osteogenic scaffolds, mandibular reconstruction, tissue engineering, regeneration triad, bone morphogenic
protein, bone marrow mesenchymal stem cells, beta-tri calcium phosphate, gene activated matrix

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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