TISSUE ENGINEERING

Step ahead in Maxillofacial Reconstruction……

PRESENTED BY :- Mr. Joyabrata Sarkar

3rd Professional BDS student,
Kusum Devi Sunderlal Dugar Jain
Dental College & Hospital

GUIDED BY :- Dr. Surbhi Chowdhary

Senior Lecturer,
Department of Oral & Maxillofacial Surgery,
Kusum Devi Sunderlal Dugar Jain Dental
College & Hospital
• INTRODUCTION
• WHY TISSUE ENGINEERING IN MAXILLOFACIAL RECONSTRCUTION ?
• KEY COMPONENTS & BASIC PRINCIPLES OF TISSUE ENGINEERING
• APPROACHES TO REGENERATE A TISSUE
• STEPS INVOLVED IN TISSUE ENGINEERING
• APPLICATION OF TISSUE ENGINEERING IN ORAL & MAXILLOFACIAL SURGERY
• BONE REGENERATION
• CARTILAGE REGENERATION
• SOFT TISSUE REGENERATION
• SALIVARY GLAND REGENERATION
• FAT, MUSCLE, NERVE REGENERATION
• CHALLENGES IN USING TISSUE ENGINEERING AS A TREATMENT MODULE
• FUTURE ADVANCES IN RECONSTRUCTION
• CONCLUSION
• REFERENCES
• ACKNOWLEDGEMENT
According to Langer & Vacanti,
“TISSUE ENGINEERING is an interdisciplinary field that applies the
principles of engineering and life sciences toward the development of
biological substitutes that restore, maintain or improve tissue
function or a whole organ.”
 Complications of current Advantages of tissue
autologous tissue transfer engineering in the field of
techniques :- reconstruction :-

1. Declination in donor site morbidity

1. Vascular thrombosis.
and recipient site morbidity.

2. Partial or complete flap loss due to

2. Decrease in procedural sensitivity of
necrosis (higher for pedicled
the repair.
myocutaneous flap than free flaps).

3. Donor site morbidity like skin graft

3. Capacity to intimately mimic the
failure, delayed wound healing,
original lost tissue in form, function
infection, subsequent dysesthesia in
and esthetics.
areas distal to the harvested flap.
 SCAFFOLDS OR EXTRACELLULAR
MATRIX
(Natural or synthetic
And Bioinactive or bioactive or
bioresorbable)

Attachment and Signaling molecules

migration of cells released in and
into scaffold around scaffold
TIME
TRAID OF REGENERATION
OF TISSUES OR
TISSUE ORGANS
APPROPRIATE
ENGINEERING ENVIORNMENT
STEM CELLS SIGNALING MOLECULES
(Embryonic or Adult-derived (Growth factors, cytokines,
stem cells or Induced mechanical or electrical
Proliferation and stimulus)
Pluripotent stem cells)
differentiation of cells
 BIOACTIVE SCAFFOLDS ARE USED

1. INDUCTION
ONLY SCAFFOLDS ARE USED

2. CONDUCTION
CELL TRANSPLANTATION ALONG WITH BIOACTIVE
SCAFFOLDS

3. CELL
TRANSPLANTATION
 In-vitro cell
Cell expansion(isolation
harvesting & cultivation) Proliferation and
differentiation of cells
into scaffold in
presence of signaling
molecules

Surgical
Evaluation Implantation
of in-vivo of regenerated
results tissue
 CARTILAGE
REGENERATION

BONE SOFT TISSUE

REGENERATION REGENERATION

FAT, MUSCLE,NERVE
REGENERATION
IN In which cases In case of:-
do you regenerate • SMALL/LARGE MANDIBULAR
bone? CONGENITAL/POST-TRAUMATIC/POST-
OPERATIVE DEFECTS
• MAXILLARY CLEFT REPAIR
• MAXILLARY & MANDIBULAR RIDGE
AUGMENTATION
• MAXILLARY SINUS AUGMENTATION

By using :-
Stem cells like BMSCs, ADSCs, DPSCs,
IN How do you etc.
regenerate? Scaffolds like polymers, collagen,
hydroxyapatite, tricalcium phosphate.
Signaling molecules like rH-BMP, BMP-
7, BMP-2, PRP & PDGRF.

In cranio-facial region, it can be used
for restoration of :-
CONGENITAL/ TRAUMATIC DEFECT
OF
• ARTICULAR DISC OF
TEMPOROMANDIBULAR JOINT
• NASAL SEPTUM
• EAR.
By using :-
• Stem cells with chondrogenic
potential like BMSCs, PERIOSTEUM
DERIVED STEM CELLs.
• Scaffolds like carbon fibre pads,
decalcified bone fibrin glue, collagen
gels, alginate hydrogels.
• Signaling molecules like FGF-2, FGF-β,
bFGF
 SKIN:-
1. Skin substitutes are available with one that replace dermis and one which replaces
the epidermis : ALLODERM(dead de-epidermalized dermis)
2. These can be used in cases of BURNS, TRAUMA, POST-CANCER SURGERY.
3. But none of these substitutes fulfill all fully functional properties of skin.

ORAL MUCOSA:-
1. EVPOME, ALLODERM are commercially available tissue engineered oral mucosa
substitutes.
2. These can be used in case of intra-oral defects such as CLEFT-LIP, CLEFT-PALATE,
TRAUMA, MUCOSAL LOSS AFTER SURGERY.
Joraku et al. cultivated human salivary gland epithelial cells in a polyglutamic acid polymer
scaffolds.
They developed this using an in vitro collagen and matrigel culture system to
reconstitute human salivary gland tissue.

They showed functional, differentiated salivary units & ducts in a 3-D construct,
with the production of secretory granules and expression of aquaporin 5 protein.

SECRETION OF SALIVA FROM ARTIFICIAL SALIVARY GLAND IS IN RESEARCH.

Adipose tissue, myotubules, and nerves have been regenerated in laboratories with
relevant signaling molecules and scaffolds.

But motor end plate is must for a muscle to contract and relax. Tissue engineers have
failed to regenerate such functional muscles.

RESEARCH IS GOING ON FOR THE SAME.

• RECONSTRUCTION OF TISSUE LOSS AS A RESULT OF PARAFUNCTIONAL HABITS, NON-
PHYSIOLOGICAL LOADING PATTERNS, IMMUNOLOGICALLY MEDIATED DEGENERATION
WHICH OFTEN CONTINUES EVEN AFTER RECONSTRUCTION.
• TO AVOID :-
 DILUTIONAL EFFECTS OF MOISTURE, AS GRAFTED TISSUE IS EXPOSED TO ORAL CAVITY,NASAL PASAGE,SINUSES.
 COLONISATION OF INFECTIVE ORGANISMS IN POROUS CONSTRUCTS.
 DYSFUNCTION DUE TO FUNCTIONAL LOADS LIKE CHEWING.
• TO ENGINEER COMPOSITE TISSUES AND TO ATTACH VARIOUS CONSTRUCTS TO EACH
OTHER IN THEIR NORMAL ANATOMICAL RELATIONSHIP IN CASE OF COMPOSITE DEFECTS.
• TO RESTORE FACIAL SYMMETRY AND ACCURATE REPRODUCTION OF EXTERNAL FORM TO
PRESERVE FACIAL ESTHETICS.
STEREOLITHOGRAPHIC MODELS guiding about the normal
anatomy, defect and assist in the fabrication of scaffolds
to support the reconstruction of missing tissue.

3-D BIO-PRINTING is the process of automated deposition

of biological molecules on a substrate to form
a 3D heterogeneous functional structure with data
derived from a digital model.
A rendering of in-situ bioprinting for craniofacial
reconstruction, where a human is under a bioprinter.

4-D BIO-PRINTING is analogous to 4D printing in that it is

the printing of smart, environmentally responsive
biological structures, tissues and organs. 4D bio-printing
begins with the printing of multiple cells or biological
matrices resulting in structures that undergo subsequent,
designed and anticipated (not spontaneous) but self-
originated development in response to an environment.
 SIMPLE TISSUE ENGINEERING
HAS BEEN SUCCESSFULLY
MAXILLOFACIAL
BUT RESTORATION SURGEONS
OF COMPLEX &
ACHIEVED TO RESTORE
TISSUE
TISSUE ENGINEERS
STRUCTURES AND ITS
TISSUE DEFECT.
SHOULD
FUNCTIONWORK ASSTILL
ARE A TEAM
IN THEFOR
THE FUTURERESEARCH
DEVELOPMENTS IN
THE FIELD OF TISSUE ENGINEERING.
1. Raj Rai, Rushik Raval, Rakshit Vijay Sinai Khandeparker, Swati K Chidrawar, Abdul Ahad Khan, and Makne Sachin Ganpat
Tissue Engineering: Step Ahead in Maxillofacial Reconstruction. J Int Oral Health. 2015 Sep; 7(9): 138–142.
2. Srisuwan T, Tilkorn DJ, Wilson JL, Morrison WA, Messer HM, Thompson EW, et al. Molecular aspects of tissue engineering
in the dental field. Periodontol. 2000;41:88–108.
3. Wang KH, Inman JC, Hayden RE. Modern concepts in mandibular reconstruction in oral and oropharyngeal cancer. Curr
Opin Otolaryngol Head Neck Surg. 2011;19(2):119–24.
4. Susarla SM, Swanson E, Gordon CR. Craniomaxillofacial reconstruction using allotransplantation and tissue engineering:
Challenges, opportunities, and potential synergy. Ann Plast Surg. 2011;67(6):655–61.
5. Ward BB, Brown SE, Krebsbach PH. Bioengineering strategies for regeneration of craniofacial bone: A review of emerging
technologies. Oral Dis. 2010;16(8):709–16.
6. Feinberg SE, Aghaloo TL, Cunningham LL., Jr Role of tissue engineering in oral and maxillofacial reconstruction: Findings
of the 2005 AAOMS research summit. J Oral Maxillofac Surg. 2005;63(10):1418–25.
7. Dougherty WR, Chalabian JR. Skin substitutes. West J Med. 1995;162(6):540–1.
8. MacFarlane DF. Current techniques in skin grafting. Adv Dermatol. 2006;22:125–38.
9. Joraku A, Sullivan CA, Yoo J, Atala A. In-vitro reconstitution of three-dimensional human salivary gland tissue structures.
Differentiation. 2007;75(4):318–24.
10. Bach AD, Beier JP, Stern- Staeter J, Horch RE. Skeletal muscle tissue engineering. J Cell Mol Med. 2004;8(4):413–22.
11. Patrick Spicer, Simon Young, F. Kurtis Kasper, Kyriacos A. Athanasiou, Antonios G. Mikos and Mark Eu-Kien Wong Tissue
Engineering in Oral and Maxillofacial Surgery.
 Dr. (Prof.) Aditya Mitra
Principal and HOD of Dept. of conservative dentistry and Endodontics
Kusum Devi Sundarlal Dugar Jain Dental College and Hospital

Dr. (Prof.) Jayanta Chattopadhyay

Dean and HOD of Dept. of Oral and Maxillofacial Pathology
Kusum Devi Sundarlal Dugar Jain Dental College and Hospital

Dr.(Prof.) Tapas Bala

HOD of Dept. of Oral and Maxillofacial Surgery
Kusum Devi Sundarlal Dugar Jain Dental College and Hospital

My parents

My dear batch mates and Juniors