Dental Hard Tissue Engineering
Improved methods of bone regeneration are needed to greatly improve the medical treatment options to vast numbers of patients suffering from different types of bone injury. Bone can be injured in many ways: as a result of trauma or aging, and from disease
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Contents Introduction . . . . . . . . . . . . . . . . . . . . . . . . 345
26.4.4 Dentin/Pulp Regeneration . . . . . . . . . . . . . 360
26.1.1 Bone Graft Gold Standard . . . . . . . . . . . . . 346
26.4.5 Articular Cartilage Repair . . . . . . . . . . . . . 361
26.1.2 Materials Science . . . . . . . . . . . . . . . . . . . . 346
26.4.6 Complete Regeneration of Teeth and Jaws 362
26.1.3 Use of Biologics . . . . . . . . . . . . . . . . . . . . . 346
26.5
26.1
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . 362 References . . . . . . . . . . . . . . . . . . . . . . . . . 363
26.1.4 Role of Inflammation and Fibrosis . . . . . . . 347 26.1.5 Regeneration Versus Scar Formation . . . . . 347 26.1.6 Practical Considerations for Bone Regeneration Technology . . . . . . . . . . . . . . 348 26.2
Basic Tissue Engineering Principles . . . . . 348
26.3
Approaches to Apply Tissue Engineering Techniques . . . . . . . . . . . . . . . . . . . . . . . . . 349
26.3.1 Group 1: Scaffold/Matrix Material . . . . . . . 350
26.1
Introduction
26.3.2 Group 2: Protein or Gene Delivery . . . . . . 350 26.3.3 Group 3: Cells/“Stem Cells” Delivery . . . . 351 26.3.4 Group 4: Scaffold Plus Protein or Gene Delivery . . . . . . . . . . . . . . . . . . . . 352 26.3.5 Group 5: Scaffold + Cells Delivery . . . . . . . 353 26.3.6 Group 6: Protein (or Gene) + Cells . . . . . . . 354 26.3.7 Group 7: Scaffold + Protein (or Gene) + Cells . . . . . . . . . . . . . . . . . . . . . 354 26.3.8 Practical Issues Involving Gene and Cell Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . 355 26.4
Clinical Application of Biologics for the Regeneration of Craniofacial Hard Tissue . 356
26.4.1 Osseointegration of Dental Implants . . . . . 356 26.4.2 Grafting of Dentoalveolar Bone Defects . . 358 26.4.3 Periodontal Regeneration . . . . . . . . . . . . . . 358
Improved methods of bone regeneration are needed to greatly improve the medical treatment options to vast numbers of patients suffering from different types of bone injury. Bone can be injured in many ways: as a result of trauma or aging, and from diseases such as cancer, osteoporosis, and periodontal disease. Drug side effects, as seen when using bisphosphonate for treatment of osteoporosis and metastatic bone cancer, can also destroy bone [1, 2]. Specific indications for bone repair in dental and craniofacial reconstruction include bone augmentation prior to prosthetic reconstruction, fracture repair, and repair of bone defects secondary to trauma, tumor resection, and congenital deformities. In roughly half of all individuals in the United States, periodontal disease alone is projected to result in the loss of six teeth per individual by age
346
65 years [3, 4]. Clearly, bone loss remains a major health care concern.
26.1.1
Bone Graft Gold Standard Autologous iliac crest bone is currently the gold standard in bone graft material. However, there are some significant disadvantages r
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