Narrative review: craniofacial bone regeneration—where are we now?

Abstract

Background and Objective: The craniofacial structures are complex and esthetically the most important component of appearance. Defects in this region lead to noticeable deformities that are physically and psychologically devastating to patients. Advances in grafting and tissue transfer techniques have improved the surgical outcomes but our ability to fully regenerate the lost or defective tissue is limited. The purpose of this narrative review is to give attention to the advances that have been made towards the development of new techniques to reconstruct craniofacial bony defects using a tissue engineering approach. The aim is to bring together up to date knowledge about biomaterials that make up an ideal scaffold; different stem cell sources and their uses; growth factors and methods of delivery to defect sites; and gene therapy techniques through different vectors. Methods: A detailed data-based search using google scholar was performed looking for articles in English with the search including the following terms: bone regeneration, tissue engineering, craniofacial reconstruction, scaffolds, osteoinductive growth factors. The search was supplemented checking references of relevant review articles. Key Content and Findings: Currently, research and clinical approaches to achieve craniofacial bone regeneration are attempting to shift to new techniques to avoid intensive surgeries. Considering new technology and biomaterials, techniques are aimed at targeting delivery of specific cellular components and factors that influence the growth of native bone. Currently no method investigated has been proven to fulfil all characteristics needed to replace autologous grafting as the new gold standard. Conclusions: Currently the gold standard for craniofacial bone regeneration is still autologous grafting, but the invasiveness and surgical morbidities involved has prompted research to explore further options. This narrative review concludes that: the incorporation of computer aided designs have advanced our ability to mimic the configurations, morphologic traits and mechanical function of the native site; the recently developed techniques to obtain and process stem cells from new sources, have potentiated our ability to regenerate bone with ease; incorporation of growth factors, show promise in their regeneration ability; innovations in gene therapy and vectors have demonstrated successful bone regenerations capabilities. With advances in all aspects, we are inching closer to discovering a new gold standard.