Advances in Bone Grafting – Study Club Lecture 1

For decades we have been looking for an ample supply of materials that could produce vital bone for  repair of significant bony defect of the jaw. There are many opinions about the type of material to be used for the repair of missing bone.  Facial bones are the substructure needed to support the proper jaw line, teeth and projection of face which in turn are one’s self-image. Premature loss of bone in the upper and lower jaw, due to gum disease, trauma and malignancies leaves patient with very few options for tooth replacement. There are drawbacks in harvesting the patient’s own bone; explicitly, the donor site morbidity, limited supply and less than desirable results.

Bone grafting with human (cadaveric) and other mammalian bone (bovine and swine), to provide the scaffolding,  relies on the patient’s own cells in the recipient bed to produce bone, which are not predictable.  In order to produce bone predictably, there is a need of osteogenic cell (bone producing cell) in the graft site. Hence, the cell base tissue engineering.

Stem cells are defined as a group undifferentiated cells capable of producing other specialized cells, e.g. bone and cartilage. Regardless of their source, they share two characteristics:

1. They are capable unlimited but controlled self-renewal (none tumorigenic).

2. They are capable of creating one or more mature tissues (differentiation into specialized cell lines).

There are three types of stem cells: Embryonic, Fetal and Adult.

Embryonic and fetal stem cells, aside from being in a highly undifferentiated state (difficult to control), also have clinical use challenges with ethical and political controversies.  However, adult stem cells are more committed cells and are generally considered to be easily accessible and readily available. Adult mesenchymal stem cells are defined as cells capable to give rise to Bone, Cartilage, Muscle and Tendon, making these cells exceptional tools for cell-based tissue engineering, for the repair of lost or damaged maxillofacial tissues.

At San Francisco Surgical Arts, and one of our other locations (Palo Alto Oral & Maxillofacial Surgery), we are the only centers in Norton California performing this type of advance osseous (bone) reconstruction.  In combination with advances in computerized dental implant planning, cone beam CT scan and digital impression system (iTero) cases that were previously deemed impossible are done readily, but also they are performed with great degree of accuracy and very high success rates.

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