Tissue Engineering in Oral and Maxillofacial Surgery : From Lab to Clinics

Regenerative medicine aims at the functional restoration of tissue malfunction, damage or loss, and can be divided into three main approaches. Firstly, the cell-based therapies, where cells are administered to re-establish a tissue either directly or through paracrine functions. Secondly, the often referred to as classical tissue engineering, consisting of the combined use of cells and a bio-degradable scaffold to form tissue. Thirdly, there are material-based approaches, which have made significant advances which rely on biodegradable materials, often functionalized with cellular functions (De Jong et al. 2014). In 1993, Langer and Vacanti, determined tissue engineering as an “interdisciplinary field that applies the principles of engineering and the life sciences toward the development of biological substitutes that restore, maintain, or improve tissue function”. They published this definition in Science in 1993. Tissue engineering has been classically thought to consist of three elements: supporting scaffold, cells and regulating factors such as growth factors (Fig. 1). Depending on the tissue to be regenerated, all three vary. Currently, it is known, that many other factors may have an effect on the outcome of the regenerate. These include factors enabling angiogenesis, physical stimulation, culture media, gene delivery and methods to deliver patient specific implants (PSI) (Fig. 2). During the past two decades, major obstacles have been tackled and tissue engineering is currently being used clinically in some applications while in others it is just taking its first baby steps.Peer reviewe

The petrous portion of the human temporal bone: potential for forensic individuation

In this dissertation I evaluate the potential of the morphology of the petrous portion of the human temporal bone as seen on axial CT scans of the head as a means to generate identifications of fragmentary human skeletal remains. The specific goals are threefold: (1) To investigate variability in the shape of the petrous portion of the human temporal bone using two-dimensional morphometric analysis; (2) to evaluate the reliability of the resultant method in forensic identification; and (3) to consider the results within the framework of Bayesian theory in light of recent rulings regarding the admissibility of forensic testimony. The data used in this research were collected from axial CT images of the cranium. Two sets of images were collected for each of the 115 individuals in the sample so that Euclidean distance comparisons could be made between images of the same individual and images from different individuals. I collected two-dimensional coordinate data from 36 landmarks on each of the CT images and calculated the distances between each of the coordinate points to generate the data used in the statistical analyses. I pared down this set of measurements using two different models (referred to as the biological and PCFA models). The measurement sets of both models were then compared to one another using nearest neighbor analysis, to test their relative efficiency in matching replicate images to one another. The results of both models were highly accurate. Three incorrect nearest neighbor matches resulted from the biological model and 5 from the PCFA model. The errors appear to have been the result of variation in the axial plane between the first and second scans. The results of the nearest neighbor comparisons were then considered within the context of Bayes' Theorem by calculating likelihood ratios and posterior probabilities. The likelihood ratios and posterior probabilities were very high for both models, indicating that: 1) there is significant individual variability in the measurements of the petrous portion used in this research, and 2) this variation represents a high level of potential accuracy in the application of this method in the identification of forensic remains

PRELIMINARY FINDINGS OF A POTENZIATED PIEZOSURGERGICAL DEVICE AT THE RABBIT SKULL

The number of available ultrasonic osteotomes has remarkably increased. In vitro and in vivo studies have revealed differences between conventional osteotomes, such as rotating or sawing devices, and ultrasound-supported osteotomes (Piezosurgery®) regarding the micromorphology and roughness values of osteotomized bone surfaces. Objective: the present study compares the micro-morphologies and roughness values of osteotomized bone surfaces after the application of rotating and sawing devices, Piezosurgery Medical® and Piezosurgery Medical New Generation Powerful Handpiece. Methods: Fresh, standard-sized bony samples were taken from a rabbit skull using the following osteotomes: rotating and sawing devices, Piezosurgery Medical® and a Piezosurgery Medical New Generation Powerful Handpiece. The required duration of time for each osteotomy was recorded. Micromorphologies and roughness values to characterize the bone surfaces following the different osteotomy methods were described. The prepared surfaces were examined via light microscopy, environmental surface electron microscopy (ESEM), transmission electron microscopy (TEM), confocal laser scanning microscopy (CLSM) and atomic force microscopy. The selective cutting of mineralized tissues while preserving adjacent soft tissue (dura mater and nervous tissue) was studied. Bone necrosis of the osteotomy sites and the vitality of the osteocytes near the sectional plane were investigated, as well as the proportion of apoptosis or cell degeneration. Results and Conclusions: The potential positive effects on bone healing and reossification associated with different devices were evaluated and the comparative analysis among the different devices used was performed, in order to determine the best osteotomes to be employed during cranio-facial surgery