Search Results (179)

Repairing maxillofacial bone defects remains a major clinical challenge due to inadequate vascularisation and poor integration with host tissue. While bioactive scaffolds have shown promise in supporting osteogenesis and angiogenesis, achieving robust and synchronised dual regenerative outcomes is still elusive. This study presents a multifunctional, cell-free magnetic hydrogel platform designed to biomimetically coordinate osteogenic and angiogenic processes for effective maxillofacial bone regeneration. The composite poly(vinyl alcohol)-vaterite (PVA-Vat) hydrogel scaffold incorporates tuneable magnetic nanoparticles (MNPs) composed of single-domain superparamagnetic iron oxide (Fe₃O₄). By harnessing magneto-mechanical cues to orchestrate bilateral communication between human bone mesenchymal stem cells and endothelial cells, this platform provides a deeper mechanistic understanding of coupled tissue regeneration and delivers superior dual-regenerative performance for maxillofacial bone repair. Under magnetic stimulation, a coculture system demonstrated strong osteogenesis-angiogenesis coupling mediated by reciprocal VEGFA-BMP2 signalling. This reciprocal crosstalk was evidenced by a synergistic amplification of VEGFA and BMP2 expression in coculture compared to monocultures, where MNP-stimulated osteoprogenitors secreted VEGFA to drive endothelial capillary-like network formation, while endothelial cells reciprocally enhanced endogenous BMP2 levels to accelerate osteoblastic mineralisation. These findings establish MNP-integrated hydrogels as a cell-free, multifunctional platform capable of synchronising dual regenerative pathways, offering a biomimetic strategy to overcome vascularisation and integration barriers in maxillofacial bone repair. Full article

By using virtual surgical planning (VSP) and 3D printed guides, complex maxillofacial defects can be reconstructed with high accuracy and predictability. A fully digital workflow resulting in a modular all-in-one 3D printed guide system for fibula osteotomies, bone segment positioning, fully guided dental implant placement and dental prosthesis fixation for mandibular reconstruction was developed at Ghent University Hospital. A follicular ameloblastoma of the left mandible was resected in a 28-year-old male. The defect was reconstructed with a two-segment fibular free flap with immediate placement of three dental implants and immediate implant loading with a screw-retained bridge. A split thickness skin graft and Elemental PerioPlast were used as wound dressing. Comparison of the preoperative planning with the postoperative CT-scan showed a deviation immediately after surgery, which was no longer present at the 6-month follow-up. The patient achieved a stable occlusion and 44 mm mouth opening and reported high satisfaction. This case illustrates that fully digital, immediate mandibular reconstruction with simultaneous implant placement and prosthetic rehabilitation is feasible and accurate and enhances early functional recovery. Future improvements in intraoperative validation may further refine accuracy and reproducibility in complex oncologic reconstructions. Full article

Rapid vascularization is essential for bone regeneration in oral and maxillofacial surgery. This systematic review synthesised in vivo evidence on 3D-printed composite scaffolds in rodent critical-size calvarial defects quantified by Microfil perfusion and micro-CT. “Composite” was defined as an organic–inorganic construct within the printed scaffold (not a single-phase scaffold with a surface coating). PubMed, MEDLINE, and Web of Science Core Collection were searched for studies published from January 2014 to December 2025. Eligible studies compared composite scaffolds with non-composite (single-phase) scaffolds and/or empty controls and reported vascular outcomes (vessel number, vascularized area) together with bone outcomes (new bone area, bone volume fraction [BV/TV], and bone mineral density). Ten studies met the inclusion criteria. In outcome-specific exploratory analyses, composite scaffolds were associated with higher new bone area than comparators (p = 0.031). Functional modifications were associated with higher vascularized area (p = 0.025) and higher new bone area (p = 0.038), while dual-factor modifications showed the largest gain in new bone area (p = 0.002). Pore sizes ≥ 400 μm were associated with higher BV/TV (p = 0.029). Heterogeneity in designs, follow-up, and reporting, together with small sample sizes, precluded meta-analysis. Composite scaffolds appear promising, but standardised methodologies and improved reporting are needed to define optimal design features and support translation. Full article

Autogenous grafts remain the gold standard for repairing extensive maxillofacial bone defects, but their associated morbidity motivates the search for alternative strategies in tissue bioengineering. Deciduous dental pulp stem cells (DDPSCs) represent a promising cell source due to their accessibility, multipotency, and osteogenic potential, while nanostructured carbonated hydroxyapatite (cHA) microspheres exhibit biochemical similarity to bone mineral and favorable bioabsorption. This study investigated the osteogenic response induced by the association of DDPSCs with cHA in a rat calvaria critical-size defect model. DDPSCs were expanded, seeded onto cHA microspheres, and characterized in vitro prior to bilateral implantation in 12 Wistar rats, with each animal receiving cHA + DDPSC on the right defect and acellular cHA on the left. After 60 and 90 days, histological and histomorphometric analyses revealed new bone formation in both groups, predominantly from the defect margins toward the center. At 60 days, no significant difference in newly formed bone was observed between groups (p = 0.249). At 90 days, the DDPSC + cHA group demonstrated significantly greater bone formation compared with acellular cHA (median 40.70 vs. 11.10 histomorphometric points; p = 0.028) and significant reduction in connective tissue (p = 0.028). Complete scaffold resorption was observed in all DDPSC-treated defects at 90 days, whereas residual biomaterial persisted in the cHA group (p = 0.015), indicating progressive cHA resorption over time. These findings suggest that combining DDPSCs with cHA enhances bone regeneration and that this synthetic, bioabsorbable scaffold represents a promising strategy for future applications in bone tissue engineering. Full article

Background: Reconstruction of the maxilla and midface remains one of the most demanding challenges in craniofacial surgery, requiring precise planning and a clear understanding of defect geometry to achieve functional and esthetic restoration. Advances in computer-assisted surgery (CAS) and virtual surgical planning (VSP), based on 3D segmentation of radiologic imaging, have significantly improved the management of maxillary deformities, allowing for further knowledge of patient-specific information, including anatomy, pathology, surgical planning, and reconstructive issues. The integration of computer-aided design and manufacturing (CAD/CAM) and 3D printing has further transformed reconstruction through customized titanium meshes, implants, and surgical guides. Methods:This systematic review, conducted following PRISMA 2020 guidelines, synthesizes evidence from clinical studies on CAD/CAM-assisted reconstruction of maxillary and midfacial defects of congenital, acquired, or post-resection origin. It highlights the advantages and drawbacks of maxillary reconstruction with patient-specific implants (PSISs). Primary outcomes are represented by accuracy in VSP reproduction, while secondary outcomes included esthetic results, functions, and assessment of complications. Results: Of the 44 identified articles, 10 met inclusion criteria with a time frame from April 2013 to July 2022. The outcomes of 24 treated patients are reported. CAD/CAM-guided techniques seemed to improve osteotomy accuracy, flap contouring, and implant adaptation. Conclusions: Although current data support the efficacy and safety of CAD/CAM-based approaches, limitations persist, including high costs, technological dependency, and variable long-term outcome data. This article critically evaluates the role of PSISs in maxillofacial reconstruction and outlines future directions for its standardization and broader adoption in clinical practice. Full article

Bone defects in the maxillofacial region severely impair patient function and esthetics. Free autologous bone grafting remains the gold-standard treatment; however, surgical intervention at donor sites limits clinical applicability. Treatment using artificial materials also presents challenges, including insufficient bone regeneration and poor biocompatibility. Bio three-dimensional (3D) printing, which enables the fabrication of scaffold-free 3D constructs from cellular spheroids has emerged as a promising regenerative approach. This study investigated the osteogenic potential of scaffold-free constructs composed of human dental pulp stem cell (DPSC) spheroids in a rat mandibular defect model. DPSCs isolated from extracted human teeth were used to generate spheroids, which were assembled into 3D constructs using a Bio 3D printer. The spheroids exhibited higher mRNA expression of stem cells and early osteogenic markers than monolayer cultures. The constructs were transplanted into mandibular defects of immunodeficient rats, and bone regeneration was assessed eight weeks post-transplantation. Radiographic and micro-Computed Tomography analyses revealed significantly greater bone volume and mineral density in the 3D construct group. Histological and immunohistochemical examinations confirmed newly formed bone containing osteogenic cells derived from the transplanted DPSCs. These findings indicate that Bio 3D-printed, scaffold-free DPSC constructs promote mandibular bone regeneration and may provide a novel strategy for maxillofacial reconstruction. Full article

Background and Objectives: Squamous cell carcinoma (SCC) of the lip is a common malignancy of the oral and maxillofacial region. Medium-to-large post-excisional defects often require reconstructive techniques that preserve oral competence, function, and facial aesthetics. Despite its broad clinical use, the Karapandzic flap lacks comprehensive evidence describing its postoperative outcomes and associated complications. Materials and Methods: This retrospective cohort study evaluated all consecutive patients who underwent lip SCC excision followed by Karapandzic flap reconstruction at a tertiary oncologic center in Greece from 2000 to 2024. Demographic, clinical, pathological, and postoperative data were collected, and complications were categorized as early (wound dehiscence, surgical site infection, hematoma) or late (microstomia, excessive scarring). Statistical analyses included comparative tests and Firth’s logistic regression to explore potential predictors of morbidity. Results: A total of 102 patients met the inclusion criteria. Most were male (82.4%) with a median age of 68.8 years, and 94.1% had lower-lip tumors. Early complications occurred in 9.8% of patients and late complications in 17.7%, with microstomia being the most frequent late event (15.7%). Age was the only variable showing a borderline significant association with overall complications. No demographic, clinical, or pathological factor, including lesion morphology, cytological diagnosis, tumor location, or presence of metastasis, demonstrated a statistically significant association with early or late complications. Conclusions: Karapandzic flap reconstruction represents a reliable single-stage option for lip SCC defects, demonstrating relatively low complication frequencies and generally favorable functional outcomes. Further comparative studies are warranted to evaluate its performance relative to alternative reconstructive techniques. Full article

Patient-specific cutting guides are used for safe and accurate jaw resection during oral and maxillofacial surgery. This study investigated the effect of shavings from 3D-printed cutting guide materials during surgery on bone healing. The biocompatibility of commercially available biocompatible polymers including photopolymer resin (PP) and polyamide resin (PA) materials was assessed in the present study. The viability of mouse osteoblast-like MC3T3E-1 cells was evaluated upon coculture with the materials. Furthermore, the effects of PP and PA as additives on bone formation were investigated in a rat calvarial bone defect model. Both PP and PA were biocompatible and allowed cells to attach to them. However, both materials could be damaged when cutting devices were used, and their shavings impaired osteoblast proliferation and bone formation. Cutting guide materials are designed to be biocompatible when they are fabricated according to the manufacturer’s protocol. Nevertheless, the polymer shavings generated during jaw cutting might adversely affect bone healing. Full article

Objectives: Bone defects, resulting from many causes, represent a challenge in maxillofacial and orthopedic surgery. Regenerative medicine offers promising strategies by introducing exogenous materials to modify the tissue environment and modulate the body’s natural healing mechanisms. Dental pulp stem cells (DPSCs) are considered an effective source for tissue repair. Small molecules such as caffeic acid phenethyl ester (CAPE), although having promising effects in promoting bone regeneration, are characterized by low chemical stability, which impairs their clinical application. This study aimed to investigate the bone regenerative capability of four CAPE derivatives, recently synthesized in our laboratory and selected based on previous studies. Methods: DPSCs were induced to osteogenic differentiation in the presence of these compounds (0–5 μM), and cell viability, matrix deposition, alkaline phosphatase activity, and osteogenic marker gene expression were evaluated. In addition, bone biomaterials composed of a chitosan/agarose matrix reinforced with nanohydroxyapatite and enriched with these CAPE derivatives were fabricated and assessed for cytotoxicity and cell adhesion. Results: Two of the tested compounds effectively enhanced DPSC differentiation toward the osteogenic lineage. The fabricated bone biomaterials showed no cytotoxicity and supported cell adhesion. Furthermore, these compounds demonstrated stability under various conditions, confirming their suitability for incorporation into bone biomaterials. Conclusions: The tested CAPE derivatives exhibit promising osteoinductive properties and stability, offering a valid alternative to traditional therapeutic strategies in regenerative medicine. Full article

Background: The integration of 3D bioprinting, biomaterials science, and cellular biology presents a viable strategy for maxillofacial bone regeneration, overcoming the constraints of traditional graft techniques. This review offers a thorough examination of the present condition, obstacles, uses, and future outlook of 3D bioprinting technology in maxillofacial bone regeneration. An essential understanding has been attained by analyzing the technological constraints, specifically in vascularization and neuro-integration, and by delineating the vital translational pathway from benchtop models to clinical application. We have examined several bioprinting techniques—namely extrusion, inkjet, and laser-assisted methods—and the requisite bioinks, emphasizing their physicochemical and biological features vital for osteogenesis. Significant clinical applications, including the treatment of trauma-induced abnormalities and the reconstruction of oncology-related resections, have been emphasized. This review highlights the urgent necessity for established regulatory frameworks and refined printing settings to guarantee effective, functional, and durable bone substitutes, providing a distinct pathway for future research and clinical implementation in this specialized surgical domain. Aim: The purpose of this review was to present a general overview of the current clinical and diagnostic applications of bioprinting in bone tissue engineering for the reconstruction of bone defects. Methods: A search of major scientific databases, including PubMed, Science Direct, Embase, and Cochrane, was conducted. Articles published within the last 10 years that analyze the possible applications of bioprinting in bone tissue fabrication were included. Results: Several bioinks, based on hydrogels and stem cells, can enable the fabrication of such tissues using this technology. This review reports on the processes adopted for the bioprinting of bone tissue, the bioinks used, and cell cultivation methods. Conclusions: Bioprinting represents a promising solution for bone regeneration with potential applications that could revolutionize current surgical practices, despite the many challenges that future research will face. Full article

Background/Objectives: Maxillofacial volumetric deficits are often treated using structural fat grafting with autologous free fat grafts. The buccal fat pad (BFP) is commonly used as a pedicled flap for limited oral cavity applications. This study explores its use as a free graft for reconstructing deformities in the upper and lower lips caused by trauma or tumor resections. Methods: Five patients underwent soft tissue defect reconstruction using a free fat graft from the BFP, following standard surgical procedures. Techniques for harvesting, transferring, and evaluating aesthetic and functional outcomes up to three months post-surgery are detailed, with long-term follow-up extending to an average of 20 months (range 12–24 months). Results: Initial post-operative assessments showed lip asymmetry due to edema and excessive graft volume. Partial necrosis was observed within 1–2 weeks, typical of tissue healing. By 4–5 weeks, mucosal revascularization occurred, with desired lip volume and functionality achieved between 8–12 weeks. Long-term follow-up averaging 20 months demonstrated excellent graft stability with no volume regression beyond the vermilion border in all patients. Conclusions: The BFP as a free graft offers advantages such as high survival rates and easy harvesting. It effectively restores lip function, volume, and aesthetics. Challenges include graft manipulation, retention, potential fibrosis, and volume unpredictability. Future refinements in technique and follow-up are necessary to overcome these issues, enhancing the reliability of BFP for lip reconstruction. Full article

Background: This study aims to evaluate the use of the endoscopic transorbital approach for reducing frontal sinus fractures and compare its outcomes with the traditional bicoronal approach. Methods: A retrospective comparative analysis of case studies including all patients with frontal sinus fractures treated at our institution between January 2013 and December 2023 was conducted. Patients were categorized based on treatment approach (through traumatic laceration, bicoronal, or endoscopic transorbital). For the comparative analysis, cases with associated maxillofacial fractures or cerebrospinal fluid (CSF) leakage were excluded. Results: Out of 133 patients, 35 underwent surgery, with 6 patients treated using the endoscopic transorbital approach. This group of patients treated with the transorbital endoscopic approach demonstrated significantly shorter operative times compared to the bicoronal approach (mean 102 vs. 168 min, p = 0.021). They also had only minor complications, including temporary hypoesthesia and one transient ptosis. One patient had a minimal residual defect. The technique has been concluded to require endoscopic expertise. Conclusions: The endoscopic transorbital approach is a safe, minimally invasive alternative to the bicoronal approach for selected anterior wall frontal sinus fractures. Proper patient selection and surgical experience are essential to achieving favorable outcomes. Studies with longer follow-up are required to assess potential late complications, such as the development of mucoceles. Full article

Background/Objectives: The deep circumflex iliac artery (DCIA) free flap with internal abdominal oblique muscle (IAOM) is a well-known method of reconstruction used in cases of oral cavity neoplasms. Because the IAOM can be insufficient for extensive defects after removal of advanced carcinomas of the tongue, floor of the mouth, or gingiva, the additional preparation of a perforator-supported external abdominal oblique (EAOM) muscle flap can be useful. The aim of this study was to introduce the use of a DCIA flap with an IAOM and EAOM island in the reconstruction of oral cavity compound defects. Methods: A retrospective analysis was performed involving eight patients who underwent reconstruction using a DCIA free flap with IAOM and perforator-supported EAOM island. Patients underwent the operation between June 2021 and February 2025 in the Department of Maxillofacial Surgery of the Rydygier Hospital in Kraków, Poland. Results: A group of eight patients underwent an operation due to squamous cell carcinoma of the oral cavity. The most common primary subsite of disease was the floor of the mouth (n = 4, 50%), followed by the lower gingiva (n = 2, 25%) and retromolar area (n = 2, 25%). All patients required resection involving part of the mandible, the floor of the mouth, and part of the tongue simultaneously with reconstruction using a DCIA free flap with IAOM and perforator-supported EAOM island. Osteotomies were performed in two flaps (one single osteotomy, one double osteotomy). Reconstruction was successfully performed in seven out of eight patients (overall success rate 88%). Conclusions: The DCIA free flap with IAOM and perforator-supported EAOM flap is a reliable method for compound soft tissue and bone defects in maxillofacial reconstruction. The use of IAOM and EAOM can be helpful in cases of three-dimensional soft tissue defects of the lower gingiva, the floor of the mouth, and the tongue. The lower gingiva and floor of the mouth can be reconstructed with IAOM, while the more mobile part of the tongue can be reconstructed with a perforator-supported EAOM island. Full article

Background/Objectives: Oral lesions can present with a wide range of clinical appearances, often making diagnosis challenging, particularly for dental students. This study aimed to identify the most common oral lesions treated at a teaching dental clinic and to compare these findings with data from a systematic review of similar clinical settings. The goal was to inform and calibrate a clinical classification system for oral pathology used in teaching environments. Methods: A retrospective analysis was conducted using electronic medical records from a university dental clinic over the past 10 years. Oral and maxillofacial pathology cases were categorized based on clinical and histopathological diagnoses. A systematic review was also performed to provide external context, with searches conducted across four electronic databases. Two independent reviewers carried out the study selection, data extraction, and quality assessment. The review adhered to the PRISMA guidelines. Results: A total of 524 patients were identified with oral lesions. The most frequently encountered clinical diagnostic category was developmental defects, while the most common histopathological diagnosis from biopsied cases was epithelial atypia. The systematic review yielded 1215 records, of which 69 were retrieved for full-text assessment, and 28 studies met the inclusion criteria. Conclusions: The findings highlight the predominance of specific oral and maxillofacial pathoses in teaching clinic settings, underscoring the importance of targeted educational strategies to improve diagnostic confidence among students. There is also a need for more consistent diagnostic grouping in oral pathology to enable better comparison across studies and support clinical and pre-clinical teaching. By integrating these insights, we propose a referenced classification framework that may improve standardization in the clinical teaching of oral lesions and enhance diagnostic calibration and teaching effectiveness in dental education. Full article