Cell-based bone reconstruction therapies-principles of clinical approaches

Cell-based bone tissue engineering is a rapidly evolving therapy option in bone reconstruction strategies. Some cell-driven approaches, especially the biophysical stimulation of the host cell population surrounded by the bone defect, are common treatment methods in maxillofacial surgery. Others, such as autologous cell implantation, have now gained acceptance for clinical trials. More advanced or complex therapeutical options (extracorporeal tissue engineering, stem cell use, genetic engineering) have been tested in preclinical investigations but have not reached the level of clinical use. Two different aspects are of special relevance in cell-based bone reconstruction therapies. The source of cells used to regenerate bone (discussed in detail in a complementary review in this issue of The International Journal of Oral and Maxillofacial Implants) as well as the principal approach of a cell-driven bone regeneration therapy influence the outcome of such engineering strategies. All of the cell-driven repair strategies are under intensive investigation in an effort to provide surgeons with a limitless supply of tissue for bone repair and reconstruction in future procedures. An overview of the basic biological aspects as well as the inherent constraints of different cell-based approaches are given in this paper.