Milestones in Mandibular Bone Tissue Engineering: A Systematic Review of Large Animal Models and Critical-Sized...

Area of Science:

• Regenerative Medicine
• Biomaterials Science
• Oral and Maxillofacial Surgery

Background:

• Autologous bone grafting for mandibular reconstruction faces challenges like donor site morbidity.
• Bone tissue engineering (BTE) presents an alternative for regenerating functional bone.
• This review focuses on BTE for critical-sized mandibular defects in large animal models.

Purpose of the Study:

• To systematically review BTE strategies for mandibular reconstruction in large animal models.
• To evaluate the translational potential of these BTE approaches for clinical application.

Main Methods:

• Systematic review adhering to PRISMA guidelines.
• Inclusion of studies using large animal models with critical-sized mandibular defects treated with BTE components (scaffolds, cells, growth factors).
• Quality and bias assessment using ARRIVE and SYRCLE tools.

Main Results:

• Twenty-seven studies in pigs, sheep, and dogs demonstrated effective bone regeneration, vascularization, and biomechanical restoration.
• Commonly used scaffolds included β-TCP, PLGA, and PCL, often combined with BMSCs and rhBMP-2.
• Advanced techniques like in vivo bioreactors and 3D printing showed enhanced regeneration, but challenges like scaffold degradation and hypoxia persist.

Conclusions:

• BTE holds significant potential for mandibular reconstruction, showing promising preclinical results.
• Further investigation is required for scaffold optimization, enhanced vascularization, and standardized protocols for clinical translation.
• Refinement is essential to achieve consistent and scalable outcomes for widespread clinical adoption.