Fisher John P. e.a. (ed.) Tissue Engineering
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21-12 Tissue Engineering
(a)
(b)
FIGURE 21.5 Panoramic radiographs of a patient after right mandible reconstruction with only a titanium recon-
struction plate showing appearance after surgery (a) and appearance several months later after fracture of the plate
due to metal fatigue (b).
21.5 Conclusion
Tissue engineering may offer a new dimension of therapeutic care for patients. The design and devel-
opment of the tissue engineered therapeutics must be guided by basic, fundamental biological pathways
targeting specific clinical applications. Targeted clinical performance standards for the tissue engineered
therapeutic must be achieved in the design, validated by the appropriate standardized characterization
protocols (e.g., ASTM, ISO 10993), preclinical and clinical phase I–III studies. To fulfill stringent clinical
requirements for a tissue engineered bone therapeutic, specific clinical targets must be identified. Is the
target a nonload bearing or load bearing bone? Is the target a fracture in the tibia of a healthy, young male?
Or is the clinical target a distal radius fracture in a postmenopausal osteoporotic?
In this chapter, we have briefly reviewed the pathways of bone formation and some of the key signaling
molecules cuing discrete outcome events. Tissue engineered products must integrate into their design
fundamental biological elements consistent with bone formation pathways. Many of the key temporal and
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Tissue Engineering Applications — Bone 21-13
(a)
(b)
FIGURE 21.6 Appearance of a young woman treated with surgery for a tumor involving the right mandible. The
entire mandible on the right was removed and replaced using a bone flap harvested from the fibula. Appearance before
surgery (a),(b) and 1 year after surgery (c),(d). Although surgery resulted in a durable reconstruction, note the changes
in appearance due to the difference in the shape of the fibula and native mandible.
spatial aspects of bone formation (developmental, homeostatic, healing) remain a mystery. Unless these
key aspects are elucidated, rational, effective tissue engineered therapeutics will not develop.
A broad understanding by tissue engineers of the complex anatomical and physiological issues chal-
lenging surgeons and patients will provide tissue engineers with an important foundational head start
for robust design options that may include uniquely engineered compositions of cells, genes, and biomi-
metic extracellular matrices (e.g., bioactive matrices). The biomimetic extracellular matrix was especially
emphasized in this chapter to stress the importance of spatially and temporally directing the process of
tissue regeneration. Matrix design is the pivotal tissue engineering challenge.
We provided some clinical examples where bone tissue engineering will benefit craniofacial recon-
struction. The craniofacial surgeon faces different clinical challenges than the orthopedic surgeon. Tissue
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21-14 Tissue Engineering
(c)
(d)
FIGURE 21.6 Continued.
engineering must emphasize a regional-anatomic and physiological approach to design and development.
A single platform treatment for a tibial diaphyseal fracture in the healthy adult male may be inadequate
for the patient with an avulsive bone wound of the oral–antral complex.
There are significant opportunities for the tissue engineer to improve the quality of patient care. The
bedrock underscoring tissue engineering is basic biology, clinical performance standards, and patient
application focus.
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