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1. Adult Mesenchymal Stem Cells:
Biological Properties,
Characteristics, and Application in
Maxillofacial Surgery
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2. • The purpose of this article is to review the literature
on the biology of adult tissue-dervied mesenchymal
stem cells and their potential in maxillofacial surgery.
• Mesenchymal stem cells are multipotent cells
cabable of giving rise to cells of mesodermal origin,
including bone, cartilage, fat, tendon ,and muscle,
making this cell promising candidates for cell-based
tissue engineering for the repair of lost or damaged
maxillofacial tissues
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3. Mesenchymal Stem Cells: Biological Properties and
Characteristics
• Background: Friedenstein et al proposed that BM of
postnatal organism also contained non hemopoietic adherent
fibroblastic cells capable of giving rise to bones and cartilage
like colonies. Apart from BM other sources of MSCs
periosteum, synovial membrane, muscle, fat, vascular
pericytes, peridontal ligament,deciduous teeth, dermis
• In Vitro : The clinical applicability of MSCs is further
enhanced by their immunological properties . MSCs are
generally described as nonimmunogenic, based on their MHC
class1, MHCclass2, CD40, CD80, CD86 phenotype& immune
tolerance. MSC mediated immune suppresion, interesting
observation have been made on the immunomodulatory
effects of MSCs in vivo . For instance, the survival of allogeneic
skin grafts was shown to be prolonged by the intravenous
administration of MSCs in immunocompetent, outbred
baboons. The immunotolerance and the immunomodulatory
properties of MSCs thus augment their potential as awww.indiandentalacademy.com

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5. Multilineage Differentiation Potential
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6. Cell-Based Tissue Engineering
Tissue engineering is an emerging interdisciplinary field that
applies principles of both life sciences and engineering towards the
development of biological substitute that restores, maintain, and improve
function of damaged and/ or lost tissues.
The basic concept of stem cell-based tissue engineering, as
illustrated in the figure, consist of cell isolation and expansion, followed by a
reimplantation procedure in combination with a scaffolding material
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7. MSCs provides an ideal cell source for maxillofacial tissue
engineering for the following reasons
• Their use is not complicated by ethical and legal
controversies.
• They are generally considered to be easily accessible
and readily available.
• They possess extensive self-renewal or expansion
capability.
• They have the capacity to differentiate readily into
cell types relevant to maxillofacial region.
• They possess little to no immunogenic or tumorigenic
potential.
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8. Parameters of an ideal scaffolding material
• Surface Area
• Porosity
• 3-dimensional architecture
• Degradation characteristics
• Mechanical integrity
• Biocompatibility
• Ability to support cell proliferation, differentiation,
angiogenesis, and matrix deposition.
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9. Candidate scaffolding materials
• Natural
Alginate
Collagen
• Synthetic
Polycaprolactone
PLA-PGA
Human BM-derived MSCs seeded on prefabricated 3-dementional
Polycaprolactone(200-700 nm porosity and range of 5-475 micrometer)
nanofibrous scaffolds were efficiently induced to undergo osteogenesis,
chondrogenesis, and adipogenesis.
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11. Gene Therapy And Tissue Engineering
• Ability of MSCs to be transduced, gives them the potential to
serve as vehicles for either long-term or short-term
therapeutic gene transfer for instance, as in expressing BMP
for bone repair or the delivery of chemotherapeutics(eg,
Interferon- β). This was validated by “Chang et al”
• “Peterson et al” demonstrated that human BM-derived MSCs
infected with a BMP-2 containing Adenovirus has also been
shown to enhance anterior anterior spine fusion in a porcine
model.
• Administration of supraphysiological doses of BMP has been
shown to induce bone resorption .
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12. Application in Maxillofacial Surgery
• Cranifacial Skeleton
“Warnke et al” showed that custom designed titanium mesh tray
was packed with BMP, Bone mineral blocks, and a BM aspirate was
implanted in patient’s Lattismus dorsi muscle, harvested after seven
weeks, and used as a free-tissue transfer to repair a mandibular defect, the
neo mandible resulted in new bone formation and improved mastication.
“Lendeckel et al” reported that a 7-year girl sufferring from
widespread calverial defect was treated with the use of 2 large, resorbable
macroporous sheets and adipose-derived stem cells, after 3 months CT
scan new bone formation and near complete calvarial continuity .
“Qi et al” reported the effect of MSCs in Distraction Osteogenesis
in rat model . After distraction BM-derived MSCs were injected in the gap
while the control group were injected with saline , the animal were
sacrificed on day 27 and 55 , the radiographic finding showed higher
radiodensity in experimental than control group, increased bone density
in histomorphometric analysis and new Trabeculae.
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13. • Temperomandibular Joint Reconstruction
Alhadlaq and Mao reported the development of mandibular condyle
was enhanced by differentiating MSCs into both Osteogenic and
Chondrogenic lineages, more accurately mimicking the developmental
process of mandibular condyle was engineered from rat MSCs
encapsulated in PEGDA (poly ethtlene glycol diacrylate).
The same population of MSCs are treated separately with
chondrogenic and osteogenic induction medium in culture, after which the
cells were photoencapsulated as 2 separate stratified layers within the
PEGDA.
The cell laden construct were then implanted in dorsum of an
immunodefeciant mouse . After 8 weeks of in vivo implantation,
histological examination revealed 2 stratified layers of cartilagenous and
osseous phenotype in construct.
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