Update on mandibular reconstruction: computer-aided design, imaging, stem cells and future applications.

PURPOSE OF REVIEW: The development of three-dimensional (3D) computerized modelling has been rapid during the last years. The computer technology in addition to computer-aided manufacturing (CAM) has given tools for surgeons to plan, practice virtually the surgery and to design and manufacture the implants needed for the surgery. RECENT
FINDINGS: Bone tissue regeneration seems to be dependent on several critical factors. These include biocompatible patient-specific scaffolds and matrices, osteogenic cells and osteoinductive and angioinductive growth factors. At present, modern 3D computer-aided design (CAD) software and additive manufacturing technology enable patient-specific scaffold and matrix manufacturing. The scaffold, matrix or implant replaces the missing part of the jaw and allows osteogenic cells to generate bone accordingly and allows anatomic and symmetrical restoration. An increasing number of studies, both experimental and clinical, have been published that show bone formation in mandible defects after reconstruction with matrix-osteogenic cell combination. Ideally, matrix (bone substitute material) should be biocompatible, bioresorbable, osteoconductive, osteoinductive, structurally similar to bone, easy to use, cost-effective and nonanimal derived.
SUMMARY: It is still unknown which type of osteogenic cell is the most efficient. Are added cells in bone regeneration process necessary? One of the crucial issues is the vascularization of forming ectopic bone. More studies are needed on how to generate adequate vascularization for the survival of cells and formation of bone. Further studies are also needed to find more and better materials for additive manufacturing (CAD-CAM) of scaffolds, matrices and implants.