Laboratory for Biomaterials and Computational Mechanics, Department of Mechanical Engineering, University of Western Macedonia, University Campus ZEP, 50100 Kozani, Greece.
Department of Materials Science and Engineering, University of Crete, 70013 Heraklion, Greece; Foundation for Research and Technology Hellas (FO.R.T.H), Institute of Electronic Structure and Laser (IESL), 70013 Heraklion, Greece.
Biomater Adv. 2024 Sep;162:213902. doi: 10.1016/j.bioadv.2024.213902. Epub 2024 May 20.
The craniofacial region is characterized by its intricate bony anatomy and exposure to heightened functional forces presenting a unique challenge for reconstruction. Additive manufacturing has revolutionized the creation of customized scaffolds with interconnected pores and biomimetic microarchitecture, offering precise adaptation to various craniofacial defects. Within this domain, medical-grade poly(ε-caprolactone) (PCL) has been extensively used for the fabrication of 3D printed scaffolds, specifically tailored for bone regeneration. Its adoption for load-bearing applications was driven mainly by its mechanical properties, adjustable biodegradation rates, and high biocompatibility. The present review aims to consolidating current insights into the clinical translation of PCL-based constructs designed for bone regeneration. It encompasses recent advances in enhancing the mechanical properties and augmenting biodegradation rates of PCL and PCL-based composite scaffolds. Moreover, it delves into various strategies improving cell proliferation and the osteogenic potential of PCL-based materials. These strategies provide insight into the refinement of scaffold microarchitecture, composition, and surface treatments or coatings, that include certain bioactive molecules such as growth factors, proteins, and ceramic nanoparticles. The review critically examines published data on the clinical applications of PCL scaffolds in both extraoral and intraoral craniofacial reconstructions. These applications include cranioplasty, nasal and orbital floor reconstruction, maxillofacial reconstruction, and intraoral bone regeneration. Patient demographics, surgical procedures, follow-up periods, complications and failures are thoroughly discussed. Although results from extraoral applications in the craniofacial region are encouraging, intraoral applications present a high frequency of complications and related failures. Moving forward, future studies should prioritize refining the clinical performance, particularly in the domain of intraoral applications, and providing comprehensive data on the long-term outcomes of PCL-based scaffolds in bone regeneration. Future perspective and limitations regarding the transition of such constructs from bench to bedside are also discussed.
颅面区域的特点是其复杂的骨骼解剖结构和暴露于高强度功能力，这对重建提出了独特的挑战。增材制造技术已经彻底改变了具有互联孔和仿生微结构的定制支架的创建，为各种颅面缺陷提供了精确的适应性。在该领域内，医用级聚己内酯（PCL）已被广泛用于制造 3D 打印支架，专门用于骨再生。其在承重应用中的采用主要是由于其机械性能、可调节的生物降解率和高生物相容性。本综述旨在整合目前对用于骨再生的基于 PCL 的构建体的临床转化的深入了解。它涵盖了最近在增强 PCL 和基于 PCL 的复合支架的机械性能和增加生物降解率方面的进展。此外，它还探讨了各种策略来提高基于 PCL 的材料的细胞增殖和成骨潜力。这些策略深入了解了支架微结构、组成和表面处理或涂层的改进，包括某些生物活性分子，如生长因子、蛋白质和陶瓷纳米颗粒。该综述批判性地审查了关于 PCL 支架在颅颌面重建的口腔外和口腔内应用的临床应用的数据。这些应用包括颅骨修补术、鼻和眼眶底重建、颌面重建和口腔内骨再生。彻底讨论了患者的人口统计学、手术程序、随访期、并发症和失败。尽管颅面区域的口腔外应用的结果令人鼓舞，但口腔内应用的并发症和相关失败的频率很高。展望未来，未来的研究应优先提高临床性能，特别是在口腔内应用领域，并提供关于基于 PCL 的支架在骨再生中的长期结果的全面数据。还讨论了这些构建体从实验室到临床的过渡的未来前景和局限性。
