TMJ regenerative Medicine

AbstractThe temporomandibular joint (TMJ) is an articulation formed between the temporal bone and the mandibular condyle which is commonly affected and course with pain and dysfunctions of the temporomandibular joint. These affections are often so painful during fundamental oral activities that patients have lower quality of life. The treatment of these disorders includes systematically administered drugs (especially non steroid anti-inflammatory drugs and corticoids), physical therapies, and minimally invasive therapies that require intra articular injections. Limitations of therapeutics for severe TMJ diseases have led to increased interest in regenerative strategies combining stem cells, implantable scaffolds and well-targeting bioactive molecules. Recent advances in tissue engineering may provide an alternative to traditional strategies to repair and regenerate the TMJ. To succeed in functional and structural regeneration of TMJ is very challenging. Innovative strategies and biomaterials are absolutely crucial because TMJ can be considered as one of the most difficult tissues to regenerate due to its limited healing capacity, its unique histological and structural properties and the necessity for long-term prevention of its ossified or fibrous adhesions. The ideal approach for TMJ regeneration is a unique scaffold functionalized with an osteochondral molecular gradient containing a single stem cell population able to undergo osteogenic and chondrogenic differentiation such as BMSCs, ADSCs or DPSCs. The key for this complex regeneration is the functionalization with active molecules such as IGF-1, TGF-beta 1 or bFGF. This regeneration can be optimized by nano/micro-assisted functionalization and by spatiotemporal drug delivery systems orchestrating the 3D formation of TMJ tissues. Preceding the current trends in tissue engineering is an analysis of native tissue characterization, toward identifying tissue engineering objectives and validation metrics for restoring healthy and functional structures of the TMJ.