Introduction: Tissue engineering of oral mucosa combines cells, materials and engineering to produce a three-dimensional reconstruction of oral mucosa. It is meant to simulate the real anatomical structure and function of oral mucosa. Tissue engineered oral mucosa shows promise for clinical use, such as the replacement of soft tissue defects in the oral cavity.[1] These defects can be divided into two major categories: the gingival recessions (receding gums) which are tooth-related defects, and the non tooth-related defects. Non tooth-related defects can be the result of trauma, chronic infection or defects caused by tumor resection or ablation (in the case of oral cancer). Common approaches for replacing damaged oral mucosa are the use of autologous grafts and cultured epithelial sheets.
Methods: Autologous grafts are used to transfer tissue from one site to another on the same body. The use of autologous grafts prevents transplantation rejection reactions. Grafts used for oral reconstruction are preferably taken from the oral cavity itself (such as gingival and palatal grafts). However, their limited availability and small size leads to the use of either skin transplants or intestinal mucosa to be able to cover bigger defects.[2]Other than tissue shortage, donor site morbidity is a common problem that may occur when using autologous grafts. When tissue is obtained from somewhere other than the oral cavity (such as the intestine or skin) there is a risk of the graft not being able to lose its original donor tissue characteristics. For example, skin grafts are often taken from the radial forearm or lateral upper arm when covering more extensive defects. A positive aspect of using skin grafts is the large availability of skin. However, skin grafts differ from oral mucosa in: consistency, color and keratinization pattern. The transplanted skin graft often continues to grow hair in the oral cavity.Cell culture techniques make it possible to produce epithelial sheets for the replacement of damaged oral mucosa. Partial-thickness tissue engineering uses one type of cell layer, this can be in monolayers or multilayers. Monolayer epithelial sheets suffice for the study of the basic biology of oral mucosa, for example its responses to stimuli such as mechanical stress, growth factor addition and radiation damage. Oral mucosa, however, is a complex multilayer structure with proliferating and differentiating cells and monolayer epithelial sheets have been shown to be fragile, difficult to handle and likely to contract without a supporting extracellular matrix. Monolayer epithelial sheets can be used to manufacture multilayer cultures. These multilayer epithelial sheets show signs of differentiation such as the formation of a basement membrane and keratinization.[1]
Results: To obtain the best results, the type and origin of the fibroblasts and keratinocytes used in oral mucosa tissue engineering are important factors to hold into account. Fibroblasts are usually taken from the dermis of the skin or oral mucosa. Kertinocytes can be isolated from different areas of the oral cavity (such as the palate or gingiva). It is important that the fibroblasts and keratinocytes are used in the earliest stage possible as the function of these cells decreases with time. The transplanted keratinocytes and fibroblasts should adapt to their new environment and adopt their function. There is a risk of losing the transplanted tissue if the cells do not adapt properly. This adaptation goes more smoothly when the donor tissue cells resemble the cells of the native tissue.
Conclusion: Although it has not yet been commercialized for clinical use clinical studies have been done on intra- and extra-oral treatments with full-thickness engineered oral mucosa. Full-thickness engineered oral mucosa is mainly used in maxillofacial reconstructive surgery and periodontal peri-implant reconstruction. Good clinical and histological results have been obtained. For example, there is vascular ingrowth and the transplanted keratinocytes integrate well into the native epithelium. Full-thickness engineered oral mucosa has also shown good results for extra-oral applications such as urethral reconstruction, ocular surface reconstructi1. K. Moharamzadeh et al (2007), Tissue-engineered Oral Mucosa: a Review of the Scientific Literature, JDR Journal of Dental Research
2. Ulrich Meyer et al (2009), Fundamentals of Tissue Engineering and Regenerative Medicine, p. 368, ISBN 978-3-540-77754-0on and eyelid reconstruction.[1]