**6. Conclusions**

Unsteady axisymmetric MHD flow and transfer of heat with water-based carbon nanotubes amid two stretchable rotating disks is explored in the present study. Results for arising parameters for both SWCNTs and MWCNTs are illustrated. Main findings of our observations are as follows.

**Author Contributions:** Conceptualization, M.R.; Methodology, S.R.; software, S.K.; Validation, P.K. and Y.N.; Formal Analysis, S.R.; Investigation, F.H.; X.X.; Writing—Original Draft Preparation, S.R.; Writing—Review and Editing, M.R.; visualization, S.K.; Supervision, M.R.; Project Administration, M.R.; Funding Acquisition, P.K. and Y.N.; All authors have read and agreed to the published version of the manuscript.

**Funding:** This research was funded by the Bio & Medical Technology Development Program of the NRF funded by the Korean government, MSIP(NRF-2015M3A9D7067219) and also supported by the Soonchunhyang University Research Fund.

**Conflicts of Interest:** Authors have no conflict of interest regarding this publication.

## **Nomenclature**


*4.1.2 Metaproteomics*

The proteome is the complete protein complement expressed by a cell or tissue at a particular moment, and the study of the proteome is known as "proteomics." The metaproteomics or community proteomics is the variant of proteomics in the sense that it is the protein complement expressed by a metagenome from a microbial community. Currently, a small number of reports are available on gut community meta-proteomics that is attributed to the small amount of proteins available in the sample, and its detection makes it further a less applied method in comparison to metagenomics and metatranscriptome. There are still lacking standardized protocols related to protein extraction and its downstream processing. The detection of low abundant proteins in the sample is still a challenge. Moreover, its high cost, time-consuming, and labor-intensive nature further restricted its applications. But many labs have applied metaproteomics in the study of functional analysis of hostmicrobiome interactions and proteins expressed by gut metagenome. There are two types of proteomics methods, i.e., gel-dependent and gel-independent methods. First, the category of protocols includes the combination of 2D gel electrophoresis, mass spectroscopy, and various bioinformatics tools. Second, categories, namely, shotgun proteomics, mainly depend on most expensive and more sophisticated instruments like two-dimensional liquid chromatography (LC) coupled with nanospray tandem mass spectrometry (nano 2D LC–MS/MS) and powerful bioinformatics data analysis pipeline. Both types of technologies have provided large-scale protein analysis data in the case of the human gut proteome [57]. Currently,

**15**

*Genomic Techniques Used to Investigate the Human Gut Microbiota*

metaproteomics methods are applied to analyze the effect of dietary components, e.g., resistant starch on protein expression, enzymes, and composition of microbes involved in starch metabolism inside the gut. This technique is useful to investigate the ratio of two important bacterial species *Firmicutes* to *Bacteroidetes* inside gut

Metabolites are the final outcome of the gene expression process; they are highly

In the last two decades, bioinformatics has provided much needed help to annotate the complex genome sequences and metagenomic data. The microbial bioinformatics offers help to understand microbial agents of the microbial ecosystem and their mutual and host-microbes interactions. Recently, community-based bioinformatics platforms and pipelines are developed like Mothur and QIIME which help in downstreaming of high-throughput genome sequencing data of variable regions of bacterial 16S ribosomal genes or amplicons. These platforms also help in data analysis and visualization of gut microbiome composition. The high-throughput method like shotgun sequencing and WGS metagenomics produced a huge amount of data, and its annotation is a great challenge in the field of microbiome analysis [60]. In order to know the functions of a particular microbial community, it requires

integrating data from other studies such as metatranscriptomics sequencing, metagenomics, metatranscriptomics, metaproteomics, metabolomics, and other techniques. The integration of data provides holistic knowledge of a gut community in terms of its structure and functions [61]. For example, any perturbation such as antibiotics or heavy metal toxicities leads to the change in gut microbial community that can be studied at the level of metabolite production and protein expression. Multi-omics data integration is the uphill task and requires a highly advanced level of computational skill, but current few tools have been developed, e.g., XCMS is a new web-based tool that integrates transcriptome, proteome, and metabolome data [62]. The new systems-level integration can also provide valuable insights, especially when they are combined with community surveys and metagenomics (**Table 1**).

unique in the case of the gut microbiota. Large numbers of metabolites are produced by gut microbiota, which can act as pharmaceutical agents or bioactive products. The metabolomics is a high-throughput omics-based method that mainly deals with the identification and quantification of total metabolites produced in a cell, tissue, and organ which are also called the metabolome. The "meta-metabolome" is the whole complement of metabolites and is produced by a specific microbial community. The analysis of meta-metabolomics requires a set of very sophisticated tools and techniques like matrix-assisted laser desorption/ionization time-of-flight, secondary ion mass spectrometry (SIMS), and Fourier transform ion cyclotron resonance MS that are used for metabolome analysis [59]. The complete annotation of the metabolome produced by a metagenome will help us to understand the physiology and functionality of a microbial community. Inside the human gut, fermentation of short-chain fatty acid is carried out by specific bacteria and produced many types of metabolites that participate in host metabolism and influence the physiology of both host-microbial communities inside the gut. The metabolome analysis offered the investigation of functional gene products in a sample that is helpful in functional analysis of microbes present a microbial niche. Currently, many unique

metabolites are identified that are produced by gut microbiota.

*4.1.4 Bioinformatics and multi-omics data integration*

*DOI: http://dx.doi.org/10.5772/intechopen.91808*

microbiota [58].

*4.1.3 Metabolomics*

metaproteomics methods are applied to analyze the effect of dietary components, e.g., resistant starch on protein expression, enzymes, and composition of microbes involved in starch metabolism inside the gut. This technique is useful to investigate the ratio of two important bacterial species *Firmicutes* to *Bacteroidetes* inside gut microbiota [58].


It seems that one of the important years for tissue engineering is 1975; in this year, some occurrence about skin engineering was evolved in this field even though the Washington National Science Foundation applied science panel meeting to formally adopt the term "tissue engineering" for this field a decade later in 1987 [47] and Langer and Vacanti explained the definition of this field later in 1993 [1]. The first step is ascribed to the actions of two teams in the United States 40 years ago. Rheinwatd and Green were the first team who are unskilled and ignored cultivation of human epidermal keratinocytes in vitro [48]; they also created potentially the enlargement of those cultivation of cells into numerous epithelial cells for graft in 1975 [49] from a little skin diagnostic assay. Today, the work that was done in those days is called "skin epidermis tissue engineering." At the same time, Yannas et al. worked on the features of scleroprotein and degradation mechanism [50] in 1975, which now we believe that these efforts facilitate the way for the new generation of artificial dermal substitute, resulting in the "skin dermis tissue engineering" [51]. Fortunately, after 6 years, both of these groups independently revealed the clinical effect of tissue-engineered substitutes for the treatment of different grade burns, albeit in different approaches. The first graft of extensive burns with sheets of cultured epithelium (produced from epidermal cells which are autologous) was reported by O'Connor et al., two adult patients were experienced at the Peter Bent Brigham Hospital [52, 53]. Cultured epidermal autografts (CEA) were the next generation of cultured sheets which are autologous and also successively revealed to prepare cover of full-thickness burns in pediatric patients [54]. Meantime, only a short time after O'Connor et al.'s study, Burke et al. revealed that artificial dermis had experienced functional and physiological acceptable dermis in the treatment of extensive full-thickness burns on several patients [55]. These evidences resulted in randomized clinical trial for extensive burn injuries led by Heimbach et al. [56] about the application of artificial dermis; now new generation of artificial dermis is known as IntegraTM Dermal Regeneration Template. This study was done successfully by collaborating 11 centers, and other studies [57, 58] could inevitably demonstrate this dermal substitute a "gold standard" material treatment of fullthickness burns [59].

Cultured chondrocytes and porcine cartilage substance (PCS) constructs as an attainable dorsal augmentation material in rhinoplasty: preliminary animal study and, additionally Mendelson et al. in 2014 conferred this concept than designed nasal cartilage by cell homing: a model for augmentative and rehabilitative rhinoplasty. Bioactive scaffolds were developed that not solely recruited cells within the nasal dorsum in vivo, however, additionally induced chondrogenesis of the recruited cells. Bilayered scaffolds were fictional with alginate-containing gelatin microspheres encapsulating cytokines atop a porous poly(lactic-co-glycolic acid) base. Microspheres were fictional to contain recombinant human remodeling growth factor β3 at doses of 200, 500, or 1000 ng, with phosphate-buffered saline-loaded microspheres used as a bearing. A rat model of augmentation facelift was created by implanting scaffolds atop the native nasal cartilage surface that was scored to induce cell migration. Tissue formation and chondrogenesis within the scaffolds were evaluated by image analysis and microscopic anatomy staining with hematoxylin and eosin, toluidine blue, Verhoeff elastic-van Gieson, and aggrecan immunohistochemistry. Sustained release of increasing doses of remodeling growth factor β3 for up to the tested 10 weeks promoted orthotopic cartilage-like tissue formation in an exceedingly dose-dependent manner. It appears that these findings represent the primary commitment to engineer cartilage tissue by the cell orientating for facelift and will doubtlessly function as an alternate material for augmentative and rehabilitative rhino-

An important feature for rehabilitative and augmentative rhinoplasty is the ability of the graft to be tailored to the individual patient. Autologous graft area unit is stacked and sutured along in a very bundle before implantation. The bioactive poly(lactic-co-glycolic acid) scaffolds are simply changed to larger augmentations by varied the mold diameter wont to create the poly(lactic-co-glycolic acid) scaffold base. For associate degree off-the-shelf product, three totally different scaffolds can be generated with a variety of forms and sizes and simply cut for precise adjustments. Thus, the bioactive scaffolds might probably be used as completely

It seems that one of the important years for tissue engineering is 1975; in this year, some occurrence about skin engineering was evolved in this field even though the Washington National Science Foundation applied science panel meeting to formally adopt the term "tissue engineering" for this field a decade later in 1987 [47] and Langer and Vacanti explained the definition of this field later in 1993 [1]. The first step is ascribed to the actions of two teams in the United States 40 years ago. Rheinwatd and Green were the first team who are unskilled and ignored cultivation of human epidermal keratinocytes in vitro [48]; they also created potentially the enlargement of those cultivation of cells into numerous epithelial cells for graft in 1975 [49] from a little skin diagnostic assay. Today, the work that was done in those days is called "skin epidermis tissue engineering." At the same time, Yannas et al. worked on the features of scleroprotein and degradation mechanism [50] in 1975, which now

unique various implant styles to current rhinoplasty treatment [46].

plasty [46].

278 Stem Cells in Clinical Practice and Tissue Engineering

**4. Skin**

But there are still challenges, and those two groups are still far from reaching the final goal of replacing autologous skin for coverage of permanent deep dermal or full-thickness injuries in extensive burns.

**Table 2** demonstrates the current status of available tissue-engineered materials and techniques for skin substitution.

The happen which facilitates efforts is that combination between a skin allograft bank and professional laboratory which culture autologous epithelial cell sheet could be an important step, and also we should gather many scientists and engineers and absorb finance in this field. The only way that can create the demand of engineered tissue for patients is through working and collaborating with clinicians, and also this expert team brings us innovation, novel technologies, and cost management and realizes the challenges in advancement of skin tissue engineering [61–65].

glycosaminoglycan substrates containing autologous fibroblasts and

collagen type 1 hydrogels engineered with human keratinocytes and fibroblasts

keratinocytes

DenovoSkin Plastically compressed

**Table 2.** Tissue-engineered materials and current surgical techniques for skin substitution.

**Structure Advantage Disadvantage**

Permanent replacement of both dermal and epidermal layers, one-step procedure

Near-normal skin architecture No clinical trial reported

281

Long culture time, no clinical series reported

yet

Tissue Engineering Applications in Maxillofacial Surgery http://dx.doi.org/10.5772/intechopen.70904

yet

There is a recognized lot to reconstruct and restore advanced craniomaxillofacial (CMF) soft tissues that are broken and/or disfigured as a consequence of automobile accident, trauma, burn injury, or tumor surgery. In trauma, injuries usually produce extraordinarily advanced geometric and avulsion defects, and also the anatomic and purposeful intricacies of CMF composite soft tissue structures like the lips, eyelids, and nasal advanced create the recon-

Kenji Izumi et al. in 2013 within the article evaluated the appliance of tissue engineering in oral mucosa [67]; the first objective of this study was to gauge the security of a tissueengineered human ex vivo produced oral mucosa equivalent (EVPOME) in intraoral graft procedures. The secondary objective was to assess the efficacy of the grafted EVPOME in manufacturing a keratinized mucosal surface epithelial tissue. Five patients World Health Organization based on inclusion criteria that defects in mucogingival region or an absence of gingiva which is keratinized on incisors and premolars teeth, together with radiographies of adequate bone height in interdental region, were used to expand the amount of keratinized gingiva in the defect site. A specimen was taken by a punch biopsy from hard palate to accumulate oral keratinocytes, which were enlarged, associate degreed cultured on associate

struction significantly difficult for maxillofacial surgeons (**Table 3**).

degree noncellular matrix of the dermis for make of an EVPOME.

**5. Oral mucosa**

Adopted from Chua et al. [60]

**Skin substitute/ surgical technique**

Dermo-epidermal PermaDerm™ Collagen-

**Table 2.** Tissue-engineered materials and current surgical techniques for skin substitution.

The happen which facilitates efforts is that combination between a skin allograft bank and professional laboratory which culture autologous epithelial cell sheet could be an important step, and also we should gather many scientists and engineers and absorb finance in this field. The only way that can create the demand of engineered tissue for patients is through working and collaborating with clinicians, and also this expert team brings us innovation, novel technologies, and cost management and realizes the challenges in advancement of skin tissue engineering [61–65].

### **5. Oral mucosa**

**Skin substitute/ surgical technique**

280 Stem Cells in Clinical Practice and Tissue Engineering

Integra™ with CEA

Integra™ with Meek

Composite skin substitute

AlloDerm® with

CEA

Integra™ Cross-linked bovine

MatriDerm® Bovine non-cross-linked

Blobrane® Silicone membrane and

AlloDerm® Human acellular

Permacol™ Porcine acellular

TransCyte® Porcine collagen-coated

Dermagraft® Bioabsorbable polyglactin

fibroblasts

collagen

lyophilized dermis, coated with alpha-elastin

MatriDerm as a template, seeded with expanded autologous skin fibroblast and keratinocytes

nylon mesh impregnated with porcine dermal

lyophilized dermis

lyophilized dermis

nylon mesh seeded with allogeneic neonatal human foreskin fibroblasts

mesh scaffold seeded with cryopreserved allogeneic neonatal human foreskin

hydrolysate

tendon collagen-based dermal matrix linked with glycosaminoglycan (GAG)

Dermal Artificial biological materials

> Natural biological

Synthetic materials

**Structure Advantage Disadvantage**

Good longterm esthetic and functional outcome

Full wound closure

One-stage procedure, coverage of partial-thickness

bums

bed

Good esthetic and functional

Immediate availability, ease of storage

Ease of handling, no rejection, chronic wounds diabetic ulcers

Acellular, immunologically inert, provide natural dermal porosities for regeneration and vascularization on the wound

Two-stage procedure, infection, hematomas,

High cost, poor adhesion

seromas

Intolerant to

High cost, risk of transmitting disease, two-stage procedure

Multiple applications

Infection, hematomas,

Poor ECM structure, infections, cellulitis,

seromas

Temporary

contaminated wound bed

There is a recognized lot to reconstruct and restore advanced craniomaxillofacial (CMF) soft tissues that are broken and/or disfigured as a consequence of automobile accident, trauma, burn injury, or tumor surgery. In trauma, injuries usually produce extraordinarily advanced geometric and avulsion defects, and also the anatomic and purposeful intricacies of CMF composite soft tissue structures like the lips, eyelids, and nasal advanced create the reconstruction significantly difficult for maxillofacial surgeons (**Table 3**).

Kenji Izumi et al. in 2013 within the article evaluated the appliance of tissue engineering in oral mucosa [67]; the first objective of this study was to gauge the security of a tissueengineered human ex vivo produced oral mucosa equivalent (EVPOME) in intraoral graft procedures. The secondary objective was to assess the efficacy of the grafted EVPOME in manufacturing a keratinized mucosal surface epithelial tissue. Five patients World Health Organization based on inclusion criteria that defects in mucogingival region or an absence of gingiva which is keratinized on incisors and premolars teeth, together with radiographies of adequate bone height in interdental region, were used to expand the amount of keratinized gingiva in the defect site. A specimen was taken by a punch biopsy from hard palate to accumulate oral keratinocytes, which were enlarged, associate degreed cultured on associate degree noncellular matrix of the dermis for make of an EVPOME.

Another researchers believed that the long time (more than 22 months) existence of the cultured keratinocytes from oral cavity, expressed markers of stem cell. Also evidence tried to by pharmacologic approach produce cultured oral keratinocytes to produce stem cell population; and now all efforts focus on clinical application of this technology that has a lot of simply for the event of a lot of strong EVPOME for intraoral graft procedures [75]. As a result of oral mucosa keratinocyte area unit simply getable and expand quicker in vitro than skin keratinocytes [76], they will be a lot of efficacious to be used in future clinical applications in regenerative medicine. This platform technique might produce other potential extraoral uses, like repair of facial skin [77], reconstruction of eyelids and nose, or in situ tissue layer substi-

Tissue Engineering Applications in Maxillofacial Surgery http://dx.doi.org/10.5772/intechopen.70904 283

The temporomandibular joint (TMJ) may be a synovial joint that has for articulator motion relative to the os base and distributes the traditional stresses of perform (chewing and speaking) and parafunction (clenching and bruxism). It is usually noted as ginglymoarthrodial joint attributable to its slippy performance and hinging. The temporomandibular joint links the condyloid process (mandibular bone) to the temporal bone. The cartilage disc is the middle of mandibular condyle and the glenoid fossa eminence of the temporal bone and separates the joint area into inferior and superior compartments, each of that area unit crammed with

Because of the advanced loading patterns that designed tissues can expertise within the TMJ, acquisition of complete style parameters from the native tissue is important. Significantly, TMJ disc, condyle, and condylar cartilage replacement area unit in nice demand attributable to these tissues' poor regenerative capability and high rate of involvement in TMD. In response, many studies characterizing the properties of those elements are performed [79]. Though glenoid fossa and articular eminence are the concern in TMD, they need not be absolutely characterized. Within the following section, structural characteristics of the TMJ tissue area unit are summarized. Application of tissue engineering in the treatment of temporomandibular joint defects is rising as a progressive choice to substitute and remove the pathological defects automatically in the near future. Historically, basics of regenerative medicine are three necessary elements, cells, stimulator factors, and scaffolds. But new technology introduced novel methodologies and recommends how to manage TMJ disk and stimulate relevant cartilage [80]. This approach includes the scaffold-free and cell-based methodology and cells and stimulators that work together. But another approach is to construct a structure and render appropriate form of engineered tissues, permitting well-designed structure and simple handling [81]. Another mechanical feature may be appropriate for designed tissue. In the best manner the chemistry of scaffold that could be degradation with matrix synthesis. But the rate of scaffold degradation depends on the nature of scaffold and might be modified by manipulation. For induction of the mass of matrix synthesis, growth factors are added to the scaffolds. Today, all engineered tissue materials are used to regenerate condyle and TMJ disc; however, similar strategies for regeneration of mandibular fossa are not successful [82].

tutes for the urethra and conjunctiva [78].

synovial fluid [79].

**6. Temporomandibular joint disorders**

**Table 3.** The advantages and downsides of the contemporary approach to soft tissue reconstruction [66].

EVPOME grafts have special features which are used directly over associate degree healthy periosteal bed and preserved in situ. At 1 and at 7, 14, 30, 90, and 180 days postsurgery, Plaque Index and Gingival Index were recorded for every subject. Additionally, inquisitory depths, keratinized animal tissue dimension, and keratinized animal tissue thickness were recorded at baseline, 30, 90, and 180 days. Fortunately, there were no adverse outcomes or complications to EVPOME ascertained in all cases throughout the research. But the mean increased in keratinized animal tissue dimension was 3 mm (range, 3–4 mm), and no vital changes in depths were ascertained. According to our findings, we can terminate that EVPOME is useful for oral application and has the flexibility to reinforce keratinized gingiva. More randomized clinical trials in this field should be performed to demonstrate other dimensions of tissue engineering [67].

The maintenance of associate degree sufficient strip of attached gingiva includes a minimum of 2 mm of keratinized gingiva and has revealed that it could be necessary for preservation of periodontal tissue [68, 69]. Historically, FGGs' associate degreed grafts which were taken from connective tissue are applied to gain sufficient strip of attached gingiva [70]. Unfortunately, clinical evidence about the use of autologous and allogenic products confronts to some problems about FGGs, i.e., problems about morbidity around donor region and also amount of tissue for graft which is restricted [71]. Nevins [72] applied treatment by bilayered cell for mucogingival region, and this research revealed that adequate keratinized tissue was gained; however, the amount was not more than it gained with FGGs. Interestingly, each research tried to prove that clinical evidence such as texture and color have better results when compared with FGGs. Nevertheless, application of products that have allogenic cells could have important effect on the wound bed; the impact of treatment could be as a completely unique "biologic dressing" to motivate encompassing cells. One of the reliable materials was a scaffold which is biodegradable with gingival autologous fibroblasts which are cultured [73]. Another research in this field used oral mucosa cells to transplant directly to the cornea [74]. Another researchers believed that the long time (more than 22 months) existence of the cultured keratinocytes from oral cavity, expressed markers of stem cell. Also evidence tried to by pharmacologic approach produce cultured oral keratinocytes to produce stem cell population; and now all efforts focus on clinical application of this technology that has a lot of simply for the event of a lot of strong EVPOME for intraoral graft procedures [75]. As a result of oral mucosa keratinocyte area unit simply getable and expand quicker in vitro than skin keratinocytes [76], they will be a lot of efficacious to be used in future clinical applications in regenerative medicine. This platform technique might produce other potential extraoral uses, like repair of facial skin [77], reconstruction of eyelids and nose, or in situ tissue layer substitutes for the urethra and conjunctiva [78].

### **6. Temporomandibular joint disorders**

EVPOME grafts have special features which are used directly over associate degree healthy periosteal bed and preserved in situ. At 1 and at 7, 14, 30, 90, and 180 days postsurgery, Plaque Index and Gingival Index were recorded for every subject. Additionally, inquisitory depths, keratinized animal tissue dimension, and keratinized animal tissue thickness were recorded at baseline, 30, 90, and 180 days. Fortunately, there were no adverse outcomes or complications to EVPOME ascertained in all cases throughout the research. But the mean increased in keratinized animal tissue dimension was 3 mm (range, 3–4 mm), and no vital changes in depths were ascertained. According to our findings, we can terminate that EVPOME is useful for oral application and has the flexibility to reinforce keratinized gingiva. More randomized clinical trials in this field should be performed to demonstrate other dimensions of tissue

Poor color match, donor-site morbidity, lack of

will result in microstomia and associated purposeful deficits in speech and swallowing

Long recovery, donor-site morbidity, lack of performance, poor color match/esthetics, needs

Needs long immunosuppression, facet effects of immunosuppression, long and troublesome recovery, donor accessibility, needs specialized

bulk, no performance

specialized surgical skills

surgical skills and facility

Sensible color match, functional Restricted quantity, might need staged surgeries,

**Approach Advantages Disadvantages**

accessibility

tissue, esthetics

Simply harvested, vital tissue

Wonderful tube peduncle, applicable tissue thickness, and a technique to suspend the lip with the incorporated tendon

Sensible color match, purposeful

**Table 3.** The advantages and downsides of the contemporary approach to soft tissue reconstruction [66].

The maintenance of associate degree sufficient strip of attached gingiva includes a minimum of 2 mm of keratinized gingiva and has revealed that it could be necessary for preservation of periodontal tissue [68, 69]. Historically, FGGs' associate degreed grafts which were taken from connective tissue are applied to gain sufficient strip of attached gingiva [70]. Unfortunately, clinical evidence about the use of autologous and allogenic products confronts to some problems about FGGs, i.e., problems about morbidity around donor region and also amount of tissue for graft which is restricted [71]. Nevins [72] applied treatment by bilayered cell for mucogingival region, and this research revealed that adequate keratinized tissue was gained; however, the amount was not more than it gained with FGGs. Interestingly, each research tried to prove that clinical evidence such as texture and color have better results when compared with FGGs. Nevertheless, application of products that have allogenic cells could have important effect on the wound bed; the impact of treatment could be as a completely unique "biologic dressing" to motivate encompassing cells. One of the reliable materials was a scaffold which is biodegradable with gingival autologous fibroblasts which are cultured [73]. Another research in this field used oral mucosa cells to transplant directly to the cornea [74].

engineering [67].

Free grafts (full-thickness skin grafts, split-thickness

282 Stem Cells in Clinical Practice and Tissue Engineering

Local advancement and

Free vascularized tissue

Allogeneic tissue transfer/

skin grafts, etc.)

motility flaps

face transplant

transfer

The temporomandibular joint (TMJ) may be a synovial joint that has for articulator motion relative to the os base and distributes the traditional stresses of perform (chewing and speaking) and parafunction (clenching and bruxism). It is usually noted as ginglymoarthrodial joint attributable to its slippy performance and hinging. The temporomandibular joint links the condyloid process (mandibular bone) to the temporal bone. The cartilage disc is the middle of mandibular condyle and the glenoid fossa eminence of the temporal bone and separates the joint area into inferior and superior compartments, each of that area unit crammed with synovial fluid [79].

Because of the advanced loading patterns that designed tissues can expertise within the TMJ, acquisition of complete style parameters from the native tissue is important. Significantly, TMJ disc, condyle, and condylar cartilage replacement area unit in nice demand attributable to these tissues' poor regenerative capability and high rate of involvement in TMD. In response, many studies characterizing the properties of those elements are performed [79]. Though glenoid fossa and articular eminence are the concern in TMD, they need not be absolutely characterized. Within the following section, structural characteristics of the TMJ tissue area unit are summarized. Application of tissue engineering in the treatment of temporomandibular joint defects is rising as a progressive choice to substitute and remove the pathological defects automatically in the near future. Historically, basics of regenerative medicine are three necessary elements, cells, stimulator factors, and scaffolds. But new technology introduced novel methodologies and recommends how to manage TMJ disk and stimulate relevant cartilage [80]. This approach includes the scaffold-free and cell-based methodology and cells and stimulators that work together. But another approach is to construct a structure and render appropriate form of engineered tissues, permitting well-designed structure and simple handling [81]. Another mechanical feature may be appropriate for designed tissue. In the best manner the chemistry of scaffold that could be degradation with matrix synthesis. But the rate of scaffold degradation depends on the nature of scaffold and might be modified by manipulation. For induction of the mass of matrix synthesis, growth factors are added to the scaffolds. Today, all engineered tissue materials are used to regenerate condyle and TMJ disc; however, similar strategies for regeneration of mandibular fossa are not successful [82].

### **7. Conclusion**

Unfortunately, limiting factors still existed; most of them could be the differences of lab environment and human body such as unknown exact dose of BMP and applicate high dose of this material to creation of bony scaffold [83]. On the other hand, unpredictable effects of BMP and complications about application of BMP together with oncogenesis. Based on these evidences, Food and Drug Administration (FDA) restricted application of BMP to sinus alveolar process augmentation in the United States; other substitute materials in maxillofacial region should be considered moral issues even if these materials reveal high level of evidence in several experimentations [84].

**Author details**

Seied Omid Keyhan1,2,3,4, Hamidreza Fallahi<sup>5</sup>

Mohammad Hosein Amirzade-Iranaq7,8,9,10\*

\*Address all correspondence to<EMAIL_ADDRESS>
Education and Research Network (USERN), Tehran, Iran

Seyed Mohammad Reza Masoumi<sup>7</sup>

Medical Science, Birjand, Iran

6 Private Practice, Tehran, Iran

Academic Press: MA, USA. 2011

Scandinavica. 2017;**75**(1):1-11

als. Boca Raton: CRC Press; 2008. p. 185-211

Sciences, Tehran, Iran

Tehran, Iran

**References**

, Alireza Jahangirnia6

, Mohammad Hossein Khosravi7,8 and

1 Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Birjand University of

2 Vice Presidential Organization of Technology of the Islamic Republic of Iran, Iran

3 Stem Cell & Regenerative Medicine Network, Shahid Beheshti University of Medical

4 Cranio Maxillofacial Research Center, Tehran Dental Branch, Islamic Azad University,

5 Oral and Maxillofacial Surgery, Jundishapur University of Medical Sciences, Ahvaz, Iran

7 Student Research Committee (SRC), Baqiyatallah University of Medical Sciences, Tehran, Iran

9 Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

[1] Lanza R, Langer R, Vacanti JP. Principles of Tissue Engineering. Academic Press; Elsevier

[2] Fisher MB, Mauck RL. Tissue engineering and regenerative medicine: Recent innovations and the transition to translation. Tissue Engineering Part B: Reviews. 2013;**19**(1):1-13

[3] Salih V. Biodegradable scaffolds for tissue engineering. Cellular response to biomateri-

[4] Mihaylova Z, Mitev V, Stanimirov P, Isaeva A, Gateva N, Ishkitiev N. Use of platelet concentrates in oral and maxillofacial surgery: An overview. Acta Odontologica

8 International Otorhinolaryngology Research Association (IORA), Universal Scientific

10 Universal Network of Interdisciplinary Research in Oral and Maxillofacial Surgery (UNIROMS), Universal Scientific Education and Research Network (USERN), Tehran, Iran

,

Tissue Engineering Applications in Maxillofacial Surgery http://dx.doi.org/10.5772/intechopen.70904 285

Another problem like tissue transfer decreases the chance of high-quality and priced experimentations [85], and also Ripamonti et al. study revealed that growth factor and signaling systems in animal and human are totally different and huge variation between them is observed. Unfortunately, there are few clinical trials in the maxillofacial region, but the question is what the obstacles are? The main obstacles are how to predict regenerate cells to not become oncogenesis and produce our wanted cells, how to manage signaling factors to facilitate the procedure of regeneration, and how to create the scaffold that permits cell growth in the best way. More clinical trials are needed to remove the obstacles [86].

Tissue engineering is the field that is surrounded by other fields like histology, medical engineering, and pathology that every progress in these fields could change principles of tissue engineering. Our goals are simple which are to know how to regenerate human tissues from host cells and somehow that these regenerates have desirable function and esthetics. To reach to this goal, we have long way, but today engineers progressed biocompatible scaffolds, increase the flexibility to 3D tissue constructs, and designed complex tissue for the different facial areas. The latest progress guarantees that tissue engineering is the trustworthy choice for the treatment of maxillofacial defects. In future, the role of tissue engineering will increase and become routine in surgeries.

### **Acknowledgements**

Conducting this review will not be possible without team work and cooperation. We have to thank people for their work in helping us through this way, authors of all referenced articles which are used for construction of this review, Dr. Tannaz Tafakori, Eng. MT Amirzade-Iranaq, and Mr. MS Amirzade-Iranaq with their search and companionship.

### **Conflict of interest**

Authors declare that there is no conflict of interest that may damage the integrity and validity of this research.