Stem Cell Based Tissue Regeneration of the Temporomandibular Joint

Objectives: The ultimate goal of regenerative medicine is to faithfully recreate structures and organs with autogenously derived stem cells. Current technology involves creating a scaffold, derived from various materials, and populating it with mesenchymal stem cells harvested from fat or bone marrow and then sophisticated cell culture techniques are employed to coax the system to develop into a bone or organ. Progress in this area has been promising, but there are potential road blocks. When tissue is harvested and processed, the available stem cell populations may not include progenitors of the desired type. In addition, diseases such as diabetes can permanently delete whole populations of stem cells, thus possibly resulting in a critical deficit that may preclude the ability to generate a specific tissue. With time, this problem may be resolved, but in the meantime there are products available that can provide immunologically privileged stem cells from cryogenically preserved placenta that have the capability to differentiate and stimulate tissue growth. We have utilized this stem cell product in conjunction with a viable osteochondral allograft to reconstruct the temporomandibular joint in patients with internal derangement of the articular disk.
Methods: The details of a case series will be presented with a discussion of the relevant pre-operative and post-operative details.
Results: Two patients underwent discectomy and joint reconstruction using cryogenically preserved placenta and an osteochondral allograft. The immediate post-operative results demonstrated decreased pain and improved function. At the five month post-operative time point a repeat MRI was done showing that the grafts were in place and stable.
Conclusions: Tissue regenerative techniques hold great promise for the future treatment of a wide variety of conditions, but the field is still evolving. We have demonstrated that by using existing products it is possible to utilize stem cells now and in the future for the purpose of regenerating a complex structure like the TMJ.