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Jin Y, Li J, Fan H, Du J, He Y. Biomechanics and Mechanobiology of Additively Manufactured Porous Load-Bearing Bone Implants. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2025:e2409955. [PMID: 40244634 DOI: 10.1002/smll.202409955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Revised: 03/25/2025] [Indexed: 04/18/2025]
Abstract
Given that they can replicate both the biomechanical and mechanobiological functions of natural bone, metal additively manufactured porous load-bearing bone implants present a significant advancement in orthopedic applications. Additive manufacturing (AM) of metals enables precise control over pore geometry, resulting in implants that provide effective mechanical support and minimize stress shielding. In addition to its mechanical benefits, the porous architecture of the implants facilitates essential mechanobiological processes, including the transmission of mechanical signals that regulate cellular processes such as adhesion, proliferation, and differentiation. Before clinical use, the implants should first be engineered to achieve a comparable elastic modulus to native bone, mitigating implant-induced bone resorption while promoting tissue regeneration. It is also noteworthy that the microstructural features of these implants support angiogenesis-a critical process for oxygen and nutrient delivery during bone healing. Despite their potential benefits, challenges remain in balancing mechanical stability for load-bearing applications with biofunctionality for effective integration and controlled degradation. This review comprehensively discusses the biomechanical and mechanobiological factors influencing the design and performance of additively manufactured porous bone implants, highlighting their potential to enhance clinical outcomes in bone repair and regeneration.
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Affiliation(s)
- Yuan Jin
- Zhejiang-Italy Joint Lab for Smart Materials and Advanced Structures, School of Mechanical Engineering and Mechanics, Ningbo University, Ningbo, Zhejiang, 315211, China
| | - Jianhui Li
- Zhejiang-Italy Joint Lab for Smart Materials and Advanced Structures, School of Mechanical Engineering and Mechanics, Ningbo University, Ningbo, Zhejiang, 315211, China
| | - Haitao Fan
- Department of Orthopaedics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315000, China
| | - Jianke Du
- Zhejiang-Italy Joint Lab for Smart Materials and Advanced Structures, School of Mechanical Engineering and Mechanics, Ningbo University, Ningbo, Zhejiang, 315211, China
| | - Yong He
- School of Mechanical Engineering, Zhejiang University, Hangzhou, 310058, China
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2
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Smith PO, Huang G, Devries K, Nazhat SN, Phillips JB. Automated production of nerve repair constructs containing endothelial cell tube-like structures. Biofabrication 2024; 17:015024. [PMID: 39500048 DOI: 10.1088/1758-5090/ad8efd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Accepted: 11/05/2024] [Indexed: 11/21/2024]
Abstract
Engineered neural tissue (EngNT) is a stabilised aligned cellular hydrogel that offers a potential alternative to the nerve autograft for the treatment of severe peripheral nerve injury. This work aimed to automate the production of EngNT, to improve the feasibility of scalable manufacture for clinical translation. Endothelial cells were used as the cellular component of the EngNT, with the formation of endothelial cell tube-like structures mimicking the polarised vascular structures formed early on in the natural regenerative process. Gel aspiration-ejection for the production of EngNT was automated by integrating a syringe pump with a robotic positioning system, using software coded in Python to control both devices. Having established the production method and tested mechanical properties, the EngNT containing human umbilical vein endothelial cells (EngNT-HUVEC) was characterised in terms of viability and alignment, compatibility with neurite outgrowth from rat dorsal root ganglion neurons and formation of endothelial cell networksin vitro. EngNT-HUVEC manufactured using the automated system contained viable and aligned endothelial cells, which developed into a network of multinucleated endothelial cell tube-like structures inside the constructs and an outer layer of endothelialisation. The EngNT-HUVEC constructs were made in various sizes within minutes. Constructs provided support and guidance to regenerating neuritesin vitro. This work automated the formation of EngNT, facilitating high throughput manufacture at scale. The formation of endothelial cell tube-like structures within stabilised hydrogels provides an engineered tissue with potential for use in nerve repair.
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Affiliation(s)
- Poppy O Smith
- UCL Centre for Nerve Engineering, Department of Pharmacology, UCL School of Pharmacy, University College London, London, United Kingdom
| | - Guanbingxue Huang
- Department of Mining and Materials Engineering, McGill University, Montreal, Quebec, Canada
| | - Kate Devries
- Department of Mining and Materials Engineering, McGill University, Montreal, Quebec, Canada
| | - Showan N Nazhat
- Department of Mining and Materials Engineering, McGill University, Montreal, Quebec, Canada
| | - James B Phillips
- UCL Centre for Nerve Engineering, Department of Pharmacology, UCL School of Pharmacy, University College London, London, United Kingdom
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Aad R, Dragojlov I, Vesentini S. Sericin Protein: Structure, Properties, and Applications. J Funct Biomater 2024; 15:322. [PMID: 39590526 PMCID: PMC11595228 DOI: 10.3390/jfb15110322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Revised: 10/24/2024] [Accepted: 10/26/2024] [Indexed: 11/28/2024] Open
Abstract
Silk sericin, the glue protein binding fibroin fibers together, is present in the Bombyx mori silkworms' cocoons. In recent years, sericin has gained attention for its wide range of properties and possible opportunities for various applications, as evidenced by the meta-analysis conducted in this review. Sericin extraction methods have evolved over the years to become more efficient and environmentally friendly, preserving its structure. Due to its biocompatibility, biodegradability, anti-inflammatory, antibacterial, antioxidant, UV-protective, anti-tyrosinase, anti-aging, and anti-cancer properties, sericin is increasingly used in biomedical fields like drug delivery, tissue engineering, and serum-free cell culture media. Beyond healthcare, sericin shows promise in industries such as textiles, cosmetics, and food packaging. This review aims to highlight recent advancements in sericin extraction, research, and applications, while also summarizing key findings from earlier studies.
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Affiliation(s)
| | | | - Simone Vesentini
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, 20133 Milan, Italy; (R.A.); (I.D.)
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Wang Y, Lv H, Ren S, Zhang J, Liu X, Chen S, Zhai J, Zhou Y. Biological Functions of Macromolecular Protein Hydrogels in Constructing Osteogenic Microenvironment. ACS Biomater Sci Eng 2024; 10:5513-5536. [PMID: 39173130 DOI: 10.1021/acsbiomaterials.4c00910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
Irreversible bone defects resulting from trauma, infection, and degenerative illnesses have emerged as a significant health concern. Structurally and functionally controllable hydrogels made by bone tissue engineering (BTE) have become promising biomaterials. Natural proteins are able to establish connections with autologous proteins through unique biologically active regions. Hydrogels based on proteins can simulate the bone microenvironment and regulate the biological behavior of stem cells in the tissue niche, making them candidates for research related to bone regeneration. This article reviews the biological functions of various natural macromolecular proteins (such as collagen, gelatin, fibrin, and silk fibroin) and highlights their special advantages as hydrogels. Then the latest research trends on cross-linking modified macromolecular protein hydrogels with improved mechanical properties and composite hydrogels loaded with exogenous micromolecular proteins have been discussed. Finally, the applications of protein hydrogels, such as 3D printed hydrogels, microspheres, and injectable hydrogels, were introduced, aiming to provide a reference for the repair of clinical bone defects.
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Affiliation(s)
- Yihan Wang
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Hospital of Stomatology, Jilin University, Changchun 130021, P. R. China
| | - Huixin Lv
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Hospital of Stomatology, Jilin University, Changchun 130021, P. R. China
| | - Sicong Ren
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Hospital of Stomatology, Jilin University, Changchun 130021, P. R. China
| | - Jiameng Zhang
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Hospital of Stomatology, Jilin University, Changchun 130021, P. R. China
| | - Xiuyu Liu
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Hospital of Stomatology, Jilin University, Changchun 130021, P. R. China
| | - Sheng Chen
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Hospital of Stomatology, Jilin University, Changchun 130021, P. R. China
| | - Jingjie Zhai
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Hospital of Stomatology, Jilin University, Changchun 130021, P. R. China
| | - Yanmin Zhou
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Hospital of Stomatology, Jilin University, Changchun 130021, P. R. China
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Wan H, Xiang J, Mao G, Pan S, Li B, Lu Y. Recent Advances in the Application of 3D-Printing Bioinks Based on Decellularized Extracellular Matrix in Tissue Engineering. ACS OMEGA 2024; 9:24219-24235. [PMID: 38882108 PMCID: PMC11170705 DOI: 10.1021/acsomega.4c02847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/10/2024] [Accepted: 05/17/2024] [Indexed: 06/18/2024]
Abstract
In recent years, 3D bioprinting with various types of bioinks has been widely used in tissue engineering to fabricate human tissues and organs with appropriate biological functions. Decellularized extracellular matrix (dECM) is an excellent bioink candidate because it is enriched with a variety of bioactive proteins and bioactive factors and can provide a suitable environment for tissue repair or tissue regeneration while reducing the likelihood of severe immune rejection. In this Review, we systematically review recent advances in 3D bioprinting and decellularization technologies and comprehensively detail the latest research and applications of dECM as a bioink for tissue engineering in various systems, with the aim of providing a reference for researchers in tissue engineering to better understand the properties of dECM bioinks.
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Affiliation(s)
- Haoxin Wan
- Department
of Thoracic Surgery, The First Affiliated
Hospital of Soochow University, Suzhou 215000, China
| | - Jian Xiang
- Affiliated
Hospital of Yangzhou University, Yangzhou 225000, China
| | - Guocai Mao
- Department
of Thoracic Surgery, The First Affiliated
Hospital of Soochow University, Suzhou 215000, China
| | - Shu Pan
- Department
of Thoracic Surgery, The First Affiliated
Hospital of Soochow University, Suzhou 215000, China
| | - Bing Li
- The
Second Affiliated Hospital of Soochow University, Suzhou 215000, China
| | - Yi Lu
- Clinical
Medical College, Yangzhou University, Yangzhou 225000, China
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Zhu Y, Gu H, Yang J, Li A, Hou L, Zhou M, Jiang X. An Injectable silk-based hydrogel as a novel biomineralization seedbed for critical-sized bone defect regeneration. Bioact Mater 2024; 35:274-290. [PMID: 38370865 PMCID: PMC10873665 DOI: 10.1016/j.bioactmat.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/10/2024] [Accepted: 01/25/2024] [Indexed: 02/20/2024] Open
Abstract
The healing process of critical-sized bone defects urges for a suitable biomineralization environment. However, the unsatisfying repair outcome usually results from a disturbed intricate milieu and the lack of in situ mineralization resources. In this work, we have developed a composite hydrogel that mimics the natural bone healing processes and serves as a seedbed for bone regeneration. The oxidized silk fibroin and fibrin are incorporated as rigid geogrids, and amorphous calcium phosphate (ACP) and platelet-rich plasma serve as the fertilizers and loam, respectively. Encouragingly, the seedbed hydrogel demonstrates excellent mechanical and biomineralization properties as a stable scaffold and promotes vascularized bone regeneration in vivo. Additionally, the seedbed serves a succinate-like function via the PI3K-Akt signaling pathway and subsequently orchestrates the mitochondrial calcium uptake, further converting the exogenous ACP into endogenous ACP. Additionally, the seedbed hydrogel realizes the succession of calcium resources and promotes the evolution of the biotemplate from fibrin to collagen. Therefore, our work has established a novel silk-based hydrogel that functions as an in-situ biomineralization seedbed, providing a new insight for critical-sized bone defect regeneration.
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Affiliation(s)
- Yuhui Zhu
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, China
- College of Stomatology, Shanghai Jiao Tong University, No. 115 Jinzun Road, Shanghai, 200125, China
- National Center for Stomatology, No. 639 Zhizaoju Road, Shanghai, 200011, China
- National Clinical Research Center for Oral Diseases, No. 639 Zhizaoju Road, Shanghai, 200011, China
- Shanghai Key Laboratory of Stomatology, No. 639 Zhizaoju Road, Shanghai, 200011, China
- Shanghai Research Institute of Stomatology, No. 639 Zhizaoju Road, Shanghai, 200011, China
- Shanghai Engineering Research Center of Advanced Dental Technology and Materials, No. 115 Jinzun Road, Shanghai 200125, China
| | - Hao Gu
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, China
- College of Stomatology, Shanghai Jiao Tong University, No. 115 Jinzun Road, Shanghai, 200125, China
- National Center for Stomatology, No. 639 Zhizaoju Road, Shanghai, 200011, China
- National Clinical Research Center for Oral Diseases, No. 639 Zhizaoju Road, Shanghai, 200011, China
- Shanghai Key Laboratory of Stomatology, No. 639 Zhizaoju Road, Shanghai, 200011, China
- Shanghai Research Institute of Stomatology, No. 639 Zhizaoju Road, Shanghai, 200011, China
- Shanghai Engineering Research Center of Advanced Dental Technology and Materials, No. 115 Jinzun Road, Shanghai 200125, China
| | - Jiawei Yang
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, China
- College of Stomatology, Shanghai Jiao Tong University, No. 115 Jinzun Road, Shanghai, 200125, China
- National Center for Stomatology, No. 639 Zhizaoju Road, Shanghai, 200011, China
- National Clinical Research Center for Oral Diseases, No. 639 Zhizaoju Road, Shanghai, 200011, China
- Shanghai Key Laboratory of Stomatology, No. 639 Zhizaoju Road, Shanghai, 200011, China
- Shanghai Research Institute of Stomatology, No. 639 Zhizaoju Road, Shanghai, 200011, China
- Shanghai Engineering Research Center of Advanced Dental Technology and Materials, No. 115 Jinzun Road, Shanghai 200125, China
| | - Anshuo Li
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, China
- College of Stomatology, Shanghai Jiao Tong University, No. 115 Jinzun Road, Shanghai, 200125, China
- National Center for Stomatology, No. 639 Zhizaoju Road, Shanghai, 200011, China
- National Clinical Research Center for Oral Diseases, No. 639 Zhizaoju Road, Shanghai, 200011, China
- Shanghai Key Laboratory of Stomatology, No. 639 Zhizaoju Road, Shanghai, 200011, China
- Shanghai Research Institute of Stomatology, No. 639 Zhizaoju Road, Shanghai, 200011, China
- Shanghai Engineering Research Center of Advanced Dental Technology and Materials, No. 115 Jinzun Road, Shanghai 200125, China
| | - Lingli Hou
- Shanghai Institute of Precision Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 115 Jinzun Road, Shanghai, 200125, China
| | - Mingliang Zhou
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, China
- College of Stomatology, Shanghai Jiao Tong University, No. 115 Jinzun Road, Shanghai, 200125, China
- National Center for Stomatology, No. 639 Zhizaoju Road, Shanghai, 200011, China
- National Clinical Research Center for Oral Diseases, No. 639 Zhizaoju Road, Shanghai, 200011, China
- Shanghai Key Laboratory of Stomatology, No. 639 Zhizaoju Road, Shanghai, 200011, China
- Shanghai Research Institute of Stomatology, No. 639 Zhizaoju Road, Shanghai, 200011, China
- Shanghai Engineering Research Center of Advanced Dental Technology and Materials, No. 115 Jinzun Road, Shanghai 200125, China
| | - Xinquan Jiang
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, China
- College of Stomatology, Shanghai Jiao Tong University, No. 115 Jinzun Road, Shanghai, 200125, China
- National Center for Stomatology, No. 639 Zhizaoju Road, Shanghai, 200011, China
- National Clinical Research Center for Oral Diseases, No. 639 Zhizaoju Road, Shanghai, 200011, China
- Shanghai Key Laboratory of Stomatology, No. 639 Zhizaoju Road, Shanghai, 200011, China
- Shanghai Research Institute of Stomatology, No. 639 Zhizaoju Road, Shanghai, 200011, China
- Shanghai Engineering Research Center of Advanced Dental Technology and Materials, No. 115 Jinzun Road, Shanghai 200125, China
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Adamiak K, Gaida VA, Schäfer J, Bosse L, Diemer C, Reiter RJ, Slominski AT, Steinbrink K, Sionkowska A, Kleszczyński K. Melatonin/Sericin Wound Healing Patches: Implications for Melanoma Therapy. Int J Mol Sci 2024; 25:4858. [PMID: 38732075 PMCID: PMC11084828 DOI: 10.3390/ijms25094858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/19/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
Melatonin and sericin exhibit antioxidant properties and may be useful in topical wound healing patches by maintaining redox balance, cell integrity, and regulating the inflammatory response. In human skin, melatonin suppresses damage caused by ultraviolet radiation (UVR) which involves numerous mechanisms associated with reactive oxygen species/reactive nitrogen species (ROS/RNS) generation and enhancing apoptosis. Sericin is a protein mainly composed of glycine, serine, aspartic acid, and threonine amino acids removed from the silkworm cocoon (particularly Bombyx mori and other species). It is of interest because of its biodegradability, anti-oxidative, and anti-bacterial properties. Sericin inhibits tyrosinase activity and promotes cell proliferation that can be supportive and useful in melanoma treatment. In recent years, wound healing patches containing sericin and melatonin individually have attracted significant attention by the scientific community. In this review, we summarize the state of innovation of such patches during 2021-2023. To date, melatonin/sericin-polymer patches for application in post-operational wound healing treatment has been only sparingly investigated and it is an imperative to consider these materials as a promising approach targeting for skin tissue engineering or regenerative dermatology.
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Affiliation(s)
- Katarzyna Adamiak
- Department of Biomaterials and Cosmetic Chemistry, Faculty of Chemistry, Nicolaus Copernicus University, Gagarin 7, 87-100 Toruń, Poland; (K.A.); (A.S.)
| | - Vivian A. Gaida
- Department of Dermatology, University of Münster, Von-Esmarch-Str. 58, 48149 Münster, Germany; (V.A.G.); (J.S.); (L.B.); (C.D.); (K.S.)
| | - Jasmin Schäfer
- Department of Dermatology, University of Münster, Von-Esmarch-Str. 58, 48149 Münster, Germany; (V.A.G.); (J.S.); (L.B.); (C.D.); (K.S.)
| | - Lina Bosse
- Department of Dermatology, University of Münster, Von-Esmarch-Str. 58, 48149 Münster, Germany; (V.A.G.); (J.S.); (L.B.); (C.D.); (K.S.)
| | - Clara Diemer
- Department of Dermatology, University of Münster, Von-Esmarch-Str. 58, 48149 Münster, Germany; (V.A.G.); (J.S.); (L.B.); (C.D.); (K.S.)
| | - Russel J. Reiter
- Department of Cell Systems and Anatomy, Long School of Medicine, UT Health, San Antonio, TX 78229, USA;
| | - Andrzej T. Slominski
- Department of Dermatology, Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
- Pathology and Laboratory Medicine Service, VA Medical Center, Birmingham, AL 35294, USA
| | - Kerstin Steinbrink
- Department of Dermatology, University of Münster, Von-Esmarch-Str. 58, 48149 Münster, Germany; (V.A.G.); (J.S.); (L.B.); (C.D.); (K.S.)
| | - Alina Sionkowska
- Department of Biomaterials and Cosmetic Chemistry, Faculty of Chemistry, Nicolaus Copernicus University, Gagarin 7, 87-100 Toruń, Poland; (K.A.); (A.S.)
| | - Konrad Kleszczyński
- Department of Dermatology, University of Münster, Von-Esmarch-Str. 58, 48149 Münster, Germany; (V.A.G.); (J.S.); (L.B.); (C.D.); (K.S.)
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Kim JY, Kim SG, Garagiola U. Relevant Properties and Potential Applications of Sericin in Bone Regeneration. Curr Issues Mol Biol 2023; 45:6728-6742. [PMID: 37623245 PMCID: PMC10453912 DOI: 10.3390/cimb45080426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/10/2023] [Accepted: 08/12/2023] [Indexed: 08/26/2023] Open
Abstract
The potential of sericin, a protein derived from silkworms, is explored in bone graft applications. Sericin's biocompatibility, hydrophilic nature, and cost-effectiveness make it a promising candidate for enhancing traditional graft materials. Its antioxidant, anti-inflammatory, and UV-resistant properties contribute to a healthier bone-healing environment, and its incorporation into 3D-printed grafts could lead to personalized medical solutions. However, despite these promising attributes, there are still gaps in our understanding. The precise mechanism through which sericin influences bone cell growth and healing is not fully understood, and more comprehensive clinical trials are needed to confirm its long-term biocompatibility in humans. Furthermore, the best methods for incorporating sericin into existing graft materials are still under investigation, and potential allergic reactions or immune responses to sericin need further study.
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Affiliation(s)
- Jwa-Young Kim
- Department of Oral and Maxillofacial Surgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul 07441, Republic of Korea;
| | - Seong-Gon Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung 28644, Republic of Korea
| | - Umberto Garagiola
- Biomedical, Surgical and Oral Sciences Department, Maxillofacial and Dental Unit, School of Dentistry, University of Milan, 20122 Milan, Italy;
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