Infection, inflammation, and bone regeneration: a paradoxical relationship.
Various strategies have been developed to promote bone regeneration in the craniofacial region. Most of these interventions utilize implantable materials or devices. Infections resulting from colonization of these implants may result in local tissue destruction in a manner analogous to periodontitis. This destruction is mediated via the expression of various inflammatory mediators and tissue-destructive enzymes. Given the well-documented association among microbial biofilms, inflammatory mediators, and tissue destruction, it seems reasonable to assume that inflammation may interfere with bone healing and regeneration. Paradoxically, recent evidence also suggests that the presence of certain pro-inflammatory mediators is actually required for bone healing. Bone injury (e.g., subsequent to a fracture or surgical intervention) is followed by a choreographed cascade of events, some of which are dependent upon the presence of pro-inflammatory mediators. If inflammation resolves promptly, then proper bone healing may occur. However, if inflammation persists (which might occur in the presence of an infected implant or graft material), then the continued inflammatory response may result in suboptimal bone formation. Thus, the effect of a given mediator is dependent upon the temporal context in which it is expressed. Better understanding of this temporal sequence may be used to optimize regenerative outcomes.
Department of Oral Health Practice, University of Kentucky College of Dentistry, 800 Rose Street, Room D-124, Lexington, KY 40536-0297, USA. mvthom0@uky.edu
M V
MV
Thomas
D A
DA
Puleo
D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D016718:Arachidonic Acid / Q000378:metabolism; D055396:Bone Morphogenetic Protein 2 / Q000378:metabolism; D001861:Bone Regeneration / Q000502:physiology*; D016207:Cytokines / Q000096:biosynthesis; D015921:Dental Implants / Q000009:adverse effects*; D003920:Diabetes Mellitus / Q000378:metabolism; D017127:Glycation End Products, Advanced / Q000378:metabolism; D016557:Guided Tissue Regeneration, Periodontal; D006801:Humans; D007249:Inflammation / Q000378:metabolism*; D018836:Inflammation Mediators / Q000378:metabolism*; D008567:Membranes, Artificial; D016328:NF-kappa B / Q000378:metabolism; D009569:Nitric Oxide / Q000378:metabolism; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000276:immunology / Q000378:metabolism*
D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D055396:Bone Morphogenetic Protein 2; D016207:Cytokines; D015921:Dental Implants; D017127:Glycation End Products, Advanced; D018836:Inflammation Mediators; D008567:Membranes, Artificial; D016328:NF-kappa B; D016718:Arachidonic Acid; D009569:Nitric Oxide
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