Lgr5-expressing secretory cells form a Wnt inhibitory niche in cartilage critical for chondrocyte identity.

Osteoarthritis is a degenerative joint disease that causes pain, degradation, and dysfunction. Excessive canonical Wnt signaling in osteoarthritis contributes to chondrocyte phenotypic instability and loss of cartilage homeostasis; however, the regulatory niche is unknown. Using the temporomandibular joint as a model in multiple species, we identify Lgr5-expressing secretory cells as forming a Wnt inhibitory niche that instruct Wnt-inactive chondroprogenitors to form the nascent synovial joint and regulate chondrocyte lineage and identity. Lgr5 ablation or suppression during joint development, aging, or osteoarthritis results in depletion of Wnt-inactive chondroprogenitors and a surge of Wnt-activated, phenotypically unstable chondrocytes with osteoblast-like properties. We recapitulate the cartilage niche and create StemJEL, an injectable hydrogel therapy combining hyaluronic acid and sclerostin. Local delivery of StemJEL to post-traumatic osteoarthritic jaw and knee joints in rabbit, rat, and mini-pig models restores cartilage homeostasis, chondrocyte identity, and joint function. We provide proof of principal that StemJEL preserves the chondrocyte niche and alleviates osteoarthritis.

Opioid-Prescribing Patterns in Connecticut and New Jersey Following Third Molar Extractions.

OBJECTIVE: In recent years, opioid misuse has resulted in much scrutiny on providers' prescribing habits. The purpose of this study was to analyze prescribing habits in the context of third molar extractions as a model for promoting better postsurgical pain management. METHODS: This was a cross-sectional survey of oral maxillofacial surgeons in Connecticut and New Jersey. A total of 291 practitioners were contacted to complete an online survey using Qualtrics Research Services to determine prescribing habits following third molar extractions. RESULTS: The most common approach for postoperative analgesia was nonsteroidal anti-inflammatory drugs (NSAIDs) and an opioid/acetaminophen (APAP) combination as 2 separate prescriptions, reported by 36% of participants. The combination of hydrocodone/APAP was the most common opioid formulation, and an average of 10.93 ± 4.51 opioid pills were prescribed with a maximum of 20 pills reported. Most providers (79%) consistently provided patients with opioid information. Only 22% reported always checking opioid-monitoring programs; however, providers were more likely to check if prescribing more than ∼11 opioid pills (P = .0228). Most reported using dexamethasone (82%) and bupivacaine (56%) intraoperatively, while ketorolac was less common (15%). No association was found between the quantity of opioids prescribed and the use of intraoperative ketorolac, steroids, or bupivacaine (P > .05). CONCLUSION: There remains to be a universal standard for using opioids for postoperative pain management in dentistry. Providers should be mindful when prescribing opioids and consider using NSAIDs and APAP for baseline pain plus a separate opioid prescription for breakthrough pain. Additional focus on minimizing the quantity of opioids prescribed and self-reflecting on prescribing and practice habits to further reduce opioid-related complications is warranted.

Are we training oral and maxillofacial surgeons in minimally invasive cosmetic procedures?

OBJECTIVE: Oral and maxillofacial surgeons (OMS) are well trained in facial anatomy, but exposure to cosmetic procedures in residencies is inconsistent due to several factors, including the patient population, technique, and cost. The primary objective of the present study was to identify an association with exposure to treatment modality in residency with likelihood to perform these procedures in practice. STUDY DESIGN: This was a cross-sectional survey distributed to practicing OMS in the United States. Links to the online survey were distributed using communications from local, state, and regional OMS surgery societies. Information was gathered on clinical practice and training during and after residency. The study outcome was whether the respondent performed injectables (dermal fillers or neuromodulators) in their practice. RESULTS: A total of 150 responses were included in the study sample, and no responses were excluded. Only 42.7% of respondents reported performing injectables. Just 37% of respondents stated they had had an opportunity to perform these procedures as a resident, suggesting that 5.7% did not perform injectables until they started practice. Dual-degree training, additional fellowship training, and practical and didactic continuing education training were all associated with higher likelihoods of having an injectable practice. Injectable exposure in residency did not significantly affect the prevalence of having an injectable practice. CONCLUSIONS: OMS who performed injectables were more likely to seek additional forms of training outside of residency. Educators should reevaluate the way that they are approaching cosmetics procedures in residency.

The Liability of Performing Orthognathic Surgery.

Study Design: This is a retrospective case series using the Thomson Reuters Westlaw Edge database, an online subscription-based database of over 40,000 state and federal records. Objective: There is growing academic interest in the medical malpractice literature. The primary objective of this study was to examine medical malpractice in orthognathic procedures in order to characterize factors that determine legal responsibility and help make the craniomaxillofacial (CMF) surgeon more comfortable when treating this patient population. Methods: The database was queried for medical malpractice cases involving orthognathic surgery from 1985-2021. The characteristics of each lawsuit were identified, and descriptive statistics were reported. Results: A total of 42 CMF malpractice cases were available for review, and total of 15 cases were included in the final sample. Verdict decisions and settlements occurred between 1991 and 2012. Of the 15 cases, the highest concentration of cases occurred in California (6) and Pennsylvania (2). 53% of cases were ruled in favor of the defendant, 7% of cases were settled, 27% of cases were ruled in favor of the plaintiff against the surgeon, and 13% were ruled in favor of the plaintiff against the hospital with the surgeon being found not liable. The minimum award of damages was $29,999 and the maximum was $550,000. Conclusion: Litigation experience can be very time consuming and troublesome for medical practitioners. The risk of litigation and complications might be a prohibiting factor as to why CMF surgeons may not be preforming orthognathic surgery. The best defense against a malpractice case is to avoid one altogether. Learning from past mistakes is one way of ensuring that goal.

Handball-Related Head and Neck Trauma: An Analysis of the 2000-2019 National Electronic Injury Surveillance System (NEISS) Database.

PURPOSE: The purpose of this study was to report on the characteristics of head and neck injuries secondary to the sport of Handball in the United States. MATERIALS AND METHODS: This is a 20-year cross-sectional study that was conducted using the National Electronic Injury Surveillance System. Handball injuries were included in the study if they involved the head, face, eyeball, mouth, ear, or neck. The primary study predictor was age group. The study outcome was the type of injury (diagnosis) and the location of injury. Chi-squared testing (χ2) was performed to compare categorical variables. RESULTS: Males composed more than three-fourths of the sample of patients (76.2%). White patients (38.7%) composed the most common racial group. The most common anatomical location injured was the head (45.9%). The most common primary diagnoses were contusion/abrasion (22.5%). Children were most likely to injure their head (P < 0.01) among all the anatomic regions. Young adults were least likely to injure their eyeball (P < 0.05). In contrast to children, adults were least likely to injure their head (P < 0.01). In contrast to young adults, adults were most likely to injure their eyeball (P < 0.01). With regards to types of injuries, Children were least likely to incur lacerations (P < 0.01). In contrast, young adults were most likely to incur lacerations (P < 0.01); however, young adults were least likely to suffer from contusions/abrasions (P < 0.01). In contrast to young adults, adults were most likely to suffer from contusions/abrasions (P < 0.01). CONCLUSIONS: Contusions/abrasions and brain damage were the two most common injuries in this sport. The head was the most commonly injured anatomical region. Both the type of injury and the anatomical location of injury that occur during the practice of handball significantly vary depending on the age group involved in the game.

Localization of TRP Channels in Healthy Oral Mucosa from Human Donors.

The oral cavity is exposed to a remarkable range of noxious and innocuous conditions, including temperature fluctuations, mechanical forces, inflammation, and environmental and endogenous chemicals. How such changes in the oral environment are sensed is not completely understood. Transient receptor potential (TRP) ion channels are a diverse family of molecular receptors that are activated by chemicals, temperature changes, and tissue damage. In non-neuronal cells, TRP channels play roles in inflammation, tissue development, and maintenance. In somatosensory neurons, TRP channels mediate nociception, thermosensation, and chemosensation. To assess whether TRP channels might be involved in environmental sensing in the human oral cavity, we investigated their distribution in human tongue and hard palate biopsies. TRPV3 and TRPV4 were expressed in epithelial cells with inverse expression patterns where they likely contribute to epithelial development and integrity. TRPA1 immunoreactivity was present in fibroblasts, immune cells, and neuronal afferents, consistent with known roles of TRPA1 in sensory transduction and response to damage and inflammation. TRPM8 immunoreactivity was found in lamina propria and neuronal subpopulations including within the end bulbs of Krause, consistent with a role in thermal sensation. TRPV1 immunoreactivity was identified in intraepithelial nerve fibers and end bulbs of Krause, consistent with roles in nociception and thermosensation. TRPM8 and TRPV1 immunoreactivity in end bulbs of Krause suggest that these structures contain a variety of neuronal afferents, including those that mediate nociception, thermosensation, and mechanotransduction. Collectively, these studies support the role of TRP channels in oral environmental surveillance and response.

Somatosensory innervation of healthy human oral tissues.

The oral somatosensory system relays essential information about mechanical stimuli to enable oral functions such as feeding and speech. The neurochemical and anatomical diversity of sensory neurons across oral cavity sites have not been systematically compared. To address this gap, we analyzed healthy human tongue and hard-palate innervation. Biopsies were collected from 12 volunteers and underwent fluorescent immunohistochemistry (≥2 specimens per marker/structure). Afferents were analyzed for markers of neurons (ßIII tubulin), myelinated afferents (neurofilament heavy, NFH), and Merkel cells and taste cells (keratin 20, K20). Hard-palate innervation included Meissner corpuscles, glomerular endings, Merkel cell-neurite complexes, and free nerve endings. The organization of these somatosensory endings is reminiscent of fingertips, suggesting that the hard palate is equipped with a rich repertoire of sensory neurons for pressure sensing and spatial localization of mechanical inputs, which are essential for speech production and feeding. Likewise, the tongue is innervated by afferents that impart it with exquisite acuity and detection of moving stimuli that support flavor construction and speech. Filiform papillae contained end bulbs of Krause, as well as endings that have not been previously reported, including subepithelial neuronal densities, and NFH+ neurons innervating basal epithelia. Fungiform papillae had Meissner corpuscles and densities of NFH+ intraepithelial neurons surrounding taste buds. The differing compositions of sensory endings within filiform and fungiform papillae suggest that these structures have distinct roles in mechanosensation. Collectively, this study has identified previously undescribed neuronal endings in human oral tissues and provides an anatomical framework for understanding oral mechanosensory functions.

What Are the Most Commonly Reported Complications With Cosmetic Botulinum Toxin Type A Treatments?

PURPOSE: The purpose of the present study was to determine the most commonly reported complications with cosmetic botulinum toxin type A (BTX-A) treatments. MATERIALS AND METHODS: The present study was a cross-sectional review of the US Food and Drug Administration (FDA) Adverse Event Reporting System. From January 2014 through September 2019, records were included in the study sample if they implicated Botox (onabotulinumtoxinA), Dysport (abobotulinumtoxinA), Xeomin (incobotulinumtoxinA), or Jeuveau (prabotulinumtoxinA-xvfs), and if the indication for use had been to perform a cosmetic skin procedure. The study predictors included patient (ie, age, weight, gender) and treatment (ie, product, country of treatment, 10 most common reactions) characteristics. The study outcome was the frequency of serious events as defined by the standard FDA definition for biologic products. A multivariate logistical regression model was created for the study outcome using all significant univariate predictors. RESULTS: The final sample included 10,577 reports detailing 29,471 adverse events and covering 1,473 reactions. The mean patient age was 48.4 ± 11.2 years, and nearly all patients were women (95.0%). The most commonly reported events were pain (9.3%), swelling (6.4%), and eyelid/brow ptosis (6.1%). Serious outcomes occurred in 13.5% of patients. In the multivariate model, serious outcomes were independently associated with older age, heavier weight, headache, allergy, vision changes, fatigue, facial paresis, and dizziness but notably were not associated with pain, swelling, or ptosis. CONCLUSIONS: A wide range of alleged complications have been reported to the FDA, many of which were likely not mediated through injection or direct toxin effects. Patients may have inaccurately attributed some of their symptoms to BTX-A, and providers should be prepared to dispel any misinformation. Local complications such as pain, swelling, and ptosis were the most common reactions but were not associated with serious patient outcomes. However, constitutional symptoms should be approached more carefully.

Does Maxillomandibular Advancement Change the Lay Perception of Personality and Emotional Traits?

PURPOSE: Maxillomandibular advancement (MMA) is an effective treatment for obstructive sleep apnea (OSA); however, the esthetic outcome is a frequent source of concern. The purpose of the present study was to determine whether MMA altered the lay perception of patients' personality traits and emotional expressions. MATERIALS AND METHODS: We conducted a survey of the lay public recruited through Qualtrics Research Services (available at: www.qualtrics.com). Clinical photographs were obtained from patients at our institution who had undergone MMA with advancement genioplasty for OSA. Survey respondents were randomized to either pre- or postoperative photograph sets and were asked to rate the clinical photographs on 6 personality and 6 emotional traits using 7-point Likert scales. The independent predictor was the preoperative or postoperative status. The dependent outcomes were the emotional and personality trait ratings. Multivariate analyses of variance were conducted to determine whether MMA had a significant effect on 2 or more emotional or personality traits. Significant results underwent post hoc testing with Bonferroni correction to determine which individual traits were affected. RESULTS: A total of 670 individuals accessed the published survey, of whom 210 (31.3%) completed the task and had their responses included in the final sample. No significant differences were found in age (P = .54), gender (P = .31), or ethnicity (P = .26) between the included and excluded respondents. Within the final sample, 110 participants were assigned to the preoperative image set and 100 to the postoperative set. After MMA, patients were observed to have significantly different emotional expressions (P < .01) but not personality traits (P = .12). Post hoc testing found patients to be significantly less sad (P < .01) and less disgusted (P < .01). CONCLUSIONS: MMA was accompanied by favorable changes in the lay perceptions of emotional, but not personality, traits. Patients considering surgery should recognize that their outward appearance will not be negatively affected by a large functional advancement.

What Is the Health Care Burden of Treating Pediatric Dental Infections on an Inpatient Basis?

PURPOSE: The purpose of this study was to quantify the inpatient burden of pediatric dental infections. MATERIALS AND METHODS: This was a retrospective study of the Kids' Inpatient Database from 2000 to 2014. Patients with a primary admitting diagnosis of cellulitis or an abscess of the oral soft tissues were included. Predictors were drawn from patient characteristics and the types of interventions performed. The outcomes were hospital charges, length of stay (LOS), and procedure count. Multiple linear regression models for each outcome were created using all the predictors. RESULTS: The final sample included 1,779 patients. On average, admissions lasted 2.77 days, patients had a single (1.03) procedure performed, and hospitals billed for $12,729.37. During hospitalization, 41.4% of patients received definitive treatment (incision and drainage or dental extraction), with very few patients requiring some form of mechanical ventilation (2.4%) or a tracheostomy (0.9%). After we controlled for other predictors, dental stage (primary, mixed, or permanent) did not significantly influence the study outcomes. The presence of a medical comorbidity increased the LOS (+0.54 days) and hospital charges (+$3,338.81) but did not carry a need for additional procedures. Definitive treatment contributed to the cost of care (+$5,582.96) but did not meaningfully prolong hospitalization (+0.41 days) when considering the procedure and anesthesia time. Although uncommon, tracheostomy and ventilation independently had the largest impact on all study outcomes. CONCLUSIONS: On the basis of national estimates, the majority of pediatric odontogenic infections appear to follow an uncomplicated hospital course. Definitive treatment increased the cost of care but did not meaningfully prolong the LOS. This finding suggests that additional management is not usually required once source control is achieved. Future economic studies should evaluate whether definitive treatment may be safely provided on an outpatient basis or under observation status for select patients.

The Healthcare Cost of Mandibular Nonunions.

The aim of this retrospective cohort study was to compare the costs and characteristics between isolated mandible fractures and mandibular nonunions. From October 2015 to December 2016, the National Inpatient Sample (NIS) was searched for patients admitted with a primary diagnosis of a mandible fracture. The sample was divided between those admitted for an initial evaluation of an isolated fracture and a fracture nonunion. Demographic descriptors, injury characteristics, and inpatient factors were recorded. A total of 1432 patients were included in the final sample, of whom 51 (3.6%) were admitted for a nonunion. Nonunion patients were significantly older (P < 0.01), and nonunions were more often localized to the body (24 vs 11%; P = 0.02). Compared to that of isolated fractures, a greater proportion of nonunions required open reduction and internal fixation (86 vs 59%; P < 0.01) and bone grafting (37 vs 1.4%; P < 0.01), and nonunions imparted +32.6% greater hospitals costs (median: $10,680 vs 14,162; P < 0.01). In conclusion, compared to isolated mandible fractures, mandibular nonunions occurred in older patients, had a higher frequency in body of the mandible, and utilized significantly more hospital resources per admission.

Industry Payments in Oral and Maxillofacial Surgery: A Review of 112,448 Payments From a National Disclosure Program.

PURPOSE: The purpose of this study was to characterize the sources, amounts, and nature of general industry payments to oral and maxillofacial surgeons (OMSs). MATERIALS AND METHODS: The Open Payments database was searched from August 2013 to December 2017 for all general payments made to OMSs. For each payment, data were recorded regarding the date, value, paying organization, and nature of the payment. Analyses of variance were performed to compare payment amount per surgeon, number of payments per surgeon, and amount per payment across payment years. RESULTS: Overall, there were 112,448 payments totaling $28,644,063.20. Although, on average each year, 69% of OMSs received at least 1 payment, the top 10% of earners accounted for 89% ($25,607,781) of all payments. Each OMS received a median total of $93.75 (interquartile range, $33 to $263) and an average of $1,109.68 (SD, $14,297; range, $2-$2,250,345) per year. The mean payment value was $254.73 (SD, $2,727; range, $0.01-$548,126) compared with a median of $28.90 (interquartile range, $15-$82). Most payments were in the form of food and beverage (72%); however, the most dollars were spent on consulting fees ($5,594,087; 20%). From 2014 to 2016, significant decreases occurred in the payment amounts (P < .01) and number of payments (P < .01) per surgeon, as well as the value of each payment (P < .01). CONCLUSIONS: Although OMSs receive a substantial amount of industry payments, the overall figure is driven by a small percentage of top earners. Most individual payments were of nominal value, and their effect on clinical practice remains to be seen.

Prosthetically Driven Therapy for a Patient With Systemic Lupus Erythematosus and Common Variable Immunodeficiency: A Case Report.

Patients who have systemic diseases in conjunction with severely resorbed maxillary and mandibular bone present challenges for dental implant therapy and rehabilitation. This case report describes the interdisciplinary comprehensive treatment completed on a patient with systemic lupus erythematosus (SLE) and common variable immunodeficiency (CVID). Patients with these systemic conditions present a multifactorial challenge for dental treatment due to advanced carious lesions, missing teeth, lack of adequate bone quality and quantity, as well as secondary effects of their medications. The sequence of treatment presented allowed for the necessary case control to ensure successful, predictable reconstruction of the edentulous patient with limited bone available for implant placement. For this patient, we used a combination of autogenous iliac bone graft, bilateral maxillary sinus lifts with BMP-2, transitional implants, and dental endosseous root form implants. Digital dentistry aided in designing the final implant supported fixed restorations. Transitional implants eliminated the need for tissue-borne prostheses, avoiding pressure to the graft and implants. Digital dentistry allowed for prosthetically driven implant placement and a functional, esthetic result. The techniques and staging presented for implant placement and rehabilitation can be used for other patients presenting with similar challenging conditions.

Oral and Maxillofacial Surgery Program Websites Under-Report Content Related to Resident Recruitment and Education.

PURPOSE: Prospective applicants use residency program websites (PWs) to evaluate programs when deciding where to apply, interview, and rank. The purpose of this study was to evaluate the content of oral and maxillofacial surgery (OMS) PWs. MATERIALS AND METHODS: This is a cross-sectional study of all OMS programs accredited by the Commission on Dental Accreditation. PWs were identified through the American Association of Oral and Maxillofacial Surgeons Program Directory (AAOMS-PD) and a secondary internet search. The predictor variables were program characteristics (federal service, medical school curriculum, program size, and viability of AAOMS-PD link). The outcome variables were 22 content items related to resident recruitment and resident education and 4 content items related to medical school commitment. Content was recorded as present or absent without judgment on the quality or accuracy. Descriptive statistics were calculated for all outcome variables, and Student t tests were used to compare program characteristics with the amount of content reported. RESULTS: Ninety-six of 101 programs had dedicated PWs. On average, programs included 39% (range, 0 to 77%) of the recruitment and education items assessed. Most programs did not address crucial aspects of training, such as faculty research interests (22%), resident selection criteria (22%), alumni rosters (19%), surgical case load (13%), and dedicated scholarly time (8.8%). Less than half the 6-year programs discussed a tuition responsibility (44%) or tuition assistance (21%). Four-year programs provided significantly less recruitment content (P < .01) and 4-year (P < .01) and federal (P < .01) programs reported significantly less resident education content. CONCLUSIONS: As a whole, OMS PWs are under-reporting content related to resident recruitment and resident education. Program directors should update their PWs to provide adequate information for prospective applicants.

Exploiting endogenous fibrocartilage stem cells to regenerate cartilage and repair joint injury.

Tissue regeneration using stem cell-based transplantation faces many hurdles. Alternatively, therapeutically exploiting endogenous stem cells to regenerate injured or diseased tissue may circumvent these challenges. Here we show resident fibrocartilage stem cells (FCSCs) can be used to regenerate and repair cartilage. We identify FCSCs residing within the superficial zone niche in the temporomandibular joint (TMJ) condyle. A single FCSC spontaneously generates a cartilage anlage, remodels into bone and organizes a haematopoietic microenvironment. Wnt signals deplete the reservoir of FCSCs and cause cartilage degeneration. We also show that intra-articular treatment with the Wnt inhibitor sclerostin sustains the FCSC pool and regenerates cartilage in a TMJ injury model. We demonstrate the promise of exploiting resident FCSCs as a regenerative therapeutic strategy to substitute cell transplantation that could be beneficial for patients suffering from fibrocartilage injury and disease. These data prompt the examination of utilizing this strategy for other musculoskeletal tissues.

Micro-precise spatiotemporal delivery system embedded in 3D printing for complex tissue regeneration.

Three dimensional (3D) printing has emerged as an efficient tool for tissue engineering and regenerative medicine, given its advantages for constructing custom-designed scaffolds with tunable microstructure/physical properties. Here we developed a micro-precise spatiotemporal delivery system embedded in 3D printed scaffolds. PLGA microspheres (µS) were encapsulated with growth factors (GFs) and then embedded inside PCL microfibers that constitute custom-designed 3D scaffolds. Given the substantial difference in the melting points between PLGA and PCL and their low heat conductivity, µS were able to maintain its original structure while protecting GF's bioactivities. Micro-precise spatial control of multiple GFs was achieved by interchanging dispensing cartridges during a single printing process. Spatially controlled delivery of GFs, with a prolonged release, guided formation of multi-tissue interfaces from bone marrow derived mesenchymal stem/progenitor cells (MSCs). To investigate efficacy of the micro-precise delivery system embedded in 3D printed scaffold, temporomandibular joint (TMJ) disc scaffolds were fabricated with micro-precise spatiotemporal delivery of CTGF and TGFß3, mimicking native-like multiphase fibrocartilage. In vitro, TMJ disc scaffolds spatially embedded with CTGF/TGFß3-µS resulted in formation of multiphase fibrocartilaginous tissues from MSCs. In vivo, TMJ disc perforation was performed in rabbits, followed by implantation of CTGF/TGFß3-µS-embedded scaffolds. After 4 wks, CTGF/TGFß3-µS embedded scaffolds significantly improved healing of the perforated TMJ disc as compared to the degenerated TMJ disc in the control group with scaffold embedded with empty µS. In addition, CTGF/TGFß3-µS embedded scaffolds significantly prevented arthritic changes on TMJ condyles. In conclusion, our micro-precise spatiotemporal delivery system embedded in 3D printing may serve as an efficient tool to regenerate complex and inhomogeneous tissues.

Distinctive Capillary Action by Micro-channels in Bone-like Templates can Enhance Recruitment of Cells for Restoration of Large Bony Defect.

Without an active, thriving cell population that is well-distributed and stably anchored to the inserted template, exceptional bone regeneration does not occur. With conventional templates, the absence of internal micro-channels results in the lack of cell infiltration, distribution, and inhabitance deep inside the templates. Hence, a highly porous and uniformly interconnected trabecular-bone-like template with micro-channels (biogenic microenvironment template; BMT) has been developed to address these obstacles. The novel BMT was created by innovative concepts (capillary action) and fabricated with a sponge-template coating technique. The BMT consists of several structural components: inter-connected primary-pores (300-400 µm) that mimic pores in trabecular bone, micro-channels (25-70 µm) within each trabecula, and nanopores (100-400 nm) on the surface to allow cells to anchor. Moreover, the BMT has been documented by mechanical test study to have similar mechanical strength properties to those of human trabecular bone (~3.8 MPa)12. The BMT exhibited high absorption, retention, and habitation of cells throughout the bridge-shaped (Π) templates (3 cm height and 4 cm length). The cells that were initially seeded into one end of the templates immediately mobilized to the other end (10 cm distance) by capillary action of the BMT on the cell media. After 4 hr, the cells homogenously occupied the entire BMT and exhibited normal cellular behavior. The capillary action accounted for the infiltration of the cells suspended in the media and the distribution (active migration) throughout the BMT. Having observed these capabilities of the BMT, we project that BMTs will absorb bone marrow cells, growth factors, and nutrients from the periphery under physiological conditions. The BMT may resolve current limitations via rapid infiltration, homogenous distribution and inhabitance of cells in large, volumetric templates to repair massive skeletal defects.