In-Silico Models as a Tool for the Design of Specific Treatments: Applications in Bone Regeneration - Technologies for Medical Sciences - page 13

Fig. 6 Tissue distribution in within the distracted gap at days 1, 10 and 20 of the distraction
procedure (Adapted from [ 60 ])

5 Discussion and Conclusions

In this review the computational results of three examples of application that involve
intense bone regeneration have been presented: fracture healing, long bone distrac-
tion osteogenesis and mandibular distraction osteogenesis. The former provides
a biomechanical approach based on the mechanoregulation theory proposed by
Prendergast et al. [ 54 ] to design an external fixator able to stimulate mechanically
the fracture at LMHF. The tissue differentiation theory of Prendergast et al. [ 54 ]
is the only that considers the fluid flow and thus the effect of the frequency of
stimulation on the tissue outcome. In contrast, the two remaining examples study
from a mechanobiological perspective the process of distraction osteogenesis based
on the model of fracture healing proposed by Gomez-Benito et al. [ 28 ]. This
model was extended to simulate the process of distraction osteogenesis including the
maturation cell level, thus considering cell plasticity [ 56 , 62 ]. As far as the authors
know, the extended tissue differentiation theory of Gomez-Benito et al. [ 28 ]isthe
only that includes the maturation state. In fact, when simulating highly stimulated
mechanical environments in distraction osteogenesis (high distraction rates) existing
models [ 16 , 28 , 54 ] are not able to predict the nonunion observed experimentally.