In an increasingly aging population, where aesthetics plays an important role in society, the loss of bone and teeth due to disease or trauma places a large burden on healthcare systems worldwide.Following surgical intervention the use of bone grafts/substitute materials or distraction osteogenesis (DO) for the expansion of the jaws are current approaches to facilitate bone regeneration.Bone formation is a complex and dynamic process involving the interactions between cells and the surrounding milieu.Repair occurs before regeneration but healing occurs first without restoration of function.Reconstructive surgery for bony defects in the oral and maxillofacial region is a challenge.The gold standard for reconstructive surgery remains autogenous bone grafting that is osteoconductive and osteoinductive, and from an immunological point of view safe.Donor sites are available either intra-or extra orally.The bone is both of cortical and cancellous/trabecular nature.Edentulous severely resorbed maxillas are a major problem for patients when dental implants are necessary.The standard procedure installs the implants vertically in the alveolar crest.If the bone volume is not enough bone grafting is an alternative but if the patient is not healthy or a smoker it tilting implants can be an alternative.Recently, we presented a 10-year follow-up study on patients treated with this technique.The success rate was 97 % (Rosén et al 2007).When it is not possible to harvest bone due to the patients medical history or limited resources, DO can be used.The technique has been used for either restoring atrophic jaws in the vertical dimension or for expanding congenital defected jaws in the orofacial region.The device can be intra-or extraorally fixated with titanium screws in the bone.The major advantages are that a bone grafts are not necessary by allowing the soft tissue to expand in the oral region.The technique consists of five phases, the osteotomy, the latency, active distractor, consolidation and remodeling.The osteotomy triggers a biological process of bone repair.A blood clot appears and will be replaced by granulation tissue which consists of inflammation cells.Fibroblasts,collagen and invading capillaries fill the distracted bone space and stimulate the osteocytes.Recently, two patient cases in our clinic with open bite with normal occlusion in the premolar and molar region were treated successfully with the DO technique.A third case with a lost alveolar ridge following trauma, resulted in a postoperative infection that disturbed the bone distraction phase so only the lingual alveolar ridge remained after six months.A bone building therapy with synthetic bone matrix was used in a second surgery step to get enough bone for later dental implant treatment.(Rosén et al in manuscript).Osteogenesis imperfecta (OI) is an inherited genetic disorder.The connective tissues are affected throughout the whole body, including the dentin of the teeth.Orthognathic surgery in patients with OI is rare but necessary to correct the malocclusion for functional and esthetic reasons.Two patients in our clinic probably with severe types Ⅲ and Ⅳ OI, and malocclusion class Ⅲ with retrognathic maxilla and prognathic mandible, were treated successfully with orthodontic treatment and bimaxillary surgical correction (Rosén et al2011).This speech brings together clinical concepts and novel findings to the field of bone regeneration and highlights some considerations necessary when devising new strategies to treat orofacial hard tissue defects.It is apparent that individuals respond differentially to stimulus;therefore future tissue engineering approaches with biomaterials, cells or growth factors will need to be tailored to the patient.