bioreactor cultivation of anatomically shaped human bone grafts in this chapter we describe a method for engineering bone grafts in vitro with the specific geometry of the temporomandibular joint tmj condyle the anatomical geometry of the bone grafts was segmented from computed tomography ct scans converted to gcode and used to machine decellularized trabecular bone scaffolds into the identical shape of the condyle these scaffolds were seeded with human bone marrowderived mesenchymal stem cells mscs using spinner flasks and cultivated for up to 5 weeks in vitro using a customdesigned perfusion bioreactor system the flow patterns through the complex geometry were modeled using the floworks module of solidworks to optimize bioreactor design the perfused scaffolds exhibited significantly higher cellular content better matrix production and increased bone mineral deposition relative to nonperfused static controls after 5 weeks of in vitro cultivation this technology is broadly applicable for creating patientspecific bone grafts of varying shapes and sizes