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Kwon O, Choi JY, Park JH, Ham DW, Park SM, Yeom JS, Kim HJ. Transpedicular injection of rhBMP-2 with β-tricalcium phosphate to reduce the proximal junctional kyphosis after adult spinal deformity correction: preliminary study. Sci Rep 2024; 14:6660. [PMID: 38509314 PMCID: PMC10954699 DOI: 10.1038/s41598-024-57371-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 03/18/2024] [Indexed: 03/22/2024] Open
Abstract
The aim of this preliminary study was to assess the impact of injecting recombinant human bone morphogenetic protein-2 (rhBMP-2) with β-tricalcium phosphate (β-TCP) carrier into the uppermost instrumented vertebra (UIV) during surgery to prevent the development of proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). The 25 patients from study group had received 0.5 mg rhBMP-2 mixed with 1.5 g β-TCP paste injection into the UIV during surgery. The control group consisted of 75 patients who underwent surgery immediately before the start of the study. The incidences of PJK and PJF were analyzed as primary outcomes. Spinopelvic parameters and patient-reported outcomes were analyzed as secondary outcomes. Hounsfield unit (HU) measurements were performed to confirm the effect of rhBMP-2 with β-TCP on bone formation at preoperative and postoperative at computed tomography. PJK and PJF was more occurred in control group than study group (p = 0.02, 0.29, respectively). The HU of the UIV significantly increased 6 months after surgery. And the increment at the UIV was also significantly greater than that at the UIV-1 6 months after surgery. Injection of rhBMP-2 with β-TCP into the UIV reduced PJK and PJF rates 6 months after surgery with new bone formation.
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Affiliation(s)
- Ohsang Kwon
- Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam, 463-707, Republic of Korea
| | - Jun-Young Choi
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyang, Gyeonggido, Republic of Korea
| | - Jin-Ho Park
- Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam, 463-707, Republic of Korea
| | - Dae-Woong Ham
- Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Sang-Min Park
- Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam, 463-707, Republic of Korea
| | - Jin S Yeom
- Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam, 463-707, Republic of Korea
| | - Ho-Joong Kim
- Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam, 463-707, Republic of Korea.
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Carmon I, Zobrab A, Alterman M, Tabib R, Cohen A, Kandel L, Greenberg A, Reich E, Casap N, Dvir-Ginzberg M. Chondrocytes supplemented to bone graft-containing scaffolds expedite cranial defect repair. Sci Rep 2023; 13:19192. [PMID: 37932515 PMCID: PMC10628268 DOI: 10.1038/s41598-023-46604-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/02/2023] [Indexed: 11/08/2023] Open
Abstract
Critical maxillofacial bone fractures do not heal spontaneously, thus, often there is a need to facilitate repair via surgical intervention. Gold standard approaches, include the use of autologous bone graft, or devices supplemented with osteogenic growth factors and bone substitutes. This research aimed to employ a critical size calvaria defect model, to determine if the addition of chondrocytes to collagen-containing bone graft substitute, may expedite bone repair. As such, using a critical size rat calvaria defect, we implanted a collagen scaffold containing bone graft substitute (i.e., Bone graft scaffold, BG) or BG supplemented with costal chondrocytes (cBG). The rats were subjected to live CT imaging at 1, 6, 9, and 12 weeks following the surgical procedure and sacrificed for microCT imaging of the defect site. Moreover, serum markers and histological evaluation were assessed to determine osseous tissue regeneration and turnover. Live CT and microCT indicated cBG implants displayed expedited bone repair vs, BG alone, already at 6 weeks post defect induction. cBG also displayed a shorter distance between the defect edges and greater mineral apposition distance compared to BG. Summerizing, the data support the addition of chondrocytes to bone substitute, accelerates the formation of new bone within a critical size defect.
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Affiliation(s)
- Idan Carmon
- Laboratory of Cartilage Biology, Institute of Bio-Medical and Oral Research, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Anna Zobrab
- Laboratory of Cartilage Biology, Institute of Bio-Medical and Oral Research, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michael Alterman
- Department of Maxillofacial Surgery, Faculty of Dental Medicine, Hadassah-Hebrew University, P. O. Box 12272, 9112102, Jerusalem, Israel
| | - Rami Tabib
- Department of Maxillofacial Surgery, Faculty of Dental Medicine, Hadassah-Hebrew University, P. O. Box 12272, 9112102, Jerusalem, Israel
| | - Adir Cohen
- Department of Maxillofacial Surgery, Faculty of Dental Medicine, Hadassah-Hebrew University, P. O. Box 12272, 9112102, Jerusalem, Israel
| | - Leonid Kandel
- Joint Replacement and Reconstruction Unit, Orthopedic Surgery Complex, Hadassah-Hebrew University Medical Center at Mount Scopus, Jerusalem, Israel
| | - Alexander Greenberg
- Joint Replacement and Reconstruction Unit, Orthopedic Surgery Complex, Hadassah-Hebrew University Medical Center at Mount Scopus, Jerusalem, Israel
| | - Eli Reich
- Laboratory of Cartilage Biology, Institute of Bio-Medical and Oral Research, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nardi Casap
- Department of Maxillofacial Surgery, Faculty of Dental Medicine, Hadassah-Hebrew University, P. O. Box 12272, 9112102, Jerusalem, Israel.
| | - Mona Dvir-Ginzberg
- Laboratory of Cartilage Biology, Institute of Bio-Medical and Oral Research, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
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Kämmerer PW, Al-Nawas B. Bone reconstruction of extensive maxillomandibular defects in adults. Periodontol 2000 2023; 93:340-357. [PMID: 37650475 DOI: 10.1111/prd.12499] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/21/2023] [Accepted: 05/26/2023] [Indexed: 09/01/2023]
Abstract
Reconstruction of significant maxillomandibular defects is a challenge that has been much discussed over the last few decades. Fundamental principles were developed decades ago (bone bed viability, graft immobilization). Clinical decision-making criteria are highly relevant, including local/systemic factors and incision designs, the choice of material, grafting technique, and donor site morbidity. Stabilizing particulated grafts for defined defects-that is, via meshes or shells-might allow significant horizontal and vertical augmentation; the alternatives are onlay and inlay techniques. More significant defects might require extra orally harvested autologous bone blocks. The anterior iliac crest is often used for nonvascularized augmentation, whereas more extensive defects often require microvascular reconstruction. In those cases, the free fibula flap has become the standard of care. The development of alternatives is still ongoing (i.e., alloplastic reconstruction, zygomatic implants, obturators, distraction osteogenesis). Especially for these complex procedures, three-dimensional planning tools enable facilitated planning and a surgical workflow.
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Affiliation(s)
- Peer W Kämmerer
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Mainz, Germany
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Mainz, Germany
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Scribante A, Ghizzoni M, Pellegrini M, Pulicari F, Manfredini M, Poli PP, Maiorana C, Spadari F. Full-Digital Customized Meshes in Guided Bone Regeneration Procedures: A Scoping Review. PROSTHESIS 2023; 5:480-495. [DOI: 10.3390/prosthesis5020033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Meshes, especially titanium ones, are being widely applied in oral surgery. In guided bone regeneration (GBR) procedures, their use is often paired with membranes, being resorbable or non-resorbable. However, they present some limitations, such as difficulty in the treatment of severe bone defects, alongside frequent mesh exposure. Customized meshes, produced by a full-digital process, have been recently introduced in GBR procedures. Therefore, the focus of the present review is to describe the main findings in recent years of clinical trials regarding patient-specific mesh produced by CAD/CAM and 3D printing workflow, made in titanium or even PEEK, applied to GBR surgeries. The purpose is to analyze their clinical management, advantages, and complications. This scoping review considered randomized clinical trials, observational studies, cohort studies, and case series/case reports studies. Studies that did not meet inclusion criteria were excluded. The preferred reporting items for scoping reviews (PRISMA-ScR) consensus was followed. A total of 15 studies were selected for this review. Based on the studies included, the literature suggests that meshes produced by a digital process are used to restore complex and severe bone defects. Moreover, they give satisfactory aesthetic results and fit the defects, counteracting grid exposure. However, more clinical trials should be conducted to evaluate long-term results, the rate of complications, and new materials for mesh manufacturing.
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Affiliation(s)
- Andrea Scribante
- Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Martina Ghizzoni
- Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Matteo Pellegrini
- Maxillofacial Surgery and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 10, 20122 Milan, Italy
| | - Federica Pulicari
- Maxillofacial Surgery and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 10, 20122 Milan, Italy
| | - Mattia Manfredini
- Maxillofacial Surgery and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 10, 20122 Milan, Italy
| | - Pier Paolo Poli
- Maxillofacial Surgery and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 10, 20122 Milan, Italy
| | - Carlo Maiorana
- Maxillofacial Surgery and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 10, 20122 Milan, Italy
| | - Francesco Spadari
- Maxillofacial Surgery and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 10, 20122 Milan, Italy
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Carmon I, Kalmus S, Zobrab A, Alterman M, Emram R, Gussarsky M, Kandel L, Reich E, Casap N, Dvir-Ginzberg M. Repairing a critical cranial defect using WISP1-pretreated chondrocyte scaffolds. J Tissue Eng 2023; 14:20417314231159740. [PMID: 36949842 PMCID: PMC10026108 DOI: 10.1177/20417314231159740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/09/2023] [Indexed: 03/19/2023] Open
Abstract
In cranial flat bone fractures, spontaneous bone repair will occur only when the fracture ends are in close contact. However, in cases wherein bone discontinuity is extensive, surgical interventions are often required. To this end, autologous bone is harvested and surgically integrated into the site of fracture. Here we propose to use cartilage, as an alternative autologous source, to promote cranial fracture repair. The advantage of this approach is the potential reduction in donor site morbidity, likely due to the avascular and aneural nature of cartilage. As a first step we attempted to induce cartilage mineralization in vitro, using micromass primary chondrocyte cultures, incubated with BMP2 and/or WISP1, which were examined histologically following a 3-week culture period. Next, chondrocyte seeded collagen scaffolds were evaluated in vitro for expression profiles and ALP activity. Finally, chondrocyte-seeded collagen scaffolds were implanted in a Lewis rats 8 mm critical calvaria defect model, which was imaged via live CT for 12 weeks until sacrifice. End points were analyzed for microCT, histology, and serum levels of bone related markers. Micromass cultures exhibited an osseous inducing trend following WISP1 administration, which was maintained in chondrocyte seeded scaffolds. Accordingly, in vivo analysis was carried out to assess the impact of WISP1-pretreated chondrocytes (WCS) versus untreated chondrocytes (UCS) in calvaria defect model and compared to untreated control comprised of a defect-associated blood clot (BC) or empty collagen scaffold (CS) implant. Live CT and microCT exhibited higher mineralization volumes in critical defect implanted with UCS, with some structural improvements in WCS. Histological analysis exhibited higher anabolic bone formation in WCS and trabecular bone was detected in WCS and UCS groups. Chondrocytes implanted into critical cranial defect expedite the formation of native-like osseous tissue, especially after WISP1 priming in culture. Ultimately, these data support the use of autologous chondrocytes to repair critical maxillofacial defects.
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Affiliation(s)
- Idan Carmon
- Laboratory of Cartilage Biology,
Institute of Bio-Medical and Oral Research, Faculty of Dental Medicine, Hebrew
University of Jerusalem, Jerusalem, Israel
| | - Shira Kalmus
- Laboratory of Cartilage Biology,
Institute of Bio-Medical and Oral Research, Faculty of Dental Medicine, Hebrew
University of Jerusalem, Jerusalem, Israel
| | - Anna Zobrab
- Laboratory of Cartilage Biology,
Institute of Bio-Medical and Oral Research, Faculty of Dental Medicine, Hebrew
University of Jerusalem, Jerusalem, Israel
| | - Michael Alterman
- Deptatement. of Maxillofacial Surgery,
Faculty of Dental Medicine, Hadassah-Hebrew University, Jerusalem, Israel
| | - Raphaelle Emram
- Laboratory of Cartilage Biology,
Institute of Bio-Medical and Oral Research, Faculty of Dental Medicine, Hebrew
University of Jerusalem, Jerusalem, Israel
| | - May Gussarsky
- Laboratory of Cartilage Biology,
Institute of Bio-Medical and Oral Research, Faculty of Dental Medicine, Hebrew
University of Jerusalem, Jerusalem, Israel
| | - Leonid Kandel
- Orthopedic Research Unit,
Hadassah-Hebrew University, Jerusalem, Israel
| | - Eli Reich
- Laboratory of Cartilage Biology,
Institute of Bio-Medical and Oral Research, Faculty of Dental Medicine, Hebrew
University of Jerusalem, Jerusalem, Israel
| | - Nardi Casap
- Deptatement. of Maxillofacial Surgery,
Faculty of Dental Medicine, Hadassah-Hebrew University, Jerusalem, Israel
| | - Mona Dvir-Ginzberg
- Laboratory of Cartilage Biology,
Institute of Bio-Medical and Oral Research, Faculty of Dental Medicine, Hebrew
University of Jerusalem, Jerusalem, Israel
- Mona Dvir-Ginzberg, Laboratory of Cartilage
Biology, Institute of Bio-Medical and Oral Research, Faculty of Dental Medicine,
Hebrew University of Jerusalem, P. O. Box 12272, Jerusalem 9112102, Israel.
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6
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Abu-Mostafa NA, Alotaibi YN, Alkahtani RN, Almutairi FK, Alfaifi AA, Alshahrani OD. The Outcomes of Vertical Alveolar Bone Augmentation by Guided Bone Regeneration with Titanium Mesh: A Systematic Review. J Contemp Dent Pract 2022; 23:1280-1288. [PMID: 37125527 DOI: 10.5005/jp-journals-10024-3444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
AIM This study aimed to systematically review the published studies on vertical alveolar bone augmentation (VABA) by guided bone regeneration (GBR) with titanium mesh (TM). BACKGROUND Guided bone regeneration is a procedure that can be used for VABA of the alveolar ridge. Titanium mesh is used as a barrier due to its ability to maintain a space that the newly formed bone will occupy. MATERIALS AND METHODS A computerized literature search was conducted on the databases PubMed, SCOPUS, Science Direct, and Cochrane Library to review the published article on VABA by TM from 2011 to 2021. REVIEW RESULTS Eight out of 574 retrieved articles were included in the qualitative analysis, three randomized clinical trials, two prospective clinical trials, and three retrospective trials. They were assessed for risk of bias using the critical appraisal skills program checklist. Titanium mesh was utilized as a barrier in three different ways, adapted directly on the alveolar bone, bent preoperatively on three-dimensional (3D) models, and 3D-printed. Two randomized clinical trials (RCTs) reported 20.8% bone gain, while the other studies reported the means ranging from 2.56 to 4.78 mm. All studies reported TM exposure that ranged from 7.69 to 66.66%. Exposure during the four postoperative weeks led to inadequate bone regeneration. However, late exposure had no effect or caused only slight bone resorption. Early TM removal was performed in two studies, one case per each, ranging from 2.4 to 11.1%. Infection was presented in three studies, one case per each, and the percentages were 5, 11.1, and 25%. CONCLUSION All types of TM had exposure, which was the most common complication, but early removal was indicated only in a few cases. Titanium mesh showed reliability and efficacy as a barrier for VABA by GBR. CLINICAL SIGNIFICANCE By this procedure, bone height can be restored, however, meticulous follow-up is recommended for the detection and management of TM exposures.
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Affiliation(s)
- Nedal A Abu-Mostafa
- Department of Oral and Maxillofacial Surgery and Diagnostic Science, Riyadh Elm University, Kingdom of Saudi Arabia, Phone: +00966506275782, e-mail:
| | | | - Rose N Alkahtani
- King Saud bin Abdulaziz University for Health Sciences, Kingdom of Saudi Arabia
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Kämmerer PW, Tunkel J, Götz W, Würdinger R, Kloss F, Pabst A. The allogeneic shell technique for alveolar ridge augmentation: a multicenter case series and experiences of more than 300 cases. Int J Implant Dent 2022; 8:48. [PMID: 36316597 PMCID: PMC9622968 DOI: 10.1186/s40729-022-00446-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 10/05/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Allogeneic cortical bone plates (CP) might be used for alveolar ridge augmentation as an alternative to autogenous grafts (AG) and bone substitutes (BS). We report about a multicenter case series and our experiences of more than 300 cases using CP and the shell technique for reconstruction of the alveolar process to illustrate surgical key steps, variations, and complication management. METHODS Different types of alveolar ridge defects were augmented using the shell technique via CP. The space between the CP and the alveolar bone was filled with either autogenous or allogeneic granules (AUG, ALG) or a mixture of both. Implants were placed after 4-6 months. Microscopic and histological assessments were performed. In addition, space filling using AUG, ALG and bovine BS was discussed. RESULTS Scanning electron microscopy demonstrated the compact cortical structure of CP and the porous structure of ALG allowing micro-vessel ingrowth and bone remodeling. Histological assessment demonstrated sufficient bone remodeling and graft resorption after 4-6 months. In total, 372 CP cases and 656 implants were included to data analysis. The mean follow-up period was about 3.5 years. Four implants failed, while all implant failures were caused by peri-implantitis. Next, 30 CP complications were seen, while in 26 CP complications implant placement was possible. CP rehydration, stable positioning by adjusting screws, smoothing of sharp edges, and a tension-free wound closure were identified as relevant success factors. Space filling using ALG and a mixture of AUG/ALG resulted in sufficient bone remodeling, graft resorption and stability of the augmented bone. CONCLUSIONS CP and the shell technique is appropriate for alveolar ridge augmentation with adequate bone remodeling and low complication rates. Allografts can prevent donor site morbidity and therefore may decrease discomfort for the patient.
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Affiliation(s)
- Peer W. Kämmerer
- grid.410607.4Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany
| | - Jochen Tunkel
- Private Practice for Oral Surgery and Periodontology, Königstraße 19, 32545 Bad Oeynhausen, Germany
| | - Werner Götz
- grid.15090.3d0000 0000 8786 803XDepartment of Orthodontics, University Hospital Bonn, Welschnonnenstr. 17, 53111 Bonn, Germany
| | - Robert Würdinger
- Private Practice for Oral Surgery and Periodontology, Frankfurter Str. 6, 35037 Marburg, Germany
| | - Frank Kloss
- Private Practice for Oral and Maxillofacial Surgery, Kärtnerstraße 62, 9900 Lienz, Austria
| | - Andreas Pabst
- Department of Oral and Maxillofacial Surgery, Federal Armed Forces Hospital, Rübenacherstraße 170, 56072 Koblenz, Germany
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Antúnez-Conde R, Salmerón JI, Díez-Montiel A, Agea M, Gascón D, Sada Á, Navarro Cuéllar I, Tousidonis M, Ochandiano S, Arenas G, Navarro Cuéllar C. Mandibular Reconstruction With Fibula Flap and Dental Implants Through Virtual Surgical Planning and Three Different Techniques: Double-Barrel Flap, Implant Dynamic Navigation and CAD/CAM Mesh With Iliac Crest Graft. Front Oncol 2021; 11:719712. [PMID: 34676161 PMCID: PMC8525397 DOI: 10.3389/fonc.2021.719712] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/16/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Vertical discrepancy between the fibula flap and the native mandible results in difficult prosthetic rehabilitation. The aim of this study was to evaluate the outcomes of 3D reconstruction of the mandible in oncologic patients using three different techniques through virtual surgical planning (VSP), cutting guides, customized titanium mesh and plates with CAD/CAM technology, STL models and intraoperative dynamic navigation for implant placement. Material and methods Material and Methods Three different techniques for mandibular reconstruction and implant rehabilitation were performed in 14 oncologic patients. Five patients (36%) underwent VSP, cutting guides, STL models and a customized double-barrel titanium plate with a double-barrel flap and immediate implants. In six patients (43%), VSP, STL models and a custom-made titanium mesh (CAD/CAM) for 3D reconstruction with iliac crest graft over a fibula flap with deferred dental implants were performed. Three patients (21%) underwent VSP with cutting guides and customized titanium plates for mandibular reconstruction and implant rehabilitation using intraoperative dynamic navigation was accomplished. Vertical bone reconstruction, peri-implant bone resorption, implant success rate, effects of radiotherapy in vertical reconstruction, bone resorption and implant failure, mastication, aesthetic result and dysphagia were evaluated. Results Significant differences in bone growth between the double-barrel technique and iliac crest graft with titanium mesh technique were found (p<0.002). Regarding bone resorption, there were no significant differences between the techniques (p=0.11). 60 implants were placed with an osseointegration rate of 91.49%. Five implants were lost during the osseointegration period (8%). Peri-implant bone resorption was measured with a mean of 1.27 mm. There was no significant difference between the vertical gain technique used and implant survival (p>0.385). Implant survival rates were higher in non-irradiated patients (p<0.017). All patients were rehabilitated with a fixed implant-supported prosthesis reporting a regular diet (80%), normal swallowing (85.7%) and excellent aesthetic results. Conclusions Multi-stage implementation of VSP, STL models and cutting guides, CAD/CAM technology, customized plates and in-house dynamic implant navigation for mandibular defects increases bone-to-bone contact, resolves vertical discrepancy and improves operative efficiency with reduced complication rates and minimal bone resorption. It provides accurate reconstruction that optimizes implant placement, thereby improving facial symmetry, aesthetics and function.
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Affiliation(s)
- Raúl Antúnez-Conde
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José Ignacio Salmerón
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Alberto Díez-Montiel
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Marc Agea
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Dafne Gascón
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ángela Sada
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ignacio Navarro Cuéllar
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Manuel Tousidonis
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Santiago Ochandiano
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Gema Arenas
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Carlos Navarro Cuéllar
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Virtual Surgical Planning, Stereolitographic Models and CAD/CAM Titanium Mesh for Three-Dimensional Reconstruction of Fibula Flap with Iliac Crest Graft and Dental Implants. J Clin Med 2021; 10:jcm10091922. [PMID: 33946731 PMCID: PMC8124267 DOI: 10.3390/jcm10091922] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/25/2021] [Accepted: 04/27/2021] [Indexed: 11/24/2022] Open
Abstract
Mandibular reconstruction with fibula flap shows a 3D discrepancy between the fibula and the remnant mandible. Eight patients underwent three-dimensional reconstruction of the fibula flap with iliac crest graft and dental implants through virtual surgical planning (VSP), stereolitographic models (STL) and CAD/CAM titanium mesh. Vertical ridge augmentation and horizontal dimensions of the fibula, peri-implant bone resorption of the iliac crest graft, implant success rate and functional and aesthetic results were evaluated. Vertical reconstruction ranged from 13.4 mm to 10.1 mm, with an average of 12.22 mm. Iliac crest graft and titanium mesh were able to preserve the width of the fibula, which ranged from 8.9 mm to 11.7 mm, with an average of 10.1 mm. A total of 38 implants were placed in the new mandible, with an average of 4.75 ± 0.4 implants per patient and an osseointegration success rate of 94.7%. Two implants were lost during the osseointegration period (5.3%). Bone resorption was measured as peri-implant bone resorption at the mesial and distal level of each implant, with a variation between 0.5 mm and 2.4 mm, and with a mean of 1.43 mm. All patients were rehabilitated with a fixed implant prosthesis with good aesthetic and functional results.
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