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Castilla A, Filliquist B, Spriet M, Garcia TC, Arzi B, Chou PY, Kapatkin AS. Long-Term Assessment of Bone Regeneration in Nonunion Fractures Treated with Compression-Resistant Matrix and Recombinant Human Bone Morphogenetic Protein-2 in Dogs. Vet Comp Orthop Traumatol 2023; 36:29-38. [PMID: 35760364 DOI: 10.1055/s-0042-1749451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The aim of this study was to assess bone density, bone architecture and clinical function of canine nonunion distal appendicular long bone fractures with a defect treated with fixation, compression-resistant matrix and recombinant human bone morphogenetic protein-2 (rhBMP-2). STUDY DESIGN Prospective cohort study with dogs at least 1-year post treatment. Computed tomography was performed and quantitative measurements from previous fracture sites were compared with measurements from contralateral limbs. Subjective evaluation included gait assessment and palpation. RESULTS Six patients met the inclusion criteria. The rhBMP-2 treated bone exhibited higher density at the periphery and lower density in the centre, similar to the contralateral limb. All patients were weight bearing on the treated limb and all fractures were healed. CONCLUSION The rhBMP-2-treated bone underwent restoration of normal architecture and density. Acceptable limb function was present in all patients. The results of this study can serve as a basis for long-term response in treating nonunion fractures in veterinary patients.
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Affiliation(s)
- Andrea Castilla
- Veterinary Medical Teaching Hospital, Davis, University of California, California, United States
| | - Barbro Filliquist
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California, United States
| | - Mathieu Spriet
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California, United States
| | - Tanya C Garcia
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California, United States
| | - Boaz Arzi
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California, United States.,Veterinary Institute for Regenerative Cures, School of Veterinary Medicine, University of California, Davis, California, United States
| | - Po-Yen Chou
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California, United States
| | - Amy S Kapatkin
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California, United States
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Evenhuis JV, Verstraete FJM, Arzi B. Management of failed stainless steel implants in the oromaxillofacial region of dogs. Front Vet Sci 2022; 9:992730. [PMID: 36213415 PMCID: PMC9539114 DOI: 10.3389/fvets.2022.992730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Management of complications of fracture fixation in the oromaxillofacial (OMF) region may present a diagnostic and therapeutic challenge. While titanium and stainless steel implants have been utilized in successful fracture fixation in the OMF region, the use of titanium implants is preferred due to the superior intrinsic properties of titanium. Nonetheless, stainless steel materials are still used due to their availability and familiarity. In the present methods report, we describe our approach to the management of failed stainless steel plates and screws used to treat traumatic injuries in the OMF region. Furthermore, we exemplify our approach with five dogs that exhibited complications of stainless steel implants in the OMF region and their subsequent management. In those cases, all failed implants were removed. Reconstruction with a combination of recombinant human bone morphogenetic protein-2 (rhBMP-2) and titanium implants was utilized in two cases while a mandibulectomy was performed in one case. Three cases required removal of the stainless-steel implant with no additional surgical therapy. We conclude that the success of treatment of failed stainless steel implants depends on the use of advanced imaging findings, appropriate antimicrobial therapy, as well as potentially regenerative reconstructive surgery.
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Affiliation(s)
- Janny V. Evenhuis
- Dentistry and Oral Surgery Service, William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Frank J. M. Verstraete
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Boaz Arzi
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
- *Correspondence: Boaz Arzi
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3
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Tsugawa AJ, Arzi B, Vapniarsky N, Verstraete FJM. A Retrospective Study on Mandibular Reconstruction Following Excision of Canine Acanthomatous Ameloblastoma. Front Vet Sci 2022; 9:900031. [PMID: 35647098 PMCID: PMC9132539 DOI: 10.3389/fvets.2022.900031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 04/08/2022] [Indexed: 11/15/2022] Open
Abstract
The successful excision of a locally invasive tumor such as canine acanthomatous ameloblastoma (CAA) typically results in a mandibular contour-derforming, critical-size defect that alters the jaw kinematics, and may affect the patient's quality of life. In this case series, we describe our experience using the regenerative approach of a titanium locking plate and compression resistant matrix infused with rhBMP-2 for the immediate or delayed reconstruction following mandibulectomy for the excision of mandibular CAA in 11 dogs. Surgical planning included computed tomography (CT), with and without contrast, in all cases, and 3D-printed models in four cases. Tumor-free surgical margins were achieved in all dogs. Clinical and diagnostic imaging follow-up (mean, 23.1 months) were performed in-person (11 cases) and with CT/cone-beam computed tomography in most cases, with standard radiography (3 cases) and telemedicine being utilized in 5 cases. At 2 weeks postoperatively, hard tissue was palpable at the defect. Follow-up imaging at 1 month postoperatively revealed evidence of bridging new bone with a heterogeneous appearance, that remodeled over 3–6 months to bone of a similar size, shape and trabecular pattern as native bone. Histological evaluation of regenerated bone was available in two cases, and was supportive of our clinical and imaging findings of normal remodeled bone. Clinically, all dogs returned to a normal lifestyle, rapidly resumed eating and drinking, and exhibited normal occlusion. Complications included wound dehiscence in one dog and self-limiting exuberant bone formation in two dogs. Tumor regrowth, failure of the implant or fracture of the regenerated bone were not observed. We conclude that the mandibular reconstruction using a regenerative approach is safe, feasible, and results in restoration of mandibular contour in dogs following segmental and bilateral rostral mandibulectomy for benign but invasive oral tumors such as CAA.
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Affiliation(s)
- Anson J. Tsugawa
- School of Veterinary Medicine, William R. Pritchard Veterinary Medical Teaching Hospital, University of California, Davis, Davis, CA, United States
| | - Boaz Arzi
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
- School of Veterinary Medicine, Veterinary Institute for Regenerative Cures, University of California, Davis, Davis, CA, United States
- *Correspondence: Boaz Arzi
| | - Natalia Vapniarsky
- School of Veterinary Medicine, Veterinary Institute for Regenerative Cures, University of California, Davis, Davis, CA, United States
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Frank J. M. Verstraete
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
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4
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Arzi B, Nolta JA, Vapniarsky N. The oromaxillofacial region as a model for a one-health approach in regenerative medicine. Am J Vet Res 2022; 83:291-297. [PMID: 35175935 DOI: 10.2460/ajvr.21.12.0208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The concept of a one-health approach in regenerative medicine has gained tremendous momentum in the scientific and public communities in recent years. Knowledge derived from this approach informs innovative biomedical research, clinical trials, and practice. The ultimate goal is to translate regenerative strategies for curing diseases and improving the quality of life in animals and people. Building and fostering strong and enthusiastic interdisciplinary and transdisciplinary collaboration between teams with a wide range of expertise and backgrounds is the cornerstone to the success of the one-health approach and translational sciences. The veterinarian's role in conducting clinical trials in client-owned animals with naturally occurring diseases is critical and unique as it may potentially inform human clinical trials. The veterinary regenerative medicine and surgery field is on a steep trajectory of discoveries and innovations. This manuscript focuses on oromaxillofacial-region regeneration to exemplify how the concept of interdisciplinary and transdisciplinary collaboration and the one-health approach influenced the authors' work experience at the University of California-Davis.
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Affiliation(s)
- Boaz Arzi
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA.,Veterinary Institute for Regenerative Cures, School of Veterinary Medicine, University of California-Davis, Davis, CA
| | - Jan A Nolta
- Department of Cell Biology and Human Anatomy, School of Medicine, University of California-Davis, Davis, CA.,Institute for Regenerative Cures, School of Medicine, University of California-Davis, Davis, CA
| | - Natalia Vapniarsky
- Veterinary Institute for Regenerative Cures, School of Veterinary Medicine, University of California-Davis, Davis, CA.,Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California-Davis, Davis, CA
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5
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Chung CS, Lin LS, Teo YM. Case Report: Treatment of Femoral Non-union With Rib and Iliac Crest Autografts and rhBMP-2 in a Cat. Front Vet Sci 2021; 8:756167. [PMID: 34901246 PMCID: PMC8655870 DOI: 10.3389/fvets.2021.756167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/02/2021] [Indexed: 11/18/2022] Open
Abstract
A 5-year-old, intact male Bengal cat weighing 5.2 kg was referred for the fixation failure of a right femoral fracture. Multiple surgical revisions failed, and atrophic non-union was diagnosed. The cat was then admitted for a final revision surgery using locking plate fixation in conjunction with rib and iliac crest autografts and recombinant human bone morphogenetic protein 2 (rhBMP-2). The fracture site was debrided and stabilized before filling the defect with 1.8 cm of rib bone autograft. The residual space in the defect was then filled with an iliac crest autograft. Finally, a 3 ×5 cm absorbable collagen sponge soaked with 0.5 mL of 0.2 mg/mL rhBMP-2 solution was placed around the defect. No significant complications were noted postoperatively. Bone healing was noted 2 months postoperatively, and it continued for 12 months. Although mild lameness remained, the cat's ambulatory function and quality of life were good. To the authors' knowledge, this is the first case report of a clinical transplantation of a rib segment as an autograft in combination with rhBMP-2 in a cat with a large bone defect.
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Affiliation(s)
- Cheng-Shu Chung
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung, Taiwan
| | - Lee-Shuan Lin
- Laboratory of Veterinary Diagnostic Imaging, Department of Veterinary Medicine, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung, Taiwan
| | - Yi-Min Teo
- Division of Small Animal Surgery, Veterinary Medical Teaching Hospital, National Pingtung University of Science and Technology, Pingtung, Taiwan
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6
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Snyder CJ, Lothamer C. Patient Triage, First Aid Care, and Management of Oral and Maxillofacial Trauma. Vet Clin North Am Small Anim Pract 2021; 52:271-288. [PMID: 34838254 DOI: 10.1016/j.cvsm.2021.09.006] [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: 10/19/2022]
Abstract
Maxillofacial trauma is a common presentation in veterinary medical practice. Accurate assessment, diagnostics, pain management, and finally repair are tenants to treatment. In addition to typical tenants for fracture repair, the restoration of occlusion and return to function (eating, drinking, grooming) are unique to trauma management in these patients. Options for repair include conservative management (tape muzzles), noninvasive repair techniques (interdental wiring and composite splinting), and invasive repair techniques (interfragmentary wiring and plate and screw fixation).
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Affiliation(s)
- Christopher J Snyder
- University of Wisconsin-Madison, School of Veterinary Medicine, 2015 Linden Drive, Madison, WI 53706, USA.
| | - Charles Lothamer
- University of Tennesee, College of Veterinary Medicine, 2407 River Drive, Knoxville, TN 37996, USA
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7
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Dobson LK, Zeitouni S, McNeill EP, Bearden RN, Gregory CA, Saunders WB. Canine Mesenchymal Stromal Cell-Mediated Bone Regeneration is Enhanced in the Presence of Sub-Therapeutic Concentrations of BMP-2 in a Murine Calvarial Defect Model. Front Bioeng Biotechnol 2021; 9:764703. [PMID: 34796168 PMCID: PMC8592971 DOI: 10.3389/fbioe.2021.764703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/27/2021] [Indexed: 11/15/2022] Open
Abstract
Novel bone regeneration strategies often show promise in rodent models yet are unable to successfully translate to clinical therapy. Sheep, goats, and dogs are used as translational models in preparation for human clinical trials. While human MSCs (hMSCs) undergo osteogenesis in response to well-defined protocols, canine MSCs (cMSCs) are more incompletely characterized. Prior work suggests that cMSCs require additional agonists such as IGF-1, NELL-1, or BMP-2 to undergo robust osteogenic differentiation in vitro. When compared directly to hMSCs, cMSCs perform poorly in vivo. Thus, from both mechanistic and clinical perspectives, cMSC and hMSC-mediated bone regeneration may differ. The objectives of this study were twofold. The first was to determine if previous in vitro findings regarding cMSC osteogenesis were substantiated in vivo using an established murine calvarial defect model. The second was to assess in vitro ALP activity and endogenous BMP-2 gene expression in both canine and human MSCs. Calvarial defects (4 mm) were treated with cMSCs, sub-therapeutic BMP-2, or the combination of cMSCs and sub-therapeutic BMP-2. At 28 days, while there was increased healing in defects treated with cMSCs, defects treated with cMSCs and BMP-2 exhibited the greatest degree of bone healing as determined by quantitative μCT and histology. Using species-specific qPCR, cMSCs were not detected in relevant numbers 10 days after implantation, suggesting that bone healing was mediated by anabolic cMSC or ECM-driven cues and not via engraftment of cMSCs. In support of this finding, defects treated with cMSC + BMP-2 exhibited robust deposition of Collagens I, III, and VI using immunofluorescence. Importantly, cMSCs exhibited minimal ALP activity unless cultured in the presence of BMP-2 and did not express endogenous canine BMP-2 under any condition. In contrast, human MSCs exhibited robust ALP activity in all conditions and expressed human BMP-2 when cultured in control and osteoinduction media. This is the first in vivo study in support of previous in vitro findings regarding cMSC osteogenesis, namely that cMSCs require additional agonists to initiate robust osteogenesis. These findings are highly relevant to translational cell-based bone healing studies and represent an important finding for the field of canine MSC-mediated bone regeneration.
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Affiliation(s)
- Lauren K Dobson
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, United States
| | - Suzanne Zeitouni
- Department of Molecular and Cellular Medicine, Institute for Regenerative Medicine, Texas A&M Health Science Center, College Station, TX, United States
| | - Eoin P McNeill
- Department of Molecular and Cellular Medicine, Institute for Regenerative Medicine, Texas A&M Health Science Center, College Station, TX, United States
| | - Robert N Bearden
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, United States
| | - Carl A Gregory
- Department of Molecular and Cellular Medicine, Institute for Regenerative Medicine, Texas A&M Health Science Center, College Station, TX, United States
| | - W Brian Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, United States
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8
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Feigin K, Bell CM, Solano M, Boudrieau RJ. Diagnostic Imaging in Veterinary Dental Practice. J Am Vet Med Assoc 2021; 259:361-366. [PMID: 34337968 DOI: 10.2460/javma.259.4.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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9
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Franch J, Barba A, Rappe K, Maazouz Y, Ginebra MP. Use of three-dimensionally printed β-tricalcium phosphate synthetic bone graft combined with recombinant human bone morphogenic protein-2 to treat a severe radial atrophic nonunion in a Yorkshire terrier. Vet Surg 2020; 49:1626-1631. [PMID: 32640113 DOI: 10.1111/vsu.13476] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 04/10/2020] [Accepted: 05/14/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To describe a novel surgical approach to treat a critical-sized bone defect due to severe, radial atrophic nonunion in a miniature dog. STUDY DESIGN Case report ANIMAL: A 1-year-old Yorkshire terrier with a critical-sized left radial defect after failed internal fixation of a transverse radial fracture. METHODS Computed tomographic (CT) images of the radius were imported for three-dimensional (3D) printing of a custom-designed synthetic 3D-printed β-tricalcium phosphate (β-TCP) scaffold. The radius was exposed, and the β-TCP scaffold was press-fitted in the bone gap underneath the plate. Recombinant human bone morphogenic protein-2 (RhBMP-2) collagen sponges were squeezed to soak the scaffold with growth factor and then placed on both sides of the synthetic graft. Two additional cortical screws were also placed prior to routine closure of the surgical site. RESULTS Radiographic examination was consistent with complete healing of the radius defect 4 months after surgery. The bone plate was removed 10 months after surgery. According to CT examination 18 months after surgery, there was no evidence of the synthetic graft; instead, complete corticalization of the affected area was noted. Complete functional recovery was observed until the last clinical follow-up 36 months postoperatively. CONCLUSION Screw fixation and use of a 3D-printed ceramic scaffold augmented with rhBMP-2 resulted in excellent bone regeneration of the nonunion and full recovery of a miniature breed dog. CLINICAL SIGNIFICANCE The therapeutic approach used in this dog could be considered as an option for treatment of large-bone defects in veterinary orthopedics, especially for defects affecting the distal radius of miniature dogs.
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Affiliation(s)
- Jordi Franch
- Surgery Department, Veterinary School, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Albert Barba
- Surgery Department, Veterinary School, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain.,Biomaterials, Biomechanics, and Tissue Engineering Group, Materials Science and Metallurgical Engineering Department, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Katrin Rappe
- Surgery Department, Veterinary School, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Yassine Maazouz
- Biomaterials, Biomechanics, and Tissue Engineering Group, Materials Science and Metallurgical Engineering Department, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Maria-Pau Ginebra
- Biomaterials, Biomechanics, and Tissue Engineering Group, Materials Science and Metallurgical Engineering Department, Universitat Politècnica de Catalunya, Barcelona, Spain
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Arzi B, Verstraete FJM, Garcia TC, Lee M, Kim SE, Stover SM. Kinematic analysis of mandibular motion before and after mandibulectomy and mandibular reconstruction in dogs. Am J Vet Res 2019; 80:637-645. [PMID: 31246128 DOI: 10.2460/ajvr.80.7.637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate and quantify the kinematic behavior of canine mandibles before and after bilateral rostral or unilateral segmental mandibulectomy as well as after mandibular reconstruction with a locking reconstruction plate in ex vivo conditions. SAMPLE Head specimens from cadavers of 16 dogs (range in body weight, 30 to 35 kg). PROCEDURE Specimens were assigned to undergo unilateral segmental (n = 8) or bilateral rostral (8) mandibulectomy and then mandibular reconstruction by internal fixation with locking plates. Kinematic markers were attached to each specimen in a custom-built load frame. Markers were tracked in 3-D space during standardized loading conditions, and mandibular motions were quantified. Differences in mandibular range of motion among 3 experimental conditions (before mandibulectomy [ie, with mandibles intact], after mandibulectomy, and after reconstruction) were assessed by means of repeated-measures ANOVA. RESULTS Both unilateral segmental and bilateral rostral mandibulectomy resulted in significantly greater mandibular motion and instability, compared with results for intact mandibles. No significant differences in motion were detected between mandibles reconstructed after unilateral segmental mandibulectomy and intact mandibles. Similarly, the motion of mandibles reconstructed after rostral mandibulectomy was no different from that of intact mandibles, except in the lateral direction. CONCLUSIONS AND CLINICAL RELEVANCE Mandibular kinematics in head specimens from canine cadavers were significantly altered after unilateral segmental and bilateral rostral mandibulectomy. These alterations were corrected after mandibular reconstruction with locking reconstruction plates. Findings reinforced the clinical observations of the beneficial effect of reconstruction on mandibular function and the need for reconstructive surgery after mandibulectomy in dogs.
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11
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Snyder CJ, Bleedorn JA, Soukup JW. Successful Treatment of Mandibular Nonunion With Cortical Allograft, Cancellous Autograft, and Locking Titanium Miniplates in a Dog. J Vet Dent 2018; 33:160-169. [PMID: 28327074 DOI: 10.1177/0898756416671060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Discontinuities of the mandible can occur for a variety of reasons including primary pathology of bone, pathologic fracture secondary to periodontal disease, and segmental resection for the treatment of neoplasia. Surgical intervention is necessary in many cases to establish normal occlusion and normal mandibular function. Rigid stabilization and treatment of these defects can be challenging due to the limited availability of bone for fixation as well as limited soft tissue coverage. This case report describes successful treatment of a nonunion fracture using cortical allograft and locking titanium miniplates. Complete osseointegration and bone healing were achieved, allowing for complete return to normal occlusion and function.
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Affiliation(s)
- Christopher J Snyder
- 1 Veterinary Dentistry and Oral Surgery, Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Jason A Bleedorn
- 2 Department of Surgery, Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Jason W Soukup
- 1 Veterinary Dentistry and Oral Surgery, Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
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12
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de Freitas EP, Rahal SC, Shimano AC, da Silva JVL, Noritomi PY, El-Warrak AO, Melchert A. Bridging Plate Development for Treatment of Segmental Bone Defects of the Canine Mandible: Mechanical Tests and Finite Element Method. J Vet Dent 2016; 33:18-25. [PMID: 27487652 DOI: 10.1177/0898756416639191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
With regard to the canine mandible, a mistaken concept of application is to assume that systemic plate-bone resistance is provided by the implant so that biomechanical position could be ignored. Because the alveolar border of the mandible is a tensile zone, the plate would ideally be positioned near this area while avoiding important structures. The aim of this study was to develop 2 bridging plates for the treatment of a segmental bone defect of the canine mandible using monocortical screws to avoid damage to the tooth roots and remaining neurovascular structures. Computed tomography images of the heads of 4 dogs (rottweiler, Doberman, boxer, and miniature poodle breeds) were used as models to develop the project. The images were reconstructed in 3-dimensional (3D) format. For each dog breed, 6 mandible prototypes were produced, each with a segmental bone defect in the right mandible. The mandibular reconstruction was performed with pure titanium bridging plate and locking screws. One plate model was developed for medium- and large-breed dogs and another for small-breed dogs. Mechanical testing showed the platemandible system resists the bite forces in all dog breeds. All safety factors were greater than I in the platemandible system for medium- and large-breed dogs and greater than 10 in the plate-mandible system for small-breed dogs. Thus, bridging plates designed with differentiated geometry and monocortical locking screws showed mechanical resistance to support simulated induced bone model defects and were able to support at least 5 times the value of bite force for each evaluated dog.
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13
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Arzi B, Stover SM, Garcia TC, Leale DM, Verstraete FJM. Biomechanical evaluation of two plating configurations for critical-sized defects of the mandible in dogs. Am J Vet Res 2016; 77:445-51. [DOI: 10.2460/ajvr.77.5.445] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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14
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Arzi B, Cissell DD, Pollard RE, Verstraete FJM. Regenerative Approach to Bilateral Rostral Mandibular Reconstruction in a Case Series of Dogs. Front Vet Sci 2015; 2:4. [PMID: 26664933 PMCID: PMC4672177 DOI: 10.3389/fvets.2015.00004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 03/14/2015] [Indexed: 12/02/2022] Open
Abstract
Extensive rostral mandibulectomy in dogs typically results in instability of the mandibles that may lead to malocclusion, difficulty in prehension, mastication, and pain of the temporomandibular joint. Large rostral mandibular defects are challenging to reconstruct due to the complex geometry of this region. In order to restore mandibular continuity and stability following extensive rostral mandibulectomy, we developed a surgical technique using a combination of intraoral and extraoral approaches, a locking titanium plate, and a compression resistant matrix (CRM) infused with rhBMP-2. Furthermore, surgical planning that consisted of computed tomographic (CT) scanning and 3D model printing was utilized. We describe a regenerative surgical technique for immediate or delayed reconstruction of critical-size rostral mandibular defects in five dogs. Three dogs had healed with intact gingival covering over the mandibular defect and had immediate return to normal function and occlusion. Two dogs had the complication of focal plate exposure and dehiscence, which was corrected with mucosal flaps and suturing; these dogs have since healed with intact gingival covering over the mandibular defect. Mineralized tissue formation was palpated clinically within 2 weeks and solid bone formation within 3 months. CT findings at 6 months postoperatively demonstrated that the newly regenerated mandibular bone had increased in mineral volume with evidence of integration between the native bone, new bone, and CRM compared to the immediate postoperative CT. We conclude that rostral mandibular reconstruction using a regenerative approach provides an excellent solution for restoring mandibular continuity and preventing mandibular instability in dogs.
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Affiliation(s)
- Boaz Arzi
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis , Davis, CA , USA
| | - Derek D Cissell
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis , Davis, CA , USA ; Department of Biomedical Engineering, University of California Davis , Davis, CA , USA
| | - Rachel E Pollard
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis , Davis, CA , USA
| | - Frank J M Verstraete
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis , Davis, CA , USA
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