Mandibular Bone Reconstruction Research Articles

An innovative method for three-dimensional bone reconstruction of the anterior mandible with preserved dentition using an allogeneic bone block: A 6-month follow-up.

Bone defects around the teeth affect a large portion of the population. Bone regeneration in the area of existing teeth is completely different from that in an edentulous area. To date, no method has been developed for three-dimensional (3D) bone reconstruction in regions with preserved teeth. This study aimed to radiologically evaluate the results of the new method of 3D mandibular bone reconstruction in preserved dentition using a custom-made allogeneic bone block with a 6-month follow-up. Alveolar ridge dimensions were radiographically assessed before and 6 months after reconstruction using cone beam computed tomography (CBCT) scans in 32 patients (192 teeth). Reconstruction used a bone block that had been previously planned and prepared using CAD/CAM technology. The observed changes in alveolar bone dimensions were highly significant in most cases (p < 0.001). The closer to the tooth root apex, the lower the bone growth in the sagittal dimension (average of the mean values for each tooth examined in the measured heights): CEJ2: 2.9 mm, ½ CEJ2: 2.7 mm, ¼ CEJ2: 1.9 mm, and API: 1.4 mm. The maximum bone growth in the vertical dimension was observed on tooth 43 (9.9 mm), followed by 32 (9.8 mm), 33 (8.5 mm), 31 (8.4 mm), 42 (8 mm), and 41 (7 mm). The degree of decrease in vestibular dehiscence of the bone was greater the closer the tooth was to the midline (average of -3.8 mm and -3.4 mm for the central incisors; average of -2.8 mm and -2.6 mm for the lateral incisors; average of -2.6 mm and -2.5 mm for the canines). The results prove that it is possible to prevent bone dehiscence in patients undergoing orthodontic treatment, increasing the ability and effectiveness of covering recessions and improving the morphology of the lower part of the face.

Fibula free flap for mandibular reconstruction following total en bloc resection in ameloblastoma: a case report and literature review

Background: The fibular free flap is considered the gold standard in mandibular bone reconstruction. It has a high survival rate, is well-vascularized, and fits seamlessly into long-bone defects. The purpose of this article is to describe the use of vascularized fibular free flap in mandibular reconstruction after total en bloc resection in case of ameloblastoma suspected of repeated trauma to the mandible. Case Presentation: A case report of a 26-year-old patient undergoing a mandibular reconstruction using fibula osteocutenous free flap following total en bloc resection due to ameloblastoma on mandibular symphisis region was monitored using Doppler ultrasound every 15 minutes for three to five days. Within four months of treatment, the patient had improved, and the graft was found to be viable. Conclusion: The severity and size of the affected tissue, the tumour's histological arrangement, and the consequences were the influence of whether or not ameloblastoma patients should require surgery. To determine the best course of treatment for each individual case of ameloblastoma, an accurate clinical examination and image evaluation are required.

Fibula free flap for mandibular reconstruction following total en bloc resection in ameloblastoma: a case report and literature review

Background: The fibular free flap is considered the gold standard in mandibular bone reconstruction. It has a high survival rate, is well-vascularized, and fits seamlessly into long-bone defects. The purpose of this article is to describe the use of vascularized fibular free flap in mandibular reconstruction after total en bloc resection in case of ameloblastoma suspected of repeated trauma to the mandible. Method: A case report of a 26-year-old patient undergoing a mandibular reconstruction using fibula osteocutenous free flap following total en bloc resection due to ameloblastoma on mandibular symphisis region was monitored using Doppler ultrasound every 15 minutes for three to five days. Result: Within four months of treatment, the patient had improved, and the graft was found to be viable. Conclusion: The severity and size of the affected tissue, the tumour's histological arrangement, and the consequences were the influence of whether or not ameloblastoma patients should require surgery. To determine the best course of treatment for each individual case of ameloblastoma, an accurate clinical examination and image evaluation are required.

Total mandible and bilateral TMJ reconstruction combining a customized jaw implant with a free fibular flap: a case report and literature review

BackgroundThe need for whole mandibular bone reconstruction and bilateral joint replacement is fortunately rare, but it is an extremely challenging topic in maxillofacial surgery, due to its functional implications. CAD-CAM techniques development has opened new broad horizons in the surgical planning of complex maxillofacial reconstructions, in terms of accuracy, predictability, and functional cosmetic results. The review of the literature has revealed a small number of scientific reports on total mandibulectomy including the condyles, with only eleven cases from 1980. Most of the works describe reconstructions secondary to dysplastic or inflammatory diseases affecting the lower jaw. The aim of this work, reporting a rare case of massive fibrous dysplasia of the whole mandible, is to share our experience in the management of extended mandibular and bilateral joint reconstruction, using porous titanium patient-specific implants.Case presentationThe authors present a 20-year-old male patient suffering from massive bone fibrous dysplasia of the mandible. The mandibular body and both the rami and the condylar processes had been involved, causing severe functional impairment, tooth loss, and facial deformation. The young patient, after repeated ineffective conservative surgical treatments, has required a biarticular mandibular replacement. Using virtual surgical planning (VSP) software, the authors, in collaboration with medical engineers, have created a custom-made original titanium porous mandibular implant, suspended from a bilateral artificial temporomandibular joint. The mandibular titanium implant body has been specifically designed to support soft tissues and to fix, in the alveolar region, a free fibular bone graft, for delayed dental implant prosthetic rehabilitation.ConclusionThe surgical and technical details, as well as the new trends in mandibular reconstructions using porous titanium implants, are reported, and discussed, reviewing literature reports on this topic. Satisfactory functional and cosmetic restorative results have been obtained, and no major complications have occurred. The patient, currently in the 18th month clinical and radiological follow-up, has recently completed the functional restoration program by an implant-supported full-arch dental prosthesis.

Micro-porous PLGA/β-TCP/TPU scaffolds prepared by solvent-based 3D printing for bone tissue engineering purposes.

The 3D printing process of fused deposition modelling is an attractive fabrication approach to create tissue-engineered bone substitutes to regenerate large mandibular bone defects, but often lacks desired surface porosity for enhanced protein adsorption and cell adhesion. Solvent-based printing leads to the spontaneous formation of micropores on the scaffold's surface upon solvent removal, without the need for further post processing. Our aim is to create and characterize porous scaffolds using a new formulation composed of mechanically stable poly(lactic-co-glycol acid) and osteoconductive β-tricalcium phosphate with and without the addition of elastic thermoplastic polyurethane prepared by solvent-based 3D-printing technique. Large-scale regenerative scaffolds can be 3D-printed with adequate fidelity and show porosity at multiple levels analysed via micro-computer tomography, scanning electron microscopy and N2 sorption. Superior mechanical properties compared to a commercially available calcium phosphate ink are demonstrated in compression and screw pull out tests. Biological assessments including cell activity assay and live-dead staining prove the scaffold's cytocompatibility. Osteoconductive properties are demonstrated by performing an osteogenic differentiation assay with primary human bone marrow mesenchymal stromal cells. We propose a versatile fabrication process to create porous 3D-printed scaffolds with adequate mechanical stability and osteoconductivity, both important characteristics for segmental mandibular bone reconstruction.

Simplifying the Combined Use of Fibula Flap and Anterolateral Thigh Flap for Oromandibular Reconstruction.

Summary:Although the preferred technique for reconstruction of extensive composite oromandibular defects involves the use of a fibula flap for the inner mucosal lining and mandibular bone reconstruction and an anterolateral thigh flap for outer skin coverage and soft tissue replenishment, this approach is complicated and manpower-dependent. It also often involves prolonged operations requiring nighttime surgery with insufficient manpower in an era of restricted working hours for residents, which can negatively affect the surgical outcomes. Traditionally, the mucosal defect is first defined and the fibula flap is then dissected to ensure a size-matching skin flap for the inner lining. This flap is transferred first after mandibulectomy is completed, but is delayed by the fibula bone shaping process. Finalizing the flap inset is a sophisticated process involving the fibula bone, fibula skin, and anterolateral thigh skin. Thus, we developed a strategy to overcome the late start of fibula flap harvest, the delayed initiation of defect-site reconstruction, and the troublesome flap inset. Briefly, we dissected both flaps sequentially or simultaneously from contralateral limbs before the mucosal defect was defined, so that the flaps were ready in the daytime. Once the mandibulectomy was completed, we transferred the anterolateral thigh flap first while the fibula bone was shaped, and simplified the flap inset by using the anterolateral thigh skin for the inner lining and outer coverage and the fibula skin as a monitoring flap. We employed this approach in five patients and completed postmandibulectomy reconstruction in as fast as 4 hours.

Segmental Bone Reconstruction by Octacalcium Phosphate Collagen Composites with Teriparatide.

Octacalcium phosphate and collagen composite (OCPcol) demonstrated superior bone regeneration and has been commercialized recently in Japan. Teriparatide (TPTD) is a bioactive recombinant form of parathyroid hormone that is approved for osteoporosis treatment. Because mandibular bone reconstruction after segmental resection is a key clinical problem, it was examined whether single-dose local administration of OCPcol with TPTD can affect recovery after this procedure. OCPcol was prepared, and a commercially available hydroxyapatite and collagen composite (HAPcol) was used as a control. A 15 mm length segmental bone defect was made in the mandibular region of male beagle dogs. The experimental animals were divided in four groups. OCPcol treated with TPTD (OCPcol + TPTD), OCPcol, HAPcol treated with TPTD (HAPcol + TPTD), or HAPcol was implanted into the defect. The radiopaque areas of the implanted site were measured and statistically analyzed, and histological examination was performed after 6 months. The value of radiopaque area in total region of OCPcol + TPTD was highest (90.8 ± 7.3 mm2), followed in order by OCPcol (49.3 ± 21.8 mm2), HAPcol + TPTD (10.6 ± 2.3 mm2), and HAPcol (6.4 ± 2.3 mm2), and that of OCPcol + TPTD was significantly higher than that of HAPcol + TPTD or HAPcol. All segmented mandibles of OCPcol + TPTD and a part of those of OCPcol were bridged with newly formed bone, whereas no bone bridges were observed in HAPcol + TPTD or HAPcol. These results suggested that OCPcol treated with TPTD enabled bone reconstruction after segmental mandibular resection more than other three groups.Impact statementOctacalcium phosphate and collagen composite (OCPcol) is a bone regenerative material that has been recently commercialized in Japan. Teriparatide (TPTD) is a recombinant form of parathyroid hormone, and is used for the treatment of osteoporosis. It was investigated whether single-dose local administration of OCPcol with TPTD can repair a canine segmental bone defect, which was supposed to be an intractable bone defect. Compared with OCPcol, hydroxyapatite, and collagen composite (HAPcol) with TPTD, or HAPcol, because OCPcol with TPTD quickly enhanced bone regeneration and bridged the defect, it would be a candidate for the repair of intractable bone defect.

Vertical distraction osteogenesis of a reconstructed mandible with a free vascularized fibula flap: a report of two cases

BackgroundThe free vascularized fibula flap presents many advantages such as sufficient length of the bony segment, good vascularization, better quality of the bone, and a long vascular pedicle, but it is also associated with some disadvantages with regard to prosthetic rehabilitation because of its limited height. Improvement in bone height is necessary for ideal dental implant treatment of reconstructed mandibles.Case presentationFor two squamous cell carcinoma patients, mandibular bone reconstruction was performed secondarily with the peroneal flap after tumor resection. Since the bone height was insufficient at the time of implant treatment, occlusion reconstruction by dental implant was performed after vertical distraction osteogenesis.ConclusionsVertical distraction osteogenesis is a suitable treatment option for alveolar ridge deficiency resulting from fibula transplantation for mandibular reconstruction following tumor surgery.

Reconstrucción mandibular con el colgajo pediculado osteofascial parietal bicortical: nuestra experiencia en 9 casos

ObjectiveTo describe the advantages and disadvantages of segmental mandibular bone reconstruction with the bicortical parietal osteofascial pedicled flap, showing our experience in 9 cases. Material and methodsRetrospective study of 9 consecutive patients undergoing segmental mandibular bone reconstruction with a bicortical parietal osteofascial pedicled flap. Indications, technique, results and complications as well as the most relevant clinical data of patients are described. ResultsThe size of the reconstructed bone defect was from 3.5 to 11cm of long (average 7cm), and from 2 to 4cm of high (average 3cm). The size of the bone flap component corresponded approximately to the dimensions of the mandibular bone defect. In all cases the flap was viable. The incidence of complications was high, showing dehiscence at the donor site in two thirds of patients, requiring reconstruction of the defect in 4 patients (44%). The receiving area presented various complications, requiring reconstruction with local flaps in 2 cases(22%). ConclusionThe bicortical parietal osteofascial pedicled flap gives to the mandibular reconstruction a vascularized membranous bicortical bone. It also presents the advantages associated with being a close flap. This flap can be an alternative to microsurgical techniques when these are not available or they are not applicable and to the mandibular distraction osteogenesis by bone transport. Complications in the donor area of this flap, although not serious, may require revision surgery.

エナメル上皮腫に対する腫瘍切除，腸骨移植による下顎骨再建後に下顎骨後方移動術を行った1例

エナメル上皮腫に対する腫瘍切除，腸骨移植による下顎骨再建後に下顎骨後方移動術を行った1例

Fibula Free Flap for Mandibular Reconstruction using Simulation Surgery in Bisphosphonate related Osteonecrosis of the Jaw

Purpose Bisphophonate-related osteonecrosis of the jaw (BRONJ) is an emerging problem. Extensive osteonecrosis of the jaw needs free flap reconstruction. Free fibular flap is the most useful flap for maxilla-mandibular hard and soft tissue reconstruction. The advantages of fibular free flap are simultaneous soft and hard tissue reconstruction and placing implant in reconstructed mandible and maxilla. In this study, four consecutive BRONJ patients who underwent fibula free flap reconstruction using simulation surgery were reviewed. Materials and Methods Four BRONJ patients who underwent free fibula reconstruction between May 2006 and September 2014 were included in this study. Male to female ratio was 1:3 and average age was 67.3 years old (62-70). All patients need mandibular bone reconstruction. Three patients suffered from osteoporosis and one male patient had multiple myeloma. Postoperative flap survival, functional reconstruction, esthetic results, food taking were evaluated. Results Three osseous flaps and one osteocutaneous flap were used. All the fibular flaps were survived and patients were recovered without complications. Oro-cutaneous fistula was resolved after operation. All patients were satisfied with the esthetic results. Patients reported improved solid food intake after operation with partial denture. One fully edentulous patient had semi-fluid diet after operation. Conclusion Treatment of the BRONJ is difficult due to lack of standard protocol. Fibular free flap using simulation surgery is the workhorse flap for mandibular hard and soft tissue reconstruction, especially in stage III BRONJ patient. In this study, functional and esthetic results were successful in all patients. Normal diet was possible with partial dentures.

Functional outcomes with dental prosthesis following simultaneous mandibulectomy and mandibular bone reconstruction

PurposeThis study sought to ascertain masticatory outcomes in patients who underwent mandibulectomy or hemimandibulectomy together with mandibular bone reconstruction to allow for placement of a removable dental prosthesis. MethodsPerioperative changes in masticatory performance, masticatory ability for solids, and patients’ subjective satisfaction were evaluated for 101 patients who had mandibulectomy immediately followed by bone reconstruction. Differences in masticatory performance and masticatory ability for solids after surgery were determined according to occlusal support after surgery and whether the patient was wearing a removable dental prosthesis or not. Occlusal support areas were classified according to Eichner's classification. ResultsPreoperative Eichner's class A patients had no experience of wearing a dental prosthesis before surgery and after surgery did not want one. Their masticatory performance was better than that of patients who wanted a dental prosthesis after surgery. Retrospective analysis of postoperative Class B and C patients revealed that masticatory performance was lower in those who wanted a dental prosthesis than in those who did not want one. When patients wore a dental prosthesis after surgery, masticatory performance was markedly improved over not wearing it. All patients’ subjective satisfaction was significantly improved after surgery. ConclusionsIncreasing the number of occlusal support areas by wearing a removable dental prosthesis after simultaneous mandibulectomy or hemimandibulectomy and mandibular bone reconstruction may improve masticatory functions. Those professional involved in the rehabilitation for the mandibular defect should be mindful that masticatory functions after such surgeries were affected by the masticatory functions before surgery and the number of occlusal support areas after surgery.

Treatment of Odontogenic Myxoma: A Multidisciplinary Approach—6-Year Follow-Up Case

The most aggressive diseases that affect the oral environment are considered tumors of the jaw. The surgical treatment is preferably done by surgical resection of the lesion, resulting in a great loss of tissue and esthetics. Multidisciplinary planning is required for the rehabilitation of these cases. Autogenous grafting techniques or vascularized flaps allow ridge reconstruction for implant placement, restoring function, and esthetics. This paper reports a 6-year follow-up case of an odontogenic myxoma treated with wide resection and mandibular bone reconstruction for posterior rehabilitation with dental implants.

Tissue-Engineered Mandibular Bone Reconstruction for Continuity Defects: A Systematic Approach to the Literature

Despite significant surgical advances over the last decades, segmental mandibular bone repair remains a challenge. In light of this, tissue engineering might offer a next step in the evolution of mandibular reconstruction. The purpose of the present report was to (1) systematically review preclinical in vivo as well as clinical literature regarding bone tissue engineering for mandibular continuity defects, and (2) to analyze their effectiveness. An electronic search in the databases of the National Library of Medicine and ISI Web of Knowledge was carried out. Only publications in English were considered, and the search was broadened to animals and humans. Furthermore, the reference lists of related review articles and publications selected for inclusion in this review were systematically screened. Results of histology data and amount of bone bridging were chosen as primary outcome variables. However, for human reports, clinical radiographic evidence was accepted for defined primary outcome variable. The biomechanical properties, scaffold degradation, and clinical wound healing were selected as co-outcome variables. The electronic search in the databases of the National Library of Medicine and ISI Web of Knowledge resulted in the identification of 6727 and 5017 titles, respectively. Thereafter, title assessment and hand search resulted in 128 abstracts, 101 full-text articles, and 29 scientific papers reporting on animal experiments as well as 11 papers presenting human data on the subject of tissue-engineered reconstruction of mandibular continuity defects that could be included in the present review. It was concluded that (1) published preclinical in vivo as well as clinical data are limited, and (2) tissue-engineered approaches demonstrate some clinical potential as an alternative to autogenous bone grafting.

Reconstruction of large mandibular and surrounding soft-tissue defects using distraction with bone transport

Reconstruction of large bone and soft-tissue defects of the inferior third of the face is possible using various surgical techniques. Patients who require these procedures need to be in good general health, may have sequelae linked to donor sites, and require several interventions to achieve good aesthetic and functional results. The aim of this study was to report outcomes in patients with large mandibular and soft-tissue defects treated using osteogenic distraction with bone transport. Between 2001 and 2008, 14 patients had distraction with bone transport. Most patients were men (92.1%). The mean age was 43.1 years. The average mandibular bone reconstruction was 13.6cm. The mean duration of distraction was 2.3 months. No infections occurred, and in all cases reconstruction of soft tissues was obtained. Two patients had non-union and underwent reconstruction using an iliac bone graft. Patients with sufficient bone height (57.1%) had dental implants. 44 implants were inserted, two of which were lost. 36 implants were activated. Six patients had satisfactory oral rehabilitation with implant-supported prostheses. Osteogenic distraction with bone transport allows total or partial restoration of oral function, provides an acceptable appearance, and enables patients to resume a reasonable quality of life.

An Audit of Mandibular defect Reconstruction Methods in a Nigerian Tertiary Hospital

To audit methods of mandibular defect reconstruction used in our institution. A retrospective study of mandibular bone reconstruction at the University College Hospital Ibadan between January 2001 and December 2007. Relevant records were retrieved from patients' case notes and operation register. Comparative analysis of various methods of reconstruction was done by assessing treatment outcomes such as restoration of continuity and stability, graft infection, extrusion and fractures. Only 65 of the 82 patients that had mandibular continuity defect during the study period had reconstruction. Ameloblastoma accounted for 67% [n=55] of pathologies that required mandibular resection. Methods of reconstruction included non vascularised iliac bone anchored with either stainless steel wire (NVIBw) [n=38] or titanium plate (NVIBp) [n=9], titanium reconstruction plate [n=4] Steinman pin [n=12], rib graft [1] and acrylic plate temporisation [n=1]. The findings showed that titanium plate and NVIBp had the least complications in terms of infection, graft extrusion, fracture and wound dehiscence. NVIBw and Steinman pin had the highest infection rates. We recommend the use of NVIBp and titanium reconstruction plate as they have the least complication rate. We also advocate future prospective study.

Osteosynthesis and simultaneous irregular trifocal distraction osteogenesis for segmental mandibular defect after tumor ablative surgery: a case report

This paper describes a case of secondary mandibular bone reconstruction performed to place dental implants. Osteosynthesis and simultaneous irregular trifocal distraction osteogenesis were documented. The patient was a 51-year-old man with recurrent ameloblastoma of the mandible. Segmental mandibulectomy for tumor ablation and immediate mandibular reconstruction were performed. Because the volume of reconstructed bone was insufficient to place dental implants, trifocal distraction osteogenesis (vertical and horizontal distraction osteogenesis) was performed. Because the mandible had lost its continuity, osteosynthesis was performed simultaneously. Through this procedure, the bone was well augmented. Absorption of the distracted bone was not seen. Adequate-length implants were placed. Irregular trifocal distraction osteogenesis synchronized with osteosynthesis shortened the treatment period and produced stable bone augmentation for placement of dental implants. Therefore, this procedure could be indicated for complicated segmental mandibular bone defects.

Mandibular bone reconstruction using osteoinductive material produced by osteoblastic cells in vitro

Mandibular bone reconstruction using osteoinductive material produced by osteoblastic cells in vitro