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Odontology

, Volume 105, Issue 4, pp 484–493 | Cite as

Treatment of stage II medication-related osteonecrosis of the jaw with necrosectomy and autologous bone marrow mesenchymal stem cells

  • Pit Jacob Voss
  • Akihiko MatsumotoEmail author
  • Esteban Alvarado
  • Rainer Schmelzeisen
  • Fabian Duttenhöfer
  • Philipp Poxleitner
Original Article
  • 570 Downloads

Abstract

Treatment strategies for medication-related osteonecrosis of the jaw (MRONJ) remain controversial. Although the AAOMS suggests a conservative approach, a surgical management with necrosectomy is often required when conservative management has failed. Moreover, recent studies have shown promising results using an early stage surgical treatment. Over the past decade, cell-based bone regeneration utilizing bone marrow mesenchymal stem cells (MSCs) received increased attention. MSCs are known to promote wound healing and induce new bone formation in compromised tissue. Accordingly, the aim of this study was to assess the role of MSCs in the management of MRONJ. This study included 6 patients referred to our department with the diagnosis of MRONJ. Upon informed consent, the patients underwent surgical resection of necrotic bone followed by MSCs grafting. The MSCs were separated from bone marrow cells aspirated from the iliac crest using a bone marrow aspirate concentrate system. The MSCs were grafted into the defect with autologous thrombin and the defect was covered with a collagen membrane. In all cases, bony edges were rounded and the wound was closed using a three-layered technique. In the follow-up from 12 to 54 months, all patients including those who had impaired conditions, sepsis, or pathological fracture, showed satisfactory healing with no signs of wound infection. This pilot study indicated that surgical management in combination with MSCs transplantation seems to be a promising treatment modality in the therapy of MRONJ.

Keywords

Medication-related osteonecrosis of the jaw Bisphosphonate Mesenchymal stem cells Stem cell transplantation 

Notes

Acknowledgements

Funding

This study was supported by the Osteology Foundation Grant No. 08-026.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the local Ethics Committee of the University of Freiburg (Nr. 242/09).

Informed consent

All patients signed informed consent before involvement into the study.

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Copyright information

© The Society of The Nippon Dental University 2017

Authors and Affiliations

  • Pit Jacob Voss
    • 1
  • Akihiko Matsumoto
    • 2
    Email author
  • Esteban Alvarado
    • 3
  • Rainer Schmelzeisen
    • 1
  • Fabian Duttenhöfer
    • 1
  • Philipp Poxleitner
    • 1
  1. 1.Department of Oral and Maxillofacial SurgeryUniversity Medical Center FreiburgFreiburg im BreisgauGermany
  2. 2.Section of Oral and Maxillofacial Surgery, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental ScienceKyushu UniversityFukuokaJapan
  3. 3.Section of Orthodontics and Maxillofacial SurgeryLatinamerican University of Science and TechnologyBarrio TournónCosta Rica

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