Abstract
Reconstruction of maxillomandibular defects is met with unique challenges due to the polymicrobial environment of the oral cavity and poor native tissue regenerative potential. The lack of dynamic stimulation and functional use and the resorption rate of these defects without immediate tissue preservation or augmentation can accelerate as early as the first year after surgery. Autogenous bone graft is the material of choice in maxillofacial reconstruction, although it is extremely vulnerable to intraoral bacterial contamination. Furthermore, a donor harvest site for autogenous graft increases complication rate and hospitalization cost and often requires staged surgical approach. Due to the combination of infection risks to the recipient bed and the limited availability of autogenous donor sites and morbidity associated with the harvesting, traditional autogenous grafting is limited to staging the surgery into two parts. The first stage is the creation of the surgical defect with adequate healing time, followed by the second stage which applies the use of a transcervical approach to bone graft to allow for an isolated recipient bed from the oral cavity. The advancement of tissue engineering has allowed surgeons to offer patients alternative reconstructive options, with excellent, evidence-based outcomes compared to the gold standard set by autogenous bone grafting. In this chapter, we will explore how tissue engineering using bone marrow aspirate concentrate (BMAC), recombinant human morphogenic protein (rhBMP-2), and allogenic bone graft fulfills the three basic principles of osteoregeneration and its application in immediate, one-staged surgery with a transoral approach.
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References
Vacanti CA. The history of tissue engineering. J Cell Mol Med. 2006;10(3):569–76.
Langer R, Vacanti J. Tissue engineering. Science. 1993;260:920.
Lindeboom JA, van den Akker HP. A prospective placebo-controlled double-blind trial of antibiotic prophylaxis in intraoral bone grafting procedures: a pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96(6):669–72.
Melville JC, Tursun R, Green JM, Marx RE. Reconstruction of a post-traumatic maxillary ridge using a radial forearm free flap and immediate tissue engineering (bone morphogenetic protein, bone marrow aspirate concentrate, and cortical-cancellous bone): case report. J Oral Maxillofac Surg. 2017;75(2):438.e1–6.
Smith B, Goldstein T, Ekstein C. Biologic adjuvants and bone: current use in orthopedic surgery. Curr Rev Muscoskelet Med. 2015;8(2):193–9.
Pittenger MF, et al. Multilineage potential of adult human mesenchymal stem cells. Science. 1999;284(5411):143–7.
Marx R. Atlas of oral and extraoral bone harvesting. Hanover Park: Quintessence Pub Co; 2010.
Payne KA, Didiano DM, Chu CR. Donor sex and age influence the chondrogenic potential of human femoral bone marrow stem cells. Osteoarthr Cartil. 2010;18(5):705–13.
McKay WF, Peckham SM, Badura JM. A comprehensive clinical review of recombinant human bone morphogenetic protein-2 (INFUSE® Bone Graft). Int Orthop. 2007;31(6):729–34.
Boyne PJ, Lilly LC, Marx RE, Moy PK, Nevins M, Spagnoli DB, Triplett RG. De novo bone induction by recombinant human bone morphogenetic protein-2 (rhBMP-2) in maxillary sinus floor augmentation. J Oral Maxillofac Surg. 2005;63:1693–707.
Fiorellini JP, Howell TH, Cochran D, Malmquist J, Lilly LC, Spagnoli D, Toljanic J, Jones A, Nevins M. Randomized study evaluating recombinant human bone morphogenetic protein-2 for extraction socket augmentation. J Periodontol. 2005;76(4):605–13.
Medtronic package insert no. M704819B001. INFUSE® Bone Graft for Certain Oral Maxillofacial and Dental Regenerative Uses. 2007.
Khan SN, Cammisa FP Jr, Sandhu HS, et al. The biology of bone grafting. J Am Acad Orthop Surg. 2005;13(1):77–86.
Kao ST, Scott DD. A review of bone substitutes. Oral Maxillofac Surg Clin North Am. 2007;19(4):513–21.
Rakhmatia YD, Ayukawa Y, Furuhashi A, Koyano K. Current barrier membranes: titanium mesh and other membranes for guided bone regeneration in dental applications. J Prosthodont Res. 2013;57(1):3–14.
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Melville, J.C., Tran, H.Q., Alsuwied, D., Chandra, S.R., Shum, J.W. (2019). Tissue Engineering for Transoral Reconstruction of Large Mandibular Continuity Defects. In: Melville, J., Shum, J., Young, S., Wong, M. (eds) Regenerative Strategies for Maxillary and Mandibular Reconstruction. Springer, Cham. https://doi.org/10.1007/978-3-319-93668-0_11
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DOI: https://doi.org/10.1007/978-3-319-93668-0_11
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