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GMP-level adipose stem cells combined with computer-aided manufacturing to reconstruct mandibular ameloblastoma resection defects: Experience with three cases.

Wolff J, Sándor GK, Miettinen A, Tuovinen VJ, Mannerström B, Patrikoski M, Miettinen S - Ann Maxillofac Surg (2013)

Bottom Line: ASCs were expanded ex vivo over 3 weeks and seeded onto a β-TCP scaffold with rhBMP-2.All three cases used one step in situ bone formation without the need for an ectopic bone formation step or vascularized flaps.Histological examination and in vitro analysis of cell viability and cell surface markers were performed and prosthodontic rehabilitation was completed.

View Article: PubMed Central - PubMed

Affiliation: Institute of Biomedical Technology, University of Tampere, Tampere, Finland ; Department of Eye, Ear and Oral Diseases, Tampere University Hospital, Tampere, Finland.

ABSTRACT

Background: The current management of large mandibular resection defects involves harvesting of autogenous bone grafts and repeated bending of generic reconstruction plates. However, the major disadvantage of harvesting large autogenous bone grafts is donor site morbidity and the major drawback of repeated reconstruction plate bending is plate fracture and difficulty in reproducing complex facial contours. The aim of this study was to describe reconstruction of three mandibular ameloblastoma resection defects using tissue engineered constructs of beta-tricalcium phosphate (β-TCP) granules, recombinant human bone morphogenetic protein-2 (rhBMP-2), and Good Manufacturing Practice (GMP) level autologous adipose stem cells (ASCs) with progressively increasing usage of computer-aided manufacturing (CAM) technology.

Materials and methods: Patients' three-dimensional (3D) images were used in three consecutive patients to plan and reverse-engineer patient-specific saw guides and reconstruction plates using computer-aided additive manufacturing. Adipose tissue was harvested from the anterior abdominal walls of three patients before resection. ASCs were expanded ex vivo over 3 weeks and seeded onto a β-TCP scaffold with rhBMP-2. Constructs were implanted into patient resection defects together with rapid prototyped reconstruction plates.

Results: All three cases used one step in situ bone formation without the need for an ectopic bone formation step or vascularized flaps. In two of the three patients, dental implants were placed 10 and 14 months following reconstruction, allowing harvesting of bone cores from the regenerated mandibular defects. Histological examination and in vitro analysis of cell viability and cell surface markers were performed and prosthodontic rehabilitation was completed.

Discussion: Constructs with ASCs, β-TCP scaffolds, and rhBMP-2 can be used to reconstruct a variety of large mandibular defects, together with rapid prototyped reconstruction hardware which supports placement of dental implants.

No MeSH data available.


Related in: MedlinePlus

Preoperative panoramic radiograph of case 1 with recurrent ameloblastoma at symphyseal region of anterior mandible
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Figure 1: Preoperative panoramic radiograph of case 1 with recurrent ameloblastoma at symphyseal region of anterior mandible

Mentions: A total of three patients with recurrent ameloblastomas requiring segmental mandibular resection were included in this study. There were two males and one female with an average age of 49.3 years ranging from 43 to 55 years [Table 1]. The planned mandibular segmental resection defects ranged from 6.0 to 10.0 cm in length with an average defect size of 8.2 cm [Figures 1–3]. There was no history of radiation therapy in any of the three cases. Two patients were in good health. Case 3 was congenitally blind. Case 1 had been previously presented in a single case report[36] and was now included with further follow-up as part of this series of three patients.


GMP-level adipose stem cells combined with computer-aided manufacturing to reconstruct mandibular ameloblastoma resection defects: Experience with three cases.

Wolff J, Sándor GK, Miettinen A, Tuovinen VJ, Mannerström B, Patrikoski M, Miettinen S - Ann Maxillofac Surg (2013)

Preoperative panoramic radiograph of case 1 with recurrent ameloblastoma at symphyseal region of anterior mandible
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3814659&req=5

Figure 1: Preoperative panoramic radiograph of case 1 with recurrent ameloblastoma at symphyseal region of anterior mandible
Mentions: A total of three patients with recurrent ameloblastomas requiring segmental mandibular resection were included in this study. There were two males and one female with an average age of 49.3 years ranging from 43 to 55 years [Table 1]. The planned mandibular segmental resection defects ranged from 6.0 to 10.0 cm in length with an average defect size of 8.2 cm [Figures 1–3]. There was no history of radiation therapy in any of the three cases. Two patients were in good health. Case 3 was congenitally blind. Case 1 had been previously presented in a single case report[36] and was now included with further follow-up as part of this series of three patients.

Bottom Line: ASCs were expanded ex vivo over 3 weeks and seeded onto a β-TCP scaffold with rhBMP-2.All three cases used one step in situ bone formation without the need for an ectopic bone formation step or vascularized flaps.Histological examination and in vitro analysis of cell viability and cell surface markers were performed and prosthodontic rehabilitation was completed.

View Article: PubMed Central - PubMed

Affiliation: Institute of Biomedical Technology, University of Tampere, Tampere, Finland ; Department of Eye, Ear and Oral Diseases, Tampere University Hospital, Tampere, Finland.

ABSTRACT

Background: The current management of large mandibular resection defects involves harvesting of autogenous bone grafts and repeated bending of generic reconstruction plates. However, the major disadvantage of harvesting large autogenous bone grafts is donor site morbidity and the major drawback of repeated reconstruction plate bending is plate fracture and difficulty in reproducing complex facial contours. The aim of this study was to describe reconstruction of three mandibular ameloblastoma resection defects using tissue engineered constructs of beta-tricalcium phosphate (β-TCP) granules, recombinant human bone morphogenetic protein-2 (rhBMP-2), and Good Manufacturing Practice (GMP) level autologous adipose stem cells (ASCs) with progressively increasing usage of computer-aided manufacturing (CAM) technology.

Materials and methods: Patients' three-dimensional (3D) images were used in three consecutive patients to plan and reverse-engineer patient-specific saw guides and reconstruction plates using computer-aided additive manufacturing. Adipose tissue was harvested from the anterior abdominal walls of three patients before resection. ASCs were expanded ex vivo over 3 weeks and seeded onto a β-TCP scaffold with rhBMP-2. Constructs were implanted into patient resection defects together with rapid prototyped reconstruction plates.

Results: All three cases used one step in situ bone formation without the need for an ectopic bone formation step or vascularized flaps. In two of the three patients, dental implants were placed 10 and 14 months following reconstruction, allowing harvesting of bone cores from the regenerated mandibular defects. Histological examination and in vitro analysis of cell viability and cell surface markers were performed and prosthodontic rehabilitation was completed.

Discussion: Constructs with ASCs, β-TCP scaffolds, and rhBMP-2 can be used to reconstruct a variety of large mandibular defects, together with rapid prototyped reconstruction hardware which supports placement of dental implants.

No MeSH data available.


Related in: MedlinePlus