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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

Intraoperative photograph of case 3 with reconstruction plate applied and resected fragment being lifted from the wound without the need to remove the reconstruction plate which was situated at the lower border of mandible. The reconstruction plate maintains correct orientations of the mesial and distal resection stumps
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Figure 13: Intraoperative photograph of case 3 with reconstruction plate applied and resected fragment being lifted from the wound without the need to remove the reconstruction plate which was situated at the lower border of mandible. The reconstruction plate maintains correct orientations of the mesial and distal resection stumps

Mentions: The entire tumor with a margin of healthy tissue was excised as planned in each case [Figure 13]. The healthy ends of the resected mandibles were maintained in their correct orientations with the attached hardware. The defects resulting from ameloblastoma resection were immediately reconstructed using a preformed custom-made titanium mesh fixated onto the ends of the mandibular defects using 1.5 mm titanium screws. The space beneath the mesh was filled with rhBMP-2 and ASCs seeded β-TCP granules [Figures 14–16]. To avoid exposure of the titanium mesh to the oral cavity, the final height of the titanium mesh was kept lower than that of the resected mandibular bone. Routine layered wound closure was performed.


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)

Intraoperative photograph of case 3 with reconstruction plate applied and resected fragment being lifted from the wound without the need to remove the reconstruction plate which was situated at the lower border of mandible. The reconstruction plate maintains correct orientations of the mesial and distal resection stumps
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 13: Intraoperative photograph of case 3 with reconstruction plate applied and resected fragment being lifted from the wound without the need to remove the reconstruction plate which was situated at the lower border of mandible. The reconstruction plate maintains correct orientations of the mesial and distal resection stumps
Mentions: The entire tumor with a margin of healthy tissue was excised as planned in each case [Figure 13]. The healthy ends of the resected mandibles were maintained in their correct orientations with the attached hardware. The defects resulting from ameloblastoma resection were immediately reconstructed using a preformed custom-made titanium mesh fixated onto the ends of the mandibular defects using 1.5 mm titanium screws. The space beneath the mesh was filled with rhBMP-2 and ASCs seeded β-TCP granules [Figures 14–16]. To avoid exposure of the titanium mesh to the oral cavity, the final height of the titanium mesh was kept lower than that of the resected mandibular bone. Routine layered wound closure was performed.

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