Lyophilized platelet rich fibrin and gelatin incorporated bioadhesive bone cement composite for repair of mandibular continuity defects

Mandibular continuity defects stem from conditions such as malignancies, trauma, cysts, osteomyelitis and osteoradionecrosis, presenting significant challenges. If mandibular reconstruction fails, it can result in facial collapse, causing significant aesthetic and functional concerns for the patient. In the present study we developed a bio-adhesive Bone Cement (BC) enriched with lyophilised PRF and gelatin to enhance bone repair and induce regeneration. The developed BC consisted of a mixture of Tetracalcium Phosphate (TTCP) and O-Phospho-l-serine (OPLS) in addition to lyophilised Platelet Rich Fibrin (PRF) for sustained growth factor release and gelatin (GE) for improved cement resorption. It is primarily designed for in-situ application, conforming to the shape and size of the defect for effective bone repair and regeneration. The study evaluated four groups: (i) BC (control), (ii) BC-GE (control), (iii) BC-PRF, and (iv) BC-GE-PRF. All the four groups were characterised using FTIR, SEM and XRD. The mechanical studies of the prepared beads exhibited a significant increase in the compressive strength of the PRF loaded bone cement composites. In vitro degradation study of the beads over a 60-day period revealed a significantly higher percentage of bone cement resorption in the gelatin-incorporated groups, BC-GE (44 ± 0.5 %), and BC-GE-PRF (45 ± 2 %). The assessment of growth factor release (TGF-β and VEGF) using ELISA revealed a prolonged and sustained release of both growth factors over a 28-day period. In vitro studies were performed on human Dental Follicle Stem Cells (DFSCs) to assess cell attachment, proliferation, mineralisation and osteogenic differentiation. These studies clearly depicted that BC-PRF and BC-GE-PRF showed significantly greater proliferation of DFSCs. Furthermore, BC-PRF and BC-GE-PRF samples exhibited notably elevated expression of Runx2 and OPN (osteogenic markers), as well as a higher intensity of alizarin red stain (mineralisation). Therefore, it was concluded that PRF incorporated bioadhesive bone cement composites greatly enhance the cell attachment, proliferation, mineralisation and osteogenic differentiation of the DFSCs. Thus, the PRF and gelatin incorporated bone cement composites is expected to facilitate effective and faster bone regeneration and healing in a wide range of dental and maxillofacial defects.

Autologous double barrel vascularized fibular bone graft for reconstruction after hemi resection of mandible due to ameloblastoma: Surgical case report

INTRODUCTION

Mandibular abnormalities caused by ameloblastoma present significant surgical and reconstructive difficulties. This study investigates double barrel fibular bone graft to correct these abnormalities and improve mandibular function and appearance.

CASE PRESENTATION

A 28-year-old male presented with a mandibular lump and facial asymmetry. The radiographic and histologic examination detected was subsequently diagnosed as ameloblastoma. After undergoing a hemi mandibulectomy procedure, a free vascularized fibular bone graft was harvested from the patient's left leg and transplanted to reconstruct the mandibular angle. The evaluation of the patient's functional outcomes was assessed utilising the University of Washington Quality of Life (UW-QOL) questionnaire. The patient UW - QOL Score has increased 62.5 pre-treatment to 93.75 post-treatment.

DISCUSSION

The suggested strategy to treating aggressive ameloblastomas is radical surgery, involving the use of wide resection and following bone reconstruction. Vascularized grafts, including the double-barrel fibular bone graft, are usually preferred in relation to mandibular defect reconstruction for their ability to offer improved stability, height, and thickness, which enhances functional results. In contrast to conventional approaches, our case did not show any signs of facial deformities or bone resorption. The utilization of the vascularized fibular bone graft proved to be a valuable option for early rehabilitation in patients with mandibular continuity defects, offering promising outcomes in terms of patient well-being and quality of life. This final result provides proof supporting the potential of this technique for managing mandibular defects.

CONCLUSION

Double-barrel fibular bone grafts and dental rehabilitation can restore mandibular continuity defect from ameloblastoma.

Reconstruction plate-related complications in mandibular continuity defects

PURPOSE

The purpose of this study was to evaluate the complications associated with the use of reconstruction plates with or without non-vascularized bone graft in reconstruction of mandibular segmental defects caused by trauma and tumor resection and to analyze various factors that are associated with the development of complications.

METHODS

A retrospective observational study was conducted, and the investigated variables included the age and gender of the patients, etiology of the defect, the site of the defect, the size of the defect, whether bone graft was used or not, type of plate used, and whether the reconstruction was immediate or delayed. The outcome variables were the postoperative complications and the success rate.

RESULTS

Fifty-one patients were enrolled in this study; the etiology of mandibular defect was trauma in 39 patients (76.5%) and resection of benign or malignant tumors in 12 patients (23.5%). The complication rate was (58.8%) and the success rate was (94.1%); the only factor that significantly increased the incidence of postoperative complications was the size of the defect.

CONCLUSION

Reconstruction plates demonstrated a high success rate despite the high complication rate. Segmental defects caused by trauma were smaller than those created after tumor resection and the only factor that increased complication rate was the size of the defect; other factors did not affect the complication rate.