Clinical application of a custom-made bioresorbable raw particulate hydroxyapatite/poly-L-lactide mesh tray for mandibular reconstruction.
Mandibular reconstruction using particulate cancellous bone and marrow (PCBM) allows functional oral reconstruction. Although ready-made titanium trays are the most common material used in this method, they have some disadvantages such as difficulty in making them form a suitable contour for the defect, and the need for removal. A forged composite of raw particulate hydroxyapatite (HA)/poly-L-lactide (PLLA) is a bioresorbable material that is stronger than pure PLLA and induces bone formation more rapidly. We present two cases successfully treated with custom-made bioresorbable HA/PLLA mesh trays for mandibular reconstruction. A 29-year-old woman with recurrent ameloblastoma and a 66-year-old man with a recurrent keratinized odontogenic tumor of the mandible gave informed consent for this reconstruction technique. Mesh sheets of HA/PLLA were customized by a rapid prototyping method based on computed tomography (CT) data. Marginal resection of the tumor was carried out, and PCBM was harvested from the bilateral posterior iliac crests. PCBM and platelet-rich plasma were transferred to the tray, and the tray was fixed rigidly with HA/PLLA screws. In the second case, dental implants were inserted. There has been no bone resorption for over 2 years since reconstruction in these two cases, and the inserted dental implants have been free from any complications 1 year after loading. The average CT value in Hounsfield units (HU) of the implant sites of two cases was 790. In conclusion, the customized HA/PLLA tray was easily adapted to the mandible, and fine bone quality was obtained. These cases show that this tray system contributed to functional oral rehabilitation with dental implants.
Department of Oral and Maxillofacial Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan. matsuoam@tokyo-med.ac.jp
Akira
A
Matsuo
Hiroshige
H
Chiba
Hidetoshi
H
Takahashi
Jun
J
Toyoda
Harutsugi
H
Abukawa
D020341:Absorbable Implants; D000328:Adult; D000368:Aged; D000564:Ameloblastoma / Q000601:surgery; D001672:Biocompatible Materials / Q000627:therapeutic use; D018786:Bone Substitutes / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006882:Hydroxyapatites / Q000627:therapeutic use; D008297:Male; D008339:Mandibular Neoplasms / Q000601:surgery*; D008341:Mandibular Prosthesis; D019930:Mandibular Prosthesis Implantation; D009808:Odontogenic Tumors / Q000601:surgery; D056948:Orthognathic Surgical Procedures / Q000379:methods*; D016348:Osseointegration / Q000502:physiology*; D011091:Polyesters / Q000627:therapeutic use; D011474:Prosthesis Design; D019651:Plastic Surgery Procedures / Q000379:methods*; D013526:Surgical Mesh; D054457:Tissue Scaffolds; D016896:Treatment Outcome
D001672:Biocompatible Materials; D018786:Bone Substitutes; D006882:Hydroxyapatites; D011091:Polyesters; C033616:poly(lactide)