title: Treatment of osteoradionecrosis of mandible with bone marrow concentrate and with dental pulp stem cells.
abstract: Osteoradionecrosis (ORN) is a noninfectious, necrotic condition of the bone occurring as a complication of radiotherapy. Most cases occur following trauma or surgical manipulation of the irradiated site. Mandible is the most common bone to be affected following head and neck irradiation. The aim was to develop a successful therapeutic approach for ORN. A spectrum of treatment modalities is practiced for ORN with variable success rate that includes simple irrigation of the affected bone to the partial or complete resection of the jaw bone. In this paper, we present two cases which had successful therapeutic approach for ORN of mandible with autologous bone marrow concentrate stem cells and allogeneic dental pulp stem cells (DPSC) with platelet rich plasma (PRP) following failure of conventional methods. Autologous bone marrow aspirate concentrate (BMAC) was injected around the socket and into the periosteum for one case, and DPSC were mixed with tricalcium phosphate and inserted at the site of the defect in one case. The patient treated with BMAC remained asymptomatic and complete bone remodeling was noticed after 1 year. The extraoral sinus was excised, and healing was uneventful without recurrence in the patient treated with allogeneic DPSC and PRP. Periodic panoramic radiographs revealed an appreciable bone formation from the 2(nd) month onward. We have successfully treated two cases of ORN with BMAC and DPSC, respectively.
authors.affiliation: Department of Oral and Maxillofacial Surgery, K.S.R. Institute of Dental Science and Research, Tiruchengode, India.
authors.forename: K
authors.initials: K
authors.lastname: Manimaran
authors.affiliation: Director, Mothercell Regenerative Centre, Trichy, Tamil Nadu, India.
authors.forename: S
authors.initials: S
authors.lastname: Sankaranarayanan
authors.affiliation: Department of Orthopedics, Maruti Hospital, Tennur, Trichy, Tamil Nadu, India.
authors.forename: V R
authors.initials: VR
authors.lastname: Ravi
authors.affiliation: Department of Oral Oral Medicine and Radiology, K.S.R. Institute of Dental Science and Research, Tiruchengode, India.
authors.forename: S
authors.initials: S
authors.lastname: Elangovan
authors.affiliation: Department of Oral and Maxillofacial Surgery, K.S.R. Institute of Dental Science and Research, Tiruchengode, India.
authors.forename: M
authors.initials: M
authors.lastname: Chandramohan
authors.affiliation: Department of Oral and Maxillofacial Surgery, K.S.R. Institute of Dental Science and Research, Tiruchengode, India.
authors.forename: S Mahendra
authors.initials: SM
authors.lastname: Perumal
keywords: Bone marrow aspiration concentrate; dental pulp stem cells; mandible; osteoradionecrosis