title: Clinical, Morphological, and Molecular Evaluations of Bone Regeneration With an Additive Manufactured Osteosynthesis Plate.
abstract: There is limited information on the biological status of bone regenerated with microvascular fibula flap combined with biomaterials. This paper describes the clinical, histological, ultrastructural, and molecular picture of bone regenerated with patient-customized plate, used for mandibular reconstruction in combination with microvascular osteomyocutaneous fibula flap. The plate was virtually planned and additively manufactured using electron beam melting. This plate was retrieved from the patient after 33 months. Microcomputed tomography, backscattered-scanning electron microscopy, histology, and quantitative-polymerase chain reaction were employed to evaluate the regenerated bone and the flap bone associated with the retrieved plate. At retrieval, the posterior two-thirds of the plate were in close adaptation with the underlying flap, whereas soft tissue was observed between the native mandible and the anterior one-third. The histological and structural analyses showed new bone regeneration, ingrowth, and osseointegration of the posterior two-thirds. The histological observations were supported by the gene expression analysis showing higher expression of bone formation and remodeling genes under the posterior two-thirds compared with the anterior one-third of the plate. The observation of osteocytes in the flap indicated its viability. The present data endorse the suitability of the customized, additively manufactured plate for the vascularized fibula mandibular reconstruction. Furthermore, the combination of the analytical techniques provides possibilities to deduce the structural and molecular characteristics of bone regenerated using this procedure.
authors: *Department of Surgical Sciences, Oral and Maxillofacial Surgery, Uppsala University, Uppsala †Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg ‡BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg §Department of Quality Technology, Mechanical Engineering and Mathematics, Mid Sweden University, Östersund ||Department of Oral and Maxillofacial Surgery, University Hospital of Lund, SUS, Lund, Sweden.
authors: Andreas
authors: A
authors: Thor
authors: Anders
authors: A
authors: Palmquist
authors: Jan-Michaél
authors: JM
authors: Hirsch
authors: Lars-Erik
authors: LE
authors: Rännar
authors: Per
authors: P
authors: Dérand
authors: Omar
authors: O
authors: Omar
mesh_terms: D001860:Bone Plates; D001861:Bone Regeneration; D016025:Bone Transplantation / Q000379:methods*; D005360:Fibula / Q000637:transplantation; D005593:Fracture Fixation, Internal / Q000379:methods*; D005598:Fractures, Spontaneous / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008337:Mandibular Fractures / Q000175:diagnosis / Q000601:surgery*; D063175:Mandibular Reconstruction / Q000379:methods*; D008875:Middle Aged; D013524:Surgical Flaps; D055114:X-Ray Microtomography