Bone replacement in patients with segmental mandibular defects secondary to aseptic bone necrosis

Background: Head and neck tumours represent 5–10% of all malignant tumours, often diagnosed at advanced stages, with the patient submitted to gross surgery, radio and chemotherapy, resulting in bone radio necrosis in up to 90% of cases which underwent thru this adjuvant therapy. Recently bisphosphonates appears as another cause of therapy associated bone necrosis. Due to the uprising number of patients with tumours that needs radiotherapy or bisphosphonates, there is an increase in jaw necrosis. Nowadays these defects are managed with biocompatible materials such as ceramics, or bone graft from patient’s fibula. We present a clinical study design for correcting these bone defects using a titanium and albumin scaffold with bone marrow stem cells obtained from hip’s bone medulla.

Objectives: Establish a clinical design to develop a new therapeutic option for bone necrosis. Accomplish a new procedure for bone rehabilitation surgery, integrating previously known treatments for bone induction and conduction.

Methods: A literature research among current treatment modalities on bone necrosis, and a comparative on newly developed therapeutic options for osteogenesis and bone induction that are approved to be used on human for different pathologies.

Results: Currently studied scaffolds are bone inductors, including bio-ceramics, however albumin has been recently used as scaffold, with bone induction capacity and osteogenesis properties. Bone marrow stem cells, are currently approved as a regenerative option in several diseases; these cells can be differentiated to osteoblasts with the advantage of the patient being the donor himself.

Conclusions: We propose a clinical study design involving currently approved technics on humans, that are suitable to be use as bone regeneration therapies, and that had never been used together before as repair therapies for gross bone defect pathologies on jaw such as bone necrosis.

Key words : bone regeneration; radiotherapy; osteonecrosis; jaw

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Jan 21, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Bone replacement in patients with segmental mandibular defects secondary to aseptic bone necrosis
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