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The Utilization of Allogeneic Bone, Bone Morphogenetic Protein and Bone Marrow Aspirate Concentrate for Immediate Reconstruction of Benign Tumor continuity defects
Poster Session by implants. On the other hand, it had been necessary to do augmentation because she had shown remarkable over all ridge absorption. A patient of case 2, 55 year-year-old female, had had a lack of four front teeth in maxilla, and hoped for a treatment with implants, because caused by traffic injury. A patient of case3, 73 year-year-old female, had had a deficit cuspid-premolar region in mandible and hoped reconstruction by implants. The ridge augmentation was applied to using a particulate cancellous bone and marrow (PCBM) of tibia in case1 and 2, using chin block in case 3.We used bioresorbable material HA/PLLA composites mesh type as a tool for space making to keep a transplant bone. As a result, they have been well after the treatment. References: 1. Vertical alveolar ridge augmentation by distraction osteogenesis using a distraction device composed of biosorbable material HA/PLLA composits 2. A New Bone Fixation devices from hydroxylapatite/Poly (L-lactate) composites: Clinical Use for Oral and Maxillofacial Surgery
POSTER 271 Development of a training system using virtual reality for partial glossectomy F. Sawai: Faculty of Medicine, Kagawa University, T. Miki, A. Iwasaki, Y. Ohbayashi, M. Miyake, Y. Matsui The tongue is the most common site for oral cancers. Skillful resection is very difficult for clinicians, particularly for beginners, because the form and location of the lesion change three-dimensionally during the operation due to factors such as the direction and strength of traction, and the site, size, and stiffness of the lesion. Several surgical technique training systems using virtual reality (VR) have recently been developed in the medical field. However, the modality has yet to be introduced for glossectomy, and operative skill can thus only be acquired through clinical experience. We report herein a prototype training system using VR for partial glossectomy. As a first step, software allowing visualization of the deformation and resection of the tongue was developed from a three-dimensional physiological computational model of the tongue. Next, we made a simulator system that is able to transduce the force feedback to the operators using three-dimensional haptic interfaces. The system comprises the following two elements working simultaneously: a monitor that visualizes deformation of the tongue by pulling and cutting; and haptic devices that convey physical forces produced by traction and resection. We introduce herein an outline of the prototype system and clarify the remaining obstacles to clinical application. e-204
POSTER 272 The Utilization of Allogeneic Bone, Bone Morphogenetic Protein and Bone Marrow Aspirate Concentrate for Immediate Reconstruction of Benign Tumor continuity defects J. C. Melville, R. E. Marx, R. Tursun, M. S. Moody: University of Miami/Jackson Memorial Hospital, D. Hew, S. M. Schacht, E. Starley, V. Broumand, M. Peleg, Y. Sawatari, L. Armentano, J. Gomez Abstract: Reconstruction of hard tissue continuity defects caused by ablative tumor surgery has been traditionally reconstructed with autogenous cancellous marrow grafts or microvascular free flaps. Although results have been predictable from both methods of reconstruction, the morbidity associated with bone harvest is quite significant for the patient. With the advances made in tissue engineering, it is our opinion that successful and predictable results can be obtained with using a combination of 100% cadaver bone, Bone Marrow Aspirate Concentrate (BMAC) and rhBMP in immediate reconstruction for benign tumor extirpations. Material and Methods: The aim of this retrospective study is to share our experience with the use of 100% allogeneic bone in combination with BMP and BMAC for immediate reconstruction of continuity defects resulted from benign tumor surgery. The present study reviewed patients treated at the University of Miami Oral and Maxillofacial Surgery Department, during a four-year period between 2010 and 2014. We identified 9 patients, (5 men, 4 women) With a mean age of 23.7 year old with 3 patients under the age of 17. All patents were presented to the University of Miami Department of Oral and Maxillofacial with benign tumors, ( Ameloblastoma, OKC, Myxoma, Ossifying Fibroma and Central Giant Cell Tumor). All patients were ASA I or II with no history of chemotherapy or radiation or prior ablative surgery. All patients had adequate soft tissue for primary closure following oncological principles. All defects range from 4cm to 12cm Our criteria for success with these cases are as follows.1) Unity of bony defect, 2) >3cm bone height and >1cm width, 3) Arch coordination, 4) Implantable bone, 5) Maintenance of osseous content for >18 months, and 6) Restoration of Acceptable facial form. All oral perforations were sutured with a horizontal mattress fashion as well as Lempert sutures to obtain a ‘ water tight closure’’ In two cases immediate bone grafting was deferred due to large stellate perforation that we were not obtain a water tight closure, These patients were excluded from our study. The freeze dried cortical cancellous bone was obtained from the University of Miami Tissue bank and used in combination with a 12mg of rhBMP-2/ACS and 120cc of Bone Marrow Aspirate Concentrate obtained from the patients anterior hip. We used the traditional 10 cc of crushed cortical cancellous bone for each 1 cm of defect. AAOMS 2014
Poster Session Out of the 9 patients all but 1 had maxillomandibular fixation for 3 week. Results: We report a 100% success rate related to reconstruction with our rigid criteria as previously stated. All patients demonstrated excellent bone quality both clinically as well as radiographically. All patients under 17 years old were subsequently underwent orthodontic treatment while patients > 17 years old have or in the process of definitive dental rehabilitation. Conclusions: The combination of 100% Allogenic bone, Bone Marrow concentrate and Bone Morphogenetic protein is an effective and predictable technique for reconstruction of continuity defects from ablative benign tumor surgery. Patient selection is critical in using this method. All patients were ASA I or II with no history of chemotherapy, radiation or previous ablative surgery. If the patient has been medically compromised related to wound healing or has a history of chemotherapy or radiation treatment we still advocate the use of some albeit and small amount of autogenous cancellous bone graft or a microvascular free flaps as the current standards for jaw reconstruction. Overall we had less patient morbidity, less time operating time, less inpatient hospital stay and overall reduction in total costs.
Result: One of the three cases needed additional mandibulectomy based on postoperative pathological examination revealing suspected residual cancer in the marginal zone of the bone. Pathological examination of the tissue obtained from the additional mandibulectomy showed new bone formation around the grafted bone. In the other two cases, the vertical dimension of the mandible at the thinnest portion was approximately 7 mm, but improved to approximately to 15 mm on computed tomography performed 3 years or more after the surgery. Conclusion: After bone grafting using the particulated coronoid process of the affected side in the jaw defect after marginal mandibulectomy of the mandibular molar region, the new bone formation was relatively good. This bone graft technique is effective in some carefully chosen patients depending on their cancer progression. References: 1. Robert DY, Colonel DC, et al: The coronoid process: A new donor source for autogenous bone grafts. Oral Surg Oral Med Oral Pathol 27: 422-428, 1969. 2. Giacomo DR, Mario SM, et al: Mandibular coronoid process grafting for alveolar ridge defects. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 114:430-436, 2012.
POSTER 274 POSTER 273 Particulated coronoid process grafts in marginal mandibulectomy M. Adachi: Shizuoka General Hospital, A. Abe
^ -tricalcium phosphate and Effect of a porous hydroxyapatite bone substitutes on bone regeneration in alveolar bone defects around dental implants Y. Ioku: Osaka Dental University, H. Haeniwa, K. Kakudo
Purpose: Depending on the residual bone height after marginal mandibulectomy, fracture may occur postoperatively. While, in certain morphology of cancer the coronoid process of the affected side can be easily collected during marginal mandibulectomy. Utilizing morphological features of the coronoid process, the coronoid process is reportedly used as a block bone graft for reconstruction of the orbital floor, temporomandibular joint, or alveolar ridge defect and for correction of midfacial concavity. However, there is no report of the coronoid process being particulated for bone grafting. Here we report three cases of bone grafting in the jaw defect after marginal mandibulectomy of the mandibular molar region, using the particulated coronoid process of the affected side. Methods: Three patients with squamous cell carcinoma of the mandibular molar region underwent marginal mandibulectomy between January 2007 and November 2008. The mandibular canal was included in all the marginal mandibulectomies. The coronoid process was resected with the tumor, and a bone graft was harvested with bone-cutting forceps from a site at least 10 mm from the soft-tissue resection margin and the mandibular foramen. The harvested coronoid process of the affected side was placed as a bone graft in the jaw defect. Then, the area was carefully sutured to avoid any dead space. AAOMS 2014
Statement of the Problem: When a sufficient bone mass or favorable bone quality is not available at the implant site, generally, fresh autologous bone transplantation is performed. However, to obtain autologous bone, surgical stress is inevitably applied to the healthy donor region, and the collectable amount of bone is limited. Thus, bone substitutes prepared with various materials have been investigated to substitute for autologous bone. Although artificial materials have no risk of infection compared to other body-derived materials, the clinical outcomes are poorer than those using other bone substitutes. Thus, we filled experimental alveolar bone defects around dental implants with 2 types of bone substitute, and histologically investigated their influences on new bone formation. Materials and Methods: Nine female beagles weighing about 10 kg were used for the experiment. The bilateral lower premolars were extracted under general anesthesia. After 3-month observation of the course and osseous healing, a 5.0 x 10-mm bone defect was prepared in the alveolar bone of each extracted tooth using a trephine bur under saline irrigation. Defects were made bilaterally (4 sites in total). Implants were placed in the distal regions of the defects, and divided into groups for filling of the periimplant bone defect with porous hydroxyapatite (HA), e-205
POSTER 271 Development of a training system using virtual reality for partial glossectomy F. Sawai: Faculty of Medicine, Kagawa University, T. Miki, A. Iwasaki, Y. Ohbayashi, M. Miyake, Y. Matsui The tongue is the most common site for oral cancers. Skillful resection is very difficult for clinicians, particularly for beginners, because the form and location of the lesion change three-dimensionally during the operation due to factors such as the direction and strength of traction, and the site, size, and stiffness of the lesion. Several surgical technique training systems using virtual reality (VR) have recently been developed in the medical field. However, the modality has yet to be introduced for glossectomy, and operative skill can thus only be acquired through clinical experience. We report herein a prototype training system using VR for partial glossectomy. As a first step, software allowing visualization of the deformation and resection of the tongue was developed from a three-dimensional physiological computational model of the tongue. Next, we made a simulator system that is able to transduce the force feedback to the operators using three-dimensional haptic interfaces. The system comprises the following two elements working simultaneously: a monitor that visualizes deformation of the tongue by pulling and cutting; and haptic devices that convey physical forces produced by traction and resection. We introduce herein an outline of the prototype system and clarify the remaining obstacles to clinical application. e-204
POSTER 272 The Utilization of Allogeneic Bone, Bone Morphogenetic Protein and Bone Marrow Aspirate Concentrate for Immediate Reconstruction of Benign Tumor continuity defects J. C. Melville, R. E. Marx, R. Tursun, M. S. Moody: University of Miami/Jackson Memorial Hospital, D. Hew, S. M. Schacht, E. Starley, V. Broumand, M. Peleg, Y. Sawatari, L. Armentano, J. Gomez Abstract: Reconstruction of hard tissue continuity defects caused by ablative tumor surgery has been traditionally reconstructed with autogenous cancellous marrow grafts or microvascular free flaps. Although results have been predictable from both methods of reconstruction, the morbidity associated with bone harvest is quite significant for the patient. With the advances made in tissue engineering, it is our opinion that successful and predictable results can be obtained with using a combination of 100% cadaver bone, Bone Marrow Aspirate Concentrate (BMAC) and rhBMP in immediate reconstruction for benign tumor extirpations. Material and Methods: The aim of this retrospective study is to share our experience with the use of 100% allogeneic bone in combination with BMP and BMAC for immediate reconstruction of continuity defects resulted from benign tumor surgery. The present study reviewed patients treated at the University of Miami Oral and Maxillofacial Surgery Department, during a four-year period between 2010 and 2014. We identified 9 patients, (5 men, 4 women) With a mean age of 23.7 year old with 3 patients under the age of 17. All patents were presented to the University of Miami Department of Oral and Maxillofacial with benign tumors, ( Ameloblastoma, OKC, Myxoma, Ossifying Fibroma and Central Giant Cell Tumor). All patients were ASA I or II with no history of chemotherapy or radiation or prior ablative surgery. All patients had adequate soft tissue for primary closure following oncological principles. All defects range from 4cm to 12cm Our criteria for success with these cases are as follows.1) Unity of bony defect, 2) >3cm bone height and >1cm width, 3) Arch coordination, 4) Implantable bone, 5) Maintenance of osseous content for >18 months, and 6) Restoration of Acceptable facial form. All oral perforations were sutured with a horizontal mattress fashion as well as Lempert sutures to obtain a ‘ water tight closure’’ In two cases immediate bone grafting was deferred due to large stellate perforation that we were not obtain a water tight closure, These patients were excluded from our study. The freeze dried cortical cancellous bone was obtained from the University of Miami Tissue bank and used in combination with a 12mg of rhBMP-2/ACS and 120cc of Bone Marrow Aspirate Concentrate obtained from the patients anterior hip. We used the traditional 10 cc of crushed cortical cancellous bone for each 1 cm of defect. AAOMS 2014
Poster Session Out of the 9 patients all but 1 had maxillomandibular fixation for 3 week. Results: We report a 100% success rate related to reconstruction with our rigid criteria as previously stated. All patients demonstrated excellent bone quality both clinically as well as radiographically. All patients under 17 years old were subsequently underwent orthodontic treatment while patients > 17 years old have or in the process of definitive dental rehabilitation. Conclusions: The combination of 100% Allogenic bone, Bone Marrow concentrate and Bone Morphogenetic protein is an effective and predictable technique for reconstruction of continuity defects from ablative benign tumor surgery. Patient selection is critical in using this method. All patients were ASA I or II with no history of chemotherapy, radiation or previous ablative surgery. If the patient has been medically compromised related to wound healing or has a history of chemotherapy or radiation treatment we still advocate the use of some albeit and small amount of autogenous cancellous bone graft or a microvascular free flaps as the current standards for jaw reconstruction. Overall we had less patient morbidity, less time operating time, less inpatient hospital stay and overall reduction in total costs.
Result: One of the three cases needed additional mandibulectomy based on postoperative pathological examination revealing suspected residual cancer in the marginal zone of the bone. Pathological examination of the tissue obtained from the additional mandibulectomy showed new bone formation around the grafted bone. In the other two cases, the vertical dimension of the mandible at the thinnest portion was approximately 7 mm, but improved to approximately to 15 mm on computed tomography performed 3 years or more after the surgery. Conclusion: After bone grafting using the particulated coronoid process of the affected side in the jaw defect after marginal mandibulectomy of the mandibular molar region, the new bone formation was relatively good. This bone graft technique is effective in some carefully chosen patients depending on their cancer progression. References: 1. Robert DY, Colonel DC, et al: The coronoid process: A new donor source for autogenous bone grafts. Oral Surg Oral Med Oral Pathol 27: 422-428, 1969. 2. Giacomo DR, Mario SM, et al: Mandibular coronoid process grafting for alveolar ridge defects. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 114:430-436, 2012.
POSTER 274 POSTER 273 Particulated coronoid process grafts in marginal mandibulectomy M. Adachi: Shizuoka General Hospital, A. Abe
^ -tricalcium phosphate and Effect of a porous hydroxyapatite bone substitutes on bone regeneration in alveolar bone defects around dental implants Y. Ioku: Osaka Dental University, H. Haeniwa, K. Kakudo
Purpose: Depending on the residual bone height after marginal mandibulectomy, fracture may occur postoperatively. While, in certain morphology of cancer the coronoid process of the affected side can be easily collected during marginal mandibulectomy. Utilizing morphological features of the coronoid process, the coronoid process is reportedly used as a block bone graft for reconstruction of the orbital floor, temporomandibular joint, or alveolar ridge defect and for correction of midfacial concavity. However, there is no report of the coronoid process being particulated for bone grafting. Here we report three cases of bone grafting in the jaw defect after marginal mandibulectomy of the mandibular molar region, using the particulated coronoid process of the affected side. Methods: Three patients with squamous cell carcinoma of the mandibular molar region underwent marginal mandibulectomy between January 2007 and November 2008. The mandibular canal was included in all the marginal mandibulectomies. The coronoid process was resected with the tumor, and a bone graft was harvested with bone-cutting forceps from a site at least 10 mm from the soft-tissue resection margin and the mandibular foramen. The harvested coronoid process of the affected side was placed as a bone graft in the jaw defect. Then, the area was carefully sutured to avoid any dead space. AAOMS 2014
Statement of the Problem: When a sufficient bone mass or favorable bone quality is not available at the implant site, generally, fresh autologous bone transplantation is performed. However, to obtain autologous bone, surgical stress is inevitably applied to the healthy donor region, and the collectable amount of bone is limited. Thus, bone substitutes prepared with various materials have been investigated to substitute for autologous bone. Although artificial materials have no risk of infection compared to other body-derived materials, the clinical outcomes are poorer than those using other bone substitutes. Thus, we filled experimental alveolar bone defects around dental implants with 2 types of bone substitute, and histologically investigated their influences on new bone formation. Materials and Methods: Nine female beagles weighing about 10 kg were used for the experiment. The bilateral lower premolars were extracted under general anesthesia. After 3-month observation of the course and osseous healing, a 5.0 x 10-mm bone defect was prepared in the alveolar bone of each extracted tooth using a trephine bur under saline irrigation. Defects were made bilaterally (4 sites in total). Implants were placed in the distal regions of the defects, and divided into groups for filling of the periimplant bone defect with porous hydroxyapatite (HA), e-205