2006 Volume 32 Issue 3 Pages 276-280
We describe mandibular reconstructions using particulate cancellous bone and marrow (PCBM) and bioabsorbable poly [L-lactic acid] (PLLA) mesh.
PLLA mesh trays/sheets and PCBM were used to regenerate the mandibles of 57 patients (23 malignant tumors, 34 benign tumors). Clinical evaluations six months after surgery showed that 32 patients (52.6%) had an excellent outcome (bone formation range greater than 2/3), 17 (29.8%) had a good outcome (bone formation range less than 2/3, but re-operation not necessary), and 10 (17.5%) had a poor outcome (all other outcomes). Long-term observations (39 cases; 1-11 years; average 5.3 years) showed that bone absorption was less than 10% of the regenerated bone for 31 (79.5%) patients. In no case was there a complication associated with using PLLA mesh.
After surgery, 21 patients were fitted with dentures and 4 patients received dental implants in the regenerated mandible. We conclude that mandibles can be successfully reconstructed using PCBM and PLLA mesh; this technique is less invasive during operation and excellent in shape and function recovery compared to the conventional bone grafting. However, therapies that combine bioactive factors to promote angiogenesis and osteogenesis or hybrid artificial bone may be needed for patients with critical bone defects over 8 cm in length, poor regional blood circulation and elderly patients with few osteoprogenitor cells.
