2012 年 25 巻 2 号 p. 282-287
Mandibular reconstruction using particulate cancellous bone and marrow (PCBM) is widely applied recently. Although titanium trays are the most popular material for this method, they have some disadvantages such as difficulty of making a suitable counter for a defect and the requirement of removal when dental implants are considered. Raw particulate hydroxylapatite/poly-L-lactide composite (HA/PLLA) is a resorbable material that has greater strength than pure PLLA and induces bone formation more rapidly.
We present the clinical course of implants in a case of reconstructed mandible using a custom-made HA/PLLA mesh tray with PCBM and platelet-rich plasma (PRP). We also evaluate the bone quality and structures of the reconstructed mandible around the implants.
The patient was a 66-year-old man who was diagnosed with a recurrent keratinized odontogenic tumor of the right molar region of the mandible. A mesh sheet type HA/PLLA was customized using the rapid prototyping method based on CT data. Resection of the tumor was carried out and PCBM was harvested from bilateral posterior iliac crests. PCBM and PRP were transferred to the tray, and the tray was rigidly fixed by HA/PLLA screws. Two dental implants were inserted in the molar area 10 months after the reconstruction with a two-stage procedure. The implants accomplished proper osseointegration, and successfully functioned without any abnormal symptom or bone resorption for 4 years of loading. Although the reconstructed bone showed a uniform structure immediately after reconstruction, CT evaluation clearly showed compact and cancellous bone structures 4 years after loading.
This case showed that the custom-made HA/PLLA tray system contributed to the implant treatment.
