• Maxillofacial Plastic and Reconstructive Surgery
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• v.23 no.2
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• pp.163-168
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• 2001

Purpose : This study is conducted to evaluate the clinical success of secondary alveolar bone grafting using autogenous iliac particulate cancellous bone marrow in cleft maxilla. Materials and methods : We evaluated 107 cleft patients who had been admitted to the Dept. of Oral and Maxillofacial Surgery of Pusan National University Hospital from January 1, 1991 to January 31, 1999 and had been performed secondary alveolar bone grafting with autogenous particulated cancellous bone marrow from iliac crest. Results : 1. Men were 70 and women were 37, which shows 65.4% and 34.6% and the proportion of males to females was 1.9:1. Unilateral cases were 89(83.2%) and bilateral cases were 18(16.8%). 2. Age of bone grafting is widely distributed from 7 to 29, and the average was 13.2. 3. Success rate was 97.8% in unilateral cases, 94.4% in bilateral cases. Overall success rate was 96.7%. 4. We evaluated the bone graft contour by the percentage of bone attachment level adjacent to the alveolar cleft and the menial side showed 82.4% and the distal 87.7%. 5. The amount of notching the alveolar ridge at the grafted site through the ratio of notching length up to the most apical base to the length of proximal segment anatomic root was 0.19.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.12 no.3
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• pp.87-91
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• 1990

This is to report a case of secondary reconstruction after partial mandibulectomy by using of marrow-cancellous bone and cortical bone harvested from the iliac crest in the case of an ameloblastoma on the mandible. According to the past experimental studies, the marrow and cancellous bone have the marked osteogenic potential of hematopoietic. And the cortical bone has the highest activity of bone induction, which is mediated through the action of bone morphogenic protein(BMP). This grafting technique, the combination of PMCB and cortical bone, has advantage in restoring lange defect of the mandible.

• Journal of Yeungnam Medical Science
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• v.8 no.1
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• pp.198-205
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• 1991

We obtained successful functional and esthetic results by grafting of iliac marrow-cancellous bone in 2 cases of alveolar-palatal cleft patients. Bone graft of alveolar-palatal clefts provide bony support to adjacent teeth of cleft area, prevented from relapse of orthodontic arch expansion, closure of oroantral fistula and improvement of speech problem. 1. In one case, extraction of upper right central incisor that was little bone support, alignment of rotated teeth and expansion of collapsed arch segment were done with pre-ortodontic treatment. The other case, Bone grafting was done after removal of prosthesis with no preorthodontic treatment. 2. After mucoperiosteal incision in cleft area. The mucosal flap of labial area, palate and nose were separation and the raised nasal mucosa was sutured for closure of oroantral fistula. Then, the iliac marrow-cancellous bones were grafted to cleft site. 3. After 6 months of operation, we had seen the new bone deposition to cleft site in dental radiography and prosthetic treatments of missing teeth were done.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.27 no.1
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• pp.85-92
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• 2005

Reconstruction of defect in the anterior part of the maxilla to enable implant placement or prothesis is a complicated treatment due to the anatomical position and lack of soft tissues. Two cases are presented in which autogenous iliac PMCB(particulate marrow and cancellous bone) with titanium mesh were used for premaxilla reconstruction and alveolar bone repair of the anterior maxillas prior to denture and implants fixation respectively. Cancellous bone from the anterior iliac crest was compressed and placed against a titanium mesh fixed to the bone of palate in a patient with severe defect of the anterior maxilla. There were no problem in the healing, and the anterior maxillas of two patients had increased height and width during the initial healing and remodeling. The clinical reports describe the use of titanium mesh for reconstruction of premaxilla. Autogenous bone grafts were harvested from the iliac crest and were loaded on a titanium mesh that were left in the patient's maxilla for 6 months before they were removed respectively. The radiographic analysis demonstrated that a 10mm vertical ridge augmentation had been achieved. In guided bone regeneration, the quantity of bone regenerated under the barrier has been demonstrated to be directly related to the amount of the space under the membrane. This space can diminish as a result of membrane collapse. To avoid this problem which involved the use of a titanium mesh barrier to protect the regenerating tissues and to achieve a rigid fixation of the bone segments, were used in association with autologous bone in 2 cases. The aim of this study was to evaluate the capability of a configured titanium mesh to serve as a mechanical and biologic device for restoring a vertically defected premaxilla.

• Archives of Plastic Surgery
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• v.36 no.5
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• pp.531-537
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• 2009

Purpose: Alveolar bone grafting has become an essential process in the treatmemt of alveolar cleft patient for stabilization of the maxillary arch, elimination of oronasal fistula, the reconstruction of the soft tissue nasal base support, and creation of bony support for tooth eruption for implant. The use of Autologous iliac cancellous bone is preferable because of the adequate quantity and high osteoinductive potential. However, even with iliac bone, insufficient osteoregeneration and absorption occur due to several factors such as the patient's age, cleft width, functional stress, and others. In order to increase osteoregeneration where the iliac bone is placed, the present study is associated with bone marrow aspirate (BMA). The experimental study evaluated the efficacy of osteoregeneration in normal cleft rabbits when alveolar bone grafting was performed with autologous iliac corticocancellous bone. Methods: Twenty - four New Zealand White rabbits were divided randomly into 2 groups (BMA, control). All animals underwent harvesting of corticocancellous bone graft from the right posterior iliac crest via standard surgical technique. $1m{\ell}$ of BMA were obtained by scraping the needle and aspirate with $10m{\ell}$ syringe from the contralateral iliac bone wall. The muco - periosteal flap on the palate was elevated. A mixture of Equal bone's volumes with BMA and saline as its control was inserted into the cleft. Animals were sacrificed at 2, 4, and 8 weeks and maxilla was harvested for dental peri - apical X-ray, bone matrix density (BMD),and histologic analysis. Result: BMD of regenerated bone to the cleft in the rabbits was higher than that of the control rabbits. X-ray, histologic analysis showed that increased osteoregeneration and low absorption rate were observed in the BMA group. Conclusion: Our experimental study showed BMA enhanced the osteoregeneration and survival rate of alveolar bone grafting. BMA is easy to extract & cost - time effective. So it can be an effective enhancers for bone grafting mixtures.

• The Journal of the Korean dental association
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• v.19 no.4 s.143
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• pp.369-373
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• 1981

This is a case of 25-year-old Korean female with a diagnosis of ossifying fibroma in the mandible. Chief complaint of the patient was facial asymmetry by slow growing mass on the right mandibular body. Diagnosis was obtained by incisional biopsy of affected mandible after taking several radiograms, which was ossifying fibroma. Patient was treated by subtotal mandiblectomy and resin splint implatation. We gained satisfactory result by secondary autogeneous cancellous and marrow bony graft from the iliac crest with titanium mesh for tray of bone chips.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.35 no.6
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• pp.397-402
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• 2009

The purpose of this study is to investigate the effects of alendronate and pamidronate on proliferation and the alkaline phosphatase activity of human bone marrow derived mesenchymal stem cells and to relate the results with bisphosphonate related osteonecrosis of the jaw(BRONJ). With the consent of patients with no systemic disease and undergoing iliac bone graft, cancellous bone was collected to obtain human bone marrow derived mesenchymal stem cells through cell culture. 96 well plate were prepared with a concentration of $10^4$cell/ well. Alendronate and pamidronate were added to each well with the concentration of $10^{-6}M$, $10^{-8}M$ and $10^{-10}M$, respectively. Then proliferation capacity of each well was evaluated with the cell counting kit. 24 well plates were prepared with a concentration of $10^5$cell/ml/well and with the bone supplement, alendronate and pamidronate were added with the concentration of $10^{-6}M$, $10^{-8}M$ and $10^{-10}M$, respectively on each plate. The plates were cultured for either 24 or 72 hours. Then the cells were sonicated to measure the alkaline phosphatase activity and protein assay was done to standardize the data for analysis. As the concentration of alendronate or pamidronate added to the culture increased, the proliferation capacity of the cells decreased. However, no statistical significance was found between the group with $10^{-10}M$ of bisphophonate and the control group. Pamidronate was not capable of increasing the alkaline phosphatase activity in all trials. However, alkaline phosphatase activity increased with 24 hours of $10^{-8}M$ of alendronate treatment and with 48 hours of $10^{-10}M$ of alendronate treatment. Cell toxicity increased as the bisphosphonate concentration increased. This seems to be associated with the long half life of bisphosphonate, resulting in high concentration of bisphosphonate in the jaw and thus displaying delayed healing after surgical procedures. Alendronate has shown to increase the alkaline phophatase activity of human bone marrow derived mesenchymal stem cells. However, this data is insufficient to conclude that alendronate facilitates the differentiation of human bone marrow derived mesenchymal stem cells. Further studies on DNA level and animal studies are required to support these results.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.41
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• pp.43.1-43.5
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• 2019

Background: Reconstructive surgery is often required for tumors of the oral and maxillofacial region, irrespective of whether they are benign or malignant, the area involved, and the tumor size. Recently, three-dimensional (3D) models are increasingly used in reconstructive surgery. However, these models have rarely been adapted for the fabrication of custom-made reconstruction materials. In this report, we present a case of maxillary reconstruction using a laboratory-engineered, custom-made mesh plate from a 3D model. Case presentation: The patient was a 56-year-old female, who had undergone maxillary resection in 2011 for intraoral squamous cell carcinoma that presented as a swelling of the anterior maxillary gingiva. Five years later, there was no recurrence of the malignant tumor and a maxillary reconstruction was planned. Computed tomography (CT) revealed a large bony defect in the dental-alveolar area of the anterior maxilla. Using the CT data, a 3D model of the maxilla was prepared, and the site of reconstruction determined. A custom-made mesh plate was fabricated using the 3D model (Okada Medical Supply, Tokyo, Japan). We performed the reconstruction using the custom-made titanium mesh plate and the particulate cancellous bone and marrow graft from her iliac bone. We employed the tunneling flap technique without alveolar crest incision, to prevent surgical wound dehiscence, mesh exposure, and alveolar bone loss. Ten months later, three dental implants were inserted in the graft. Before the final crown setting, we performed a gingivoplasty with palate mucosal graft. The patient has expressed total satisfaction with both the functional and esthetic outcomes of the procedure. Conclusion: We have successfully performed a maxillary and dental reconstruction using a custom-made, pre-bent titanium mesh plate.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.33 no.1
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• pp.10-18
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• 2011

Purpose: The purpose of this study is to find out the effects of bisphosphonates (BPs) on the proliferation and the alkaline phosphatase (ALP) activity of human bone marrow derived mesenchymal stem cells (hMSCs), and thus state its correlation with bisphosphonate related osteonecrosis of the jaw (BRONJ). Methods: hMSCs was obtained by collecting and culturing cancellous bone fragments from a patient undergoing iliac bone graft. Alendronate (Aln) and Pamidronate (Pam), Ibandronate (Ibn) were added to the culture media in the concentration from $10^{-3}$ M to $10^{-11}$ M and cell toxicity, viability were measured. For ALP activity evaluation, Aln and Pam were added to the culture media in the concentration from $5{\times}10^{-7}$ M to $1{\times}10^{-8}$ M and were cultured for 1 week, 2 weeks and 3 weeks. ALP activity data were standardized using protein assay. Control groups were prepared for each examination. Results: Aln, Pam and Ibn all failed to increase the proliferation of hMSCs. With 1 week, 2 weeks of $5{\times}10^{-8}$M of Aln treatment, the ALP activity increased. Pam treatment increased the ALP activity with 2 weeks of $5{\times}10^{-8}$ M and$1{\times}10^{-8}$M. Also Ibn treatment increased the ALP activity with 2 weeks of $5{\times}10^{-8}$ M and $1{\times}10^{-8}$ M. Conclusion: It is considered that BPs are not capable of improving the proliferation of hMSCs. Also, after a transient increase in the ALP activity with the lower concentration of BPs, the activity decreased again. Therefore, in patients on long-term medication of BPs, the proliferation and osteoblast differentiation of hMSCs are restrained, and thus delayed wound healing and increase in BRONJ complications may occur.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.40
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• pp.35.1-35.7
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• 2018

Background: After the resection at the mandibular site involving oral cancer, free vascularized fibular graft, a type of vascularized autograft, is often used for the mandibular reconstruction. Titanium mesh (T-mesh) and particulate cancellous bone and marrow (PCBM), however, a type of non-vascularized autograft, can also be used for the reconstruction. With the T-mesh applied even in the chin and angle areas, an aesthetic contour with adequate strength and stable fixation can be achieved, and the pores of the mesh will allow the rapid revascularization of the bone graft site. Especially, this technique does not require microvascular training; as such, the surgery time can be shortened. This advantage allows older patients to undergo the reconstructive surgery. Case presentation: Reported in this article are two cases of mandibular reconstruction using the ready-made type and custom-made type T-mesh, respectively, after mandibular resection. We had operated double blind peer-review process. A 79-year-old female patient visited the authors' clinic with gingival swelling and pain on the left mandibular region. After wide excision and segmental mandibulectomy, a pectoralis major myocutaneous flap was used to cover the intraoral defect. Fourteen months postoperatively, reconstruction using a ready-made type T-mesh (Striker-Leibinger, Freibrug, Germany) and iliac PCBM was done to repair the mandible left body defect. Another 62-year-old female patient visited the authors' clinic with pain on the right mandibular region. After wide excision and segmental mandibulectomy on the mandibular squamous cell carcinoma (SCC), reconstruction was done with a reconstruction plate and a right fibula free flap. Sixteen months postoperatively, reconstruction using a custom-made type T-mesh and iliac PCBM was done to repair the mandibular defect after the failure of the fibula free flap. The CAD-CAM T-mesh was made prior to the operation. Conclusions: In both cases, sufficient new-bone formation was observed in terms of volume and strength. In the CAD-CAM custom-made type T-mesh case, especially, it was much easier to fix screws onto the adjacent mandible, and after the removal of the mesh, the appearance of both patients improved, and the neo-mandibular body showed adequate bony volume for implant or prosthetic restoration.