Is Reconstruction of Large Mandibular Defects using Bioengineering Materials Effective

Abstract Purpose Clinical tissue engineering has revolutionized surgery by improving surgical efficiency and decreasing risks associated with traditional bone graft procurement techniques. Compared to autogenous bone graft, composite tissue-engineered graft fulfills the principles of osteoconduction, osteoinduction, and osteogenesis while providing adequate bone volume for maxillofacial reconstruction with less morbidity. This study aims to demonstrate the effectiveness, as defined by our success criteria, of a composite tissue-engineered bone graft in reconstruction of mandibular defects Methods We implemented a retrospective case series and enrolled a sample of patients with mandibular defects which were reconstructed using allogeneic bone in combination with recombinant human bone morphogenic protein-2 (rHBMP-2) and bone marrow aspirate concentrate (BMAC) at the OMS Department of the UTHealth in Houston over five years. Success criteria were: 1) bone union defined as a homogenous radiopaque pattern continuous with native bone without mandibular mobility, and 2) volume of grafted bone adequate for implant placement defined to be at least 1.0 cm (height) by 0.8 cm (width). Clinical exams and computed tomography (CT) were performed at 6-months postoperatively. Descriptive statistics were computed for each variable. Results From 2014-2019, tissue-engineering reconstruction was utilized in 31 patients with and 3 patients without mandibular continuity defects for a total of 34 patients. Median follow-up was 6-months. The mean length of continuity defects was 5.5 cm with a range of 1.0 to 12.5 cm. 27 of 30 patients with mandibular continuity defects achieved success criteria, with an average gained height of 2.12 ± 0.64 cm and width of 1.53 ± 0.46 cm. There was one patient lost to follow up and three failures. Conclusion While the use of autogenous graft remains the gold standard, the evolving science behind clinical tissue engineering has resulted in an effective treatment modality for complex head and neck defects with less morbidity equal to autogenous bone.