Protein-Signaled Guided Bone Regeneration Using Titanium Mesh and Rh-BMP2 in Oral Surgery: A Case Report Involving Left Mandibular Reconstruction after Tumor Resection

Abstract

Recombinant human bone morphogenetic protein-2 (rhBMP-2) is an osteoinductive protein approved for use in oral and maxillofacial defect reconstruction. Growth factors act as mediators of cellular growth on morphogenesis and mythogenesis phases. Utilized as recombinant proteins, these growth factors need the presence of local target cells capable of obtaining the required results. This cell population may be present at the wound site or added to scaffolding material before implantation at the surgical site.The aim of this study is to evaluate the clinical and radiographic results of a reported case with a large bone defect, treated with an absorbable collagen sponge, rhBMP-2 and a titanium plate and mesh. The Authors want to report a case which shows the resulting effectiveness of the rhBMP2 action regarding a large, mandibular defect reconstruction. This case also shows how the removal of a rare tumor such as a ghost cell tumor of the jaw may be treated without harvesting bone from another body site. A quick diagnosis of the lesions is important in order to perform the most suitable treatment. The Authors also underline the clinical and histological steps to insure the correct treatment is carried out to solve the case.Moreover, from results obtained from this case, it is possible to highlight several clinical benefits for the patient by adding rhBMP-2 to the common allograft to not only have alveolar reconstruction defects and sinus floor augmentation, but also to have alveolar cleft reconstruction and to treat segmental defects.

Keywords: BMP2 human protein; bone reconstruction; bone regeneration; oral surgery; titanium mesh..

Fig. (1)

Orthopantomography showed long mandibular circular lesion involving several lower jaw teeth.

Fig. (2)

A significant swelling in the left mandible may be appreciated before the tumor resection.

Fig. (3)

Clinical left mandibular swelling.

Fig. (4)

Dentinogenic Ghost Cell Tumor Histological features.

Fig. (5)

Anatomic tumor extension after the elevated flap.

Fig. (6)

Tumor consistence is clear at the resection time.

Fig. (7)

Mandibular reconstruction is performed with low titanium plate, rhBMP-2 and ACS covered by a titanium mesh.

Fig. (8)

Post op radiographic evaluation.

Fig. (9)

Post op TC evaluation.

Fig. (10)

A 3-4 months clinical evaluation. A good soft tissue healing can be appreciated.

Fig. (11)

No more swelling is underlined at frontal image 6 months post op.

Fig. (12)

OPT evaluation at 9 month follow up at removing titanium mesh time. Bone regeneration can be appreciated on the left body mandible.

Fig. (13)

4 dental implants positioned at 9 month follow up after tumor resection in order to reconstitute function and aesthetic of the left mandible area.