Reconstruction of Maxillary Bone Defects With Cellular Bone Matrix Allografts

Abstract

Study design: Retrospective Cohort Study.

Objective: Reconstruction of maxillary bone defects can be completed with vascularized and non-vascularized autografts. Cellular bone matrix allografts (CBMs), which have lineage committed bone cells, has risen as an alternative. The purpose of this study was to describe our experience and to determine the success of CBM based maxillary reconstruction in a variety of clinical scenarios.

Methods: A retrospective cohort study was designed and implemented using data from subjects who presented to the University of Louisville and were treated with a CBM for maxillary reconstruction from 2019 to 2023. Subjects were excluded if they were not treated with a CBM, data were not complete, or postoperative follow-up time was less than 3 months. Descriptive statistics were calculated for each variable. To measure the associations between the risk factors and graft success, Fisher's exact test was implemented. A P-value of <0.05 was considered significant.

Results: The sample included 48 subjects. The mean age of all subjects was 43 ± 24 years. Overall, 42 (87.5%) cases were successful. The perioperative antibiotic administered (P = 0.02), etiology (P = 0.021), and the addition of platelet rich fibrin or autograft as an adjunct influenced CBM success (P = 0.039).

Conclusions: CBMs are a viable option for reconstruction of maxillary bone defects. CBMs may be an alternative to autografts.

Keywords: cellular bone matrix; maxilla reconstruction; tissue engineering.

Figure 1.

Subject with anterior maxillary odontogenic cyst. (A) Preoperative panoramic radiograph, arrow points to lesion. (B) 3D reconstruction from cone beam computed tomography scan. (C) Intra operative photo after excision of lesion. (D) Placement of cellular bone matric allograft into defect. (E) Defect filled with cellular bone matrix. (F) CT scan taken 6 months after surgery. Left axial cuts and right coronal cuts. Note defect graft fill and consolidation.

Figure 2.

Bone graft reconstruction of right cleft maxilla with cellular bone matrix and rh-BMP2. (A) Preoperative cone beam computed tomography scan demonstrating defect. (B) Axial scan demonstrating defect. (C) Intraoperative photograph demonstrating cleft maxilla after repair of residual oral nasal fistula. (D) Placement of cellular bone matrix and rh-BMP2 into cleft maxilla. (E) Tension free closure of oral mucosa. (F) Cone beam computed tomography scan one week after surgery, right 3D reconstruction, left axial cut. (G) Cone beam computed tomography scan taken 4 months after surgery, right 3D reconstruction, left axial cuts. Note union of the maxilla.

Figure 3.

Subject with edentulous and severely hypoplastic maxilla. (A) Preoperative panoramic radiograph, left, and lateral cephalometric radiograph, right demonstrating severe maxillary hypoplasia. (B) 3D reconstruction demonstrating preoperative position (left) and proposed maxillary advancement, highlighted in blue (right). (C) Rigid internal fixation design. Frontal view (top), lateral view (bottom left), and superior view (bottom right). Note the lack of bony contact after maxillary advancement (arrow). (D) Intra operative view of maxilla after advancement and rigid internal fixation and placement of cellular bone matrix over bony defect. (E) Postoperative panoramic radiograph (left) and lateral cephalometric radiograph (right).

Figure 4.

Photomicrograph of bone core taken during endosseous dental implant in defect reconstructed with cellular bone matrix. Movat’s pentachrome staining of bone (nuclei, black to dark-bluish gray; osteoid, red or yellow; mineralized bone, yellow).