Osseous Tissue Engineering in the Management of Mandibular Osteoradionecrosis - An Evaluative Study

Manimaran Kanakaraj; Marudhamani Chinnannan; Anbu Elangovan Nagarathinam; Ravi Velamor Rangarajan; Avinash Gandi Devadas; Madhan Jeyaraman

doi:10.4103/ams.ams_164_22

Osseous Tissue Engineering in the Management of Mandibular Osteoradionecrosis - An Evaluative Study

Ann Maxillofac Surg. 2023 Jan-Jun;13(1):19-25. doi: 10.4103/ams.ams_164_22. Epub 2023 Mar 27.

Authors

Manimaran Kanakaraj¹, Marudhamani Chinnannan¹, Anbu Elangovan Nagarathinam², Ravi Velamor Rangarajan³, Avinash Gandi Devadas³, Madhan Jeyaraman^{4

5}

Affiliations

¹ Department of Oral and Maxillofacial Surgery, KSR Institute of Dental Sciences and Research, Tiruchengode, India.
² Department of Oral Pathology, SRM Dental College, Chennai, India.
³ Department of Regenerative Medicine, Mother Cell Regenerative Center, Trichy, India.
⁴ Department of Orthopaedics, ACS Medical College and Hospital, Dr. MGR Educational and Research Institute, Chennai, Tamil Nadu, India.
⁵ Department of Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida, Uttar Pradesh, India.

Abstract

Introduction: Osteoradionecrosis (ORN), a non-infectious, necrotic condition of the bone, occurs as a major complication of radiotherapy to the irradiated site. Simple irrigation of the involved bone to partial or complete resection of the involved bones is being employed in its conventional management. Osseous tissue engineering (OTE) provides a new strategy by regenerating bone cells along with biocompatible scaffolds and micromolecules to produce an engineered osseous tissue.

Materials and methods: In this study, mandibular ORN following radiation secondary to oropharyngeal squamous cell carcinoma was included. OTE with composite engineered tissue containing a mixture of autologous culture expanded dental pulp stem cells (DPSCs), autologous uncultured bone marrow aspiration concentrate (BMAC) and autologous platelet-rich plasma (PRP) loaded in β-tricalcium phosphate (β-TCP) or hydroxyapatite (HA) sponge scaffold was used in the mandibular defect and the surrounding tissues. An assessment of clinical, radiological and functional attributes was done.

Results: A total of six cases with a mean age of 58.6 years were included in the study. We noted significant improvement in the mean post-operative score for pain and mouth opening; functional improvement in eating solid/liquid food, tongue movement, speech and deglutition were observed. The aesthetics was measured with Vancouver score and revealed a significance at P < 0.05; also lip competency and occlusion were noted in all the patients. No major complications were noticed until a mean follow-up of 28 months.

Discussion: Tissue engineering with a regenerative cocktail of autologous culture expanded DPSCs, autologous uncultured BMAC and autologous PRP loaded in HA or β-TCP utilised in the surgical reconstruction of the mandible is an effective treatment modality in the management of mandibular ORN following irradiation.

Keywords: Bone marrow aspirate concentrate; dental pulp stem cells; hydroxyapatite; osteoradionecrosis; platelet-rich plasma.