Clinico-radiological evaluation of the course of reparative osteogenesis in post-cystic defects of the jaws filled with different osteoplastic materials
DOI:
https://doi.org/10.11603/2311-9624.2019.4.10879Keywords:
radicular cysts, postoperative jaw defects, reparative osteogenesis, cultured periosteal cells, postmenopausal osteoporosisAbstract
Osteogenic mesenchymal cells can be easily found in jawbone periosteum. Because there is a violation of the process of remodeling in the jawbone in osteoporosis, considerable scientific and practical interest is to study the local influence of cultured periosteum cells on the dynamics of osteoregeneration in areas of jaw defects formed after the removal of large-sized radicular cysts.
The aim of the study – to give a clinico-radiological evaluation of the features of the course of reparative osteogenesis in the post-cystic defects of the jaws after their plasticity by different osteoplastic materials.
Materials and Methods. 85 patients aged 20 to 70 years with radicular jaw cysts were enrolled in clinical observations. Depending on the diagnosed state of mineral metabolism, all patients were divided into two clinical groups: group 1 included 44 patients without age-related mineral metabolism disorders, group 2 consisted of 41 patients (women) with age-related mineral metabolism disorders. After removal of the radicular cysts, jawbone defects in patients of clinical group 1 and subgroup 1 of the clinical group 2 (31 patients) were filled by "Kolapol KP - 2". In the subgroup 2 of clinical group 2 in 10 patients after removal of radicular jaw cysts of large sizes, plastic of the formed bone defects was carried out by cultured cells of periosteum which were placed on the substrate "Kolapol KP – 2". 3, 6, 9, 12 months after surgery, we performed the radiological monitoring to establish the reduction of the post-cystic defects of the jaws, restore of the trabecular structure and mineralization of the bone regenerate. Ultrasound echoostometry was used to study mineral density in the lower jaw bone.
Results and Discussion. The healing process of bone wounds in patients who had small and medium-sized radicular cysts was similar in both clinical groups. Complete closure of post-cystic defects after 9 months was observed in 20 patients of group 1 and 16 of group 2. This process was slightly delayed in 3 patients of group 1 and in 4 patients of group 2. After 12 months radiographically observed restoration of the integrity of the jawbone in all patients. The process of healing of bone wounds after removal of large-sized radicular cysts was slower in patients of both groups. This is clearly manifested in patients with impaired mineral metabolism. 12 months after cystectomy, a complete reduction in post-cystic defect of the jaws was radiographically visualized in only 45.5 % of patients of subgroup 1 of clinical group 2. In patients of subgroup 2 of clinical group 2 were completed reparative osteogenesis in the areas of jaw lesions in similar terms in 80 % of cases.
Conclusions. The use for the osteoplasty of post-cystic defects of jaws of different sizes of "Kolapol KP – 2" in patients without violation of mineral metabolism ensures successful course of reparative osteogenesis in 80.95 % of cases. In patients with age-related disorders of mineral metabolism (postmenopausal osteoporosis), the use for the osteoplasty of "Kolapol KP-2" has proved effeciency in the treatment of post-cystic defects of the jaws of small and medium size. The results of clinico-radiological study revealed that the most optimal method of stimulation of reparative osteogenesis in post-cystic defects of the jaws of large sizes in women with postmenopausal osteoporosis is the use of combined osteoplastic material consisting of cultivated periosteal autocells, placed on “Kolapol KP – 2”.
References
Pagni, G., Kaigler, D., Rasperini, G., Avila-Ortiz, G., Bartel, R. & Giannobile, W.V. (2012). Bone repair cells for craniofacial regeneration. Advanced Drug Delivery Reviews, 56, 151-165. DOI: https://doi.org/10.1016/j.addr.2012.03.005
Egusa, H., Sonoyama, W., Nishimura, M., Atsuta, I. & Akiyama, K. (2012). Stem cells in dentistry – Part I: Stem cell sources. J. Prosthodont. Res., 56, 151-165. DOI: https://doi.org/10.1016/j.jpor.2012.06.001
Egusa, H., Sonoyama, W., Nishimura, M., Atsuta, I. & Akiyama, K. (2012). Stem cells in dentistry – Part II: Clinical applications. Journal of Prosthodontic Research, 56, 229-248. DOI: https://doi.org/10.1016/j.jpor.2012.10.001
Oryan, A., Kamali, A., Moshiri, A., & Baghaban Eslaminejad, M. (2017). Role of mesenchymal stem cells in bone regenerative medicine: What is the evidence? Cells Tissues Organs, 204, 59-83. DOI: https://doi.org/10.1159/000469704
Tollemar, V., Collier, Z.J., Mohammed, M.K., Lee, M.J., Ameer, G.A., & Reid, R.R. (2016). Stem cells, growth factors and scaffolds in craniofacial regenerative medicine. Genes & Diseases, 3 (1), 56-71. DOI: https://doi.org/10.1016/j.gendis.2015.09.004
Ferretti, C. & Mattioli-Belmonte, M. (2014). Periosteum derived stem cells for regenerative medicine proposals: Boosting current knowledge. World J. Stem Cells, 6 (3), 266-277. DOI: https://doi.org/10.4252/wjsc.v6.i3.266
Mizuno, H., Kagami, H., Mizuno, D., & Ueda, M. (2010). Efficacy of membranous cultured periosteum for the treatment of patients with severe periodontitis: a proof-of-concept study. Nagoya J. Med. Sci., 72, 59-70.
Nagata, M., Hoshina, H., Li, M., Arasawa, M., Uematsu, K., Ogawa, S., Yamada K., & Kawase, T. (2012). A clinical study of alveolar bone tissue engineering with cultured autogenous periosteal cells: coordinated activation of bone formation and resorption. Bone, 50 (5), 1123-1129. DOI: https://doi.org/10.1016/j.bone.2012.02.631
Okuda, K., Yamamiya, K., Kawase, T., & Mizuno, H. (2009). Treatment of human infrabony periodontal defects by grafting human cultured periosteum sheets combined with platelet-rich plasma and porous hydroxyapatite granules: case series. Journal of the International Academy of Periodontology, 11 (3), 206-213.
Zekiy, A.O. & Zekiy, O.Ye. (2014). Osteoporoz i sostoyaniye kostnogo remodelirovaniya nizhney chelyusti [Osteoporosis and the condition of bone remodeling of the lower jaw]. Spravochnik vracha obshchey praktiki – Handbook of a General Practitioner, 5, 54-58 [in Russian].
Lee, JH., Han, SS. Lee, C., Kim. YH. & Battulga, B. (2014). Microarchitectural changes in the mandibles of ovariectomized rats: a systematic review and meta-analysis. BMC Oral Health, 26, 19 (1),128.
Geiger, M., Blem, G.б & Ludwig, A. (2016). Evaluation of imageJ for relative bone density measurement and clinical application. J. Oral Health Craniofac, Sci., 1, 12-21. DOI: https://doi.org/10.29328/journal.johcs.1001002
Redlich, A., Perka, C., Schultz, O., Spitzer, R., Häupl, T., Burmester, G.R., & Sittinger, M. (1999). Bone engineering on the basis of periosteal cells cultured in polymer fleeces. Mater. Sci. Mater. Med., 10 (12), 767-772. DOI: https://doi.org/10.1023/A:1008994715605
Vorobyev, Yu.I., & Maksimovskiy, Yu.M. (2001). Klinika, rentgenodiagnostika i printsipy lecheniya periapikalnykh patologicheskikh protsessov [Clinic, X-ray diagnostics and principles of treatment of periapical pathological processes]. Novoye v stomatologii – New in Dentistry, 4, 4-7 [in Russian].
Dar, M., Hakim, T., Shah, A., Najar, L., Yaqoob, G., & Lanker, F. (2016). Use of autologous platelet-rich fibrin in osseous regeneration after cystic enucleation: A clinical study. Journal of Oral Biology and Craniofacial Research, 6, 29-32. DOI: https://doi.org/10.1016/j.jobcr.2016.04.004
Svetlovskiy, A.A. (1991). Akusticheskaya diagnostika perelomov nizhney chelyusti [Acoustic diagnosis of fractures of the lower jaw]. Stomatologiya: Respublikanskiy Mezhvedomstvenniy sbornik – Dentistry: Republican Interdepartmental Collection. Kyiv: Zdorovia, 26, 85-88 [in Russian].
