A Novel Surgical Approach for the Reconstruction of Critical-Size Mandibular Defects Using Calcium Sulphate/Hydroxyapatite Cement, BMP-7 and Mesenchymal Stem Cells-Histological Assessment

Abstract

A novel construct has been developed to induce bone formation within a pedicle muscle flap. A critical size defect (20 × 15 mm 2 ) was created in the mandible of ten rabbits. The masseter muscle was adapted to fill the surgical defect and a combination of calcium sulphate/hydroxyapatite cement (CERAMENT™lSPINE SUPPORT), BMP-7 and rabbits' mesenchymal stromal cells (rMSCs) was injected into the muscle tissue. Bone regeneration was evaluated 3 months after surgery. Limited areas of bone formation anatomically bridged the defect, despite the new bone forming throughout the muscle and within the connective tissue surrounding the remnants of the cement. The bone was thicker in the bucco-lingual direction compared to the contra lateral (non-operated) side. Quantitative histomorphometry assessment showed that the average bone surface area was 21.2±6.0 mm 2 , this was significantly greater than that of the contra-lateral nonoperating control side. The calculated amounts of residual cement and soft tissue or spaces were 20±12% and 41±10%, respectively. The average mineral apposition rate (MAR) was 1.92 µm/day. The findings demonstrated the remarkable potential of the use of local muscle flaps for injectable bio-cement loaded with BMP and seeded with rMSCs to induce bone formation for the reconstruction of bony defects. Keywords: bone, Bioengineering, scaffolding, calcium sulphate Figure 1 Summary of the in-vitro and in-vivo research protocol. A) bone marrow aspiration from the posterior iliac crest; B) bone marrow aspirate ready for rMSCs isolation, expansion and culture; C) Cell suspension prepared for re-implantation in vivo, D) Dissection of the masseter muscle into superficial and deep layer; E) Creation of critical size defect of the ramus of the mandible; F) Adaptation of the masseter muscle into the defect and around the titanium plate; G) injection of the bio-cement; I) Osseo-induction under the effect of cement, BMP-7 and rMSCs; J) Ideal scenario of bone regeneration after 3 months.

Assessment of novel surgical procedures using decellularised muscle and bioactive ceramic: a histological analysis

“…Interestingly, bone thickening was also noticed on the host bone next to the grafted defect because of the stimulating effect of SCPC granule dissolution on host bone cell activity. The later observation was confirmed with our previous work [ 2 ]. Collectively, the findings of the analysis indicate that the DSM/SCPC/hBMSC tissue engineering scaffold can be used for bone augmentation and tissue regeneration.…”

“…But, they are involved with the possibility of extreme immune reaction, communication of infectious diseases and slower integration with native tissue. The advancement in tissue engineering by developing skeletal muscle grafts from homologous and autologous tissues has been lately suggested as a possible option for bone replacement [2][3][4][5]. The reasoning for the utilisation of local matrix materials is the separation of site-specific extracellular matrix and gives the matrix`s proteins impressions of the previous inhabitant cells.…”

Porous Polyethylene Coated with Functionalized Hydroxyapatite Particles as a Bone Reconstruction Material

“…The advantage of this high reabsorption rate is the enhancement of pore formation and subsequent angiogenesis and bone ingrowth in vivo [ 31 ]. In addition, during bone regeneration, a variety of mechanisms have been proposed for the role of CS, including osteoconduction and/or osteoinduction [ 32 ].…”

“…The nature of cell populations around and inside the PE disc was evaluated. On another hand quantitative data was obtained using histomorphometery to estimate the percentage of regenerated bone, residual cement (empty space), and fibrous/muscular tissue was estimated, following well established protocol [ 32 ].…”

Evaluation of the regenerative potential of decellularized skeletal muscle seeded with mesenchymal stromal cells in critical-sized bone defect of rat models

“…Inadequate vascularity, nutritional background, and tissue sustainability have always been the main difficulties in the reconstruction of critical bone defects in the head and neck region ( Pogrel et al, 1997 , Schliephake, 2009 ). Therefore, to address the problem of insufficient angiogenesis with engineered grafts, studies have suggested the use of skeletal muscle as a bioreactor to optimize bone regeneration and vasculature ( Heliotis et al, 2006 , Ayoub et al, 2007 , c2008 , Kokemueller et al, 2010 , Liu et al, 2011 ; Oryan et al, 2014 , Alfotawi et al, 2017 , Alfotawi et al, 2016 ). However, these promising results are also accompanied by some limitations, including donor site morbidity and inadequate graft availability.…”