Autogenous Bone Marrow Aspirate Coated Synthetic Hydroxyapatite for Reconstruction of Maxillo-Mandibular Osseous Defects: A Prospective Study

Abstract

Purpose This prospective study was conducted to evaluate the bone regeneration capacity of synthetic hydroxyapatite mixed with autogenous bone marrow aspirate when used as a bone graft substitute in maxillo-mandibular osseous defects. Methods This study included nine patients with histopathalogically proven benign osteolytic lesions in maxilla and mandible that were treated with enucleation or marginal resection followed by bone marrow aspirate coated synthetic biphasic hydroxyapatite (hydroxyapatite and beta tricalcium phosphate) graft placement. Incorporation of graft was assessed based on Irwin's radiologic staging. The efficacy of graft to form new bone was radiologically evaluated by observing the sequential changes of density at grafted site using gray scale level histogram which was processed in adobe photoshop 7.0 elements. Clinical assessment of recipient and donor sites was done. Results Based on Irwin's radiologic staging, at 6 month follow up period, obvious incorporation of graft with new bone was observed. Sequential changes in bone density measured by gray scale histogram revealed initial resorption followed by replacement of BMA coated hydroxyapatite with new bone formation. None of the patients eventually had complications like infection, wound dehiscence, graft loss at recipient sites at 6 months follow up period. Conclusion Autogenous bone marrow aspirate in combination with synthetic hydroxyapatite is an effective option for accelerating bone regeneration in small to moderate sized jaw bone defects. This mixture provides all the three critical elements needed for bone regeneration (osteogenesis, osteoinduction and osteoconduction) with an added advantage of obviating donor site morbidity.

Repair of segmental radial defect with autologous bone marrow aspirate and hydroxyapatite in rabbit radius: A clinical and radiographic evaluation

“…Several studies have been conducted to improve HA ceramics properties. Addition of total blood [ 36 ], platelet rich plasma [ 36 , 37 ], bone morphogenetic proteins (BMPs) [ 16 , 38 ] collagen [ 39 ], mesenchymal stem cells [ 40 ], and BM [ 41 , 42 ] are among the most proposed techniques.…”

“…However, the possible cooperation between the different BM cells in tissue repair [ 10 , 43 ], suggests that use of BM aspirate, instead of mesenchymal stem cells expanded and purified, is preferable for bone defects treatment. Moreover, this technique can bypass the time-consuming and difficult process of mesenchymal stem cells expansion, which must be expanded in vitro for several weeks to reach a sufficiently high number of cells for transplantation, which not only delays the treatment but also increases treatment costs and contamination risk related to culture [ 42 ].…”

Concentrated bone marrow aspirate-coated hydroxyapatite for reconstruction of small-to-moderate-sized mandibular defects caused by the removal of benign pathologies

“…However, reconstruction of mandibular defects, postablative or posttemporomandibular joint ankylosis release, had been reported with unfractionated marrow/BMA with HA scaffolds. [1116]…”

“…[910] Gali et al have described the use of unfractionated BMA with hydroxyapatite scaffold for reconstruction of maxillomandibular osseous defects. [11] In light of these observations, using BMAC with HA scaffolds for reconstruction of postenucleation/marginal mandibulectomy defects appears very promising. However, published literature on this concept is scarce.…”

Does the Harvesting Site Influence the Osteogenic Potential of Mesenchymal Stem Cells?

“…Ceramics, including hydroxyapatite and tricalcium phosphate, are osteoconductive carriers, which are well known as bone substitutes in orthopedic surgery because of safety, effectiveness, and economic costs [6, 7]. A clinical study performed by Gali et al [8] demonstrated that a mix of autologous bone marrow aspirate and hydroxyapatite increased bone regeneration in patients with maxillo-mandibular osseous defects. In the orthopedic surgery context, in vivo study using bone marrow cells and either tricalcium phosphate or hydroxyapatite-coated acetabular cup in rabbits and goat models, respectively, proved that these mixtures could improve osteoinduction and osteointegration of the grafts, decreasing aseptic loosening [9, 10].…”