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Case Reports
. 2014 Jul-Dec;4(2):189-92.
doi: 10.4103/2231-0746.147130.

Treatment of osteoradionecrosis of mandible with bone marrow concentrate and with dental pulp stem cells

K Manimaran  1 , S Sankaranarayanan  2 , V R Ravi  3 , S Elangovan  4 , M Chandramohan  1 , S Mahendra Perumal  1
Affiliations
Case Reports

Treatment of osteoradionecrosis of mandible with bone marrow concentrate and with dental pulp stem cells

K Manimaran et al. Ann Maxillofac Surg. 2014 Jul-Dec.

Abstract

Osteoradionecrosis (ORN) is a noninfectious, necrotic condition of the bone occurring as a complication of radiotherapy. Most cases occur following trauma or surgical manipulation of the irradiated site. Mandible is the most common bone to be affected following head and neck irradiation. The aim was to develop a successful therapeutic approach for ORN. A spectrum of treatment modalities is practiced for ORN with variable success rate that includes simple irrigation of the affected bone to the partial or complete resection of the jaw bone. In this paper, we present two cases which had successful therapeutic approach for ORN of mandible with autologous bone marrow concentrate stem cells and allogeneic dental pulp stem cells (DPSC) with platelet rich plasma (PRP) following failure of conventional methods. Autologous bone marrow aspirate concentrate (BMAC) was injected around the socket and into the periosteum for one case, and DPSC were mixed with tricalcium phosphate and inserted at the site of the defect in one case. The patient treated with BMAC remained asymptomatic and complete bone remodeling was noticed after 1 year. The extraoral sinus was excised, and healing was uneventful without recurrence in the patient treated with allogeneic DPSC and PRP. Periodic panoramic radiographs revealed an appreciable bone formation from the 2(nd) month onward. We have successfully treated two cases of ORN with BMAC and DPSC, respectively.

Keywords: Bone marrow aspiration concentrate; dental pulp stem cells; mandible; osteoradionecrosis.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Preoperative radiograph showing necrosed bone with suspected hairline fracture
Figure 2
Figure 2
Stem cell matrix in place
Figure 3
Figure 3
Bone formation 2 months postoperative
Figure 4
Figure 4
Six months postoperative showing bone formation
Figure 5
Figure 5
Extraoral sinus
Figure 6
Figure 6
Preoperative OPG
Figure 7
Figure 7
Six months postoperative healed sinus area
Figure 8
Figure 8
Six months postoperative OPG
See this image and copyright information in PMC

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