Mandibular Reconstruction with Tissue Engineering in Multiple Recurrent Ameloblastoma

The aim of this paper is to present a new approach to bone regeneration in a patient with multiple recurrent ameloblastoma of the left mandibular angle. Through an extraoral approach, complete resection of the tumor was achieved. Bone marrow aspirate from the iliac crest was centrifuged to concentrate the mesenchymal cellular fraction. Based on a stereolithographic cast, titanium mesh was bent preoperatively to accurately reconstruct the mandibular angle. The mesh was filled with two blocks of xenogenic material mixed with recombinant bone morphogenetic protein 7 (BMP-7) and stem cells. Nine months later, three endosseous implants were placed in the regenerated bone to restore the patient's masticatory function. At this time, bone samples were obtained for histomorphometric analysis. New bone formation was confirmed around the particles of xenograft material. The results indicate that adequate esthetics and function may be achieved with bone marrow aspirate seeded on a scaffold obtained from bovine xenograft blocks and BMP- 7. This technique attains new bone formation with sufficient quantity and quality to allow for implant placement, with decreased patient morbidity and surgical time compared to conventional reconstructive methods.