Combination of Guided Osteogenesis With Autologous Platelet-Rich Fibrin Glue and Mesenchymal Stem Cell for Mandibular Reconstruction

Background: This study examined whether a combination of autologous platelet-rich fibrin glue (PRFG) with mesenchymal stem cells (MSCs) and MEDPOR as guided tissue regeneration (GTR) could act as an osteogenic substitute and whether this treatment yields faster new bone formation than MEDPOR alone or PRFG plus MSC. Material: MSCs were harvested and isolated from the bone marrow of dog ilium. Full-thickness bony defects (1.5 x 1.5 cm) were created in the bilateral mandible angles of the dog. Treatments for bone defect in each group were as follows: group I (n = 4), MEDPOR sheet as GTR and autologous PRFG/MSCs admixtures; group II (n = 4), autologous PRFG/MSCs admixtures; group III (n = 4), MEDPOR sheet as GTR; and group IV (n = 4), control (empty defect). The percentage of new bone regeneration in computerized tomography at 2 months and 4 months was calculated by Analyze version 7.0 software. The mandibles were harvested from all specimens at 4 months, and the grafted sites were evaluated by gross, histologic, and X-ray examination. Results: By radiographic analysis at 16 weeks posttransplantation, it was shown that an average of 72.8% +/- 8.02% new bone formation in group I, 53.34% +/- 6.87% in group II, 26.58% +/- 6.41% in group III, and 15.14% +/- 2.37% in group IV. Histologic examination revealed that the defect was repaired by typical bone tissue in groups I and II, whereas only minimal bone formation with fibrous connection was observed in the groups III and IV group. Besides, muscle incarceration was found in groups II and IV without MEDPOR as GTR. Conclusion: Autologous PRFG plus osteoinduced MSCs have good potential for bone regeneration. In combination with MEDPOR as GTR, bone regeneration is enhanced by preventing soft tissue ingrowth hindering bone regeneration.