Therapy of delayed consolidation of mandible fractures
Keywords:fracture of the mandible, delayed consolidation, osteogenesis, fibrin-enriched platelets, bone morphogenetic protein
The aim of the study is to improve the effectiveness of treatment for delayed consolidation of mandibular fractures by developing and clinical testing of integrated therapy using growth factors and bone morphogenetic protein-2. Clinical material is based on the study of 62 patients with the problem of mandibular fractures consolidation. The examinations of bone density were carried out on a cone-beamed computerized tomograph Planmeca Promax 3D (Finland) with an X-ray emitter of 85 kV 5-7 mA on the day 7 and 21 of the study. The evaluation of the density of jaw bone tissue was conducted by U. Lekholm and G. Zarb (1985) classifications, and by S. Mish (1990). Bone density of more than 850 units was considered as an intact dense bone, the values from 350 to 850 units - as a relatively intact, loose bone, and less than 350 Hounsfield units - local osteoporosis. Statistical processing of materials was carried out using standard methods of variation statistics using the STATISTIKA (ver. 6.1; Statsoft Inc., USA, No. AGAR 909E415822FA). Use in the therapy of delayed consolidation of mandible fractures of the developed complex, which includes strontium ranelate – a drug with osteotropic action, antioxidant Mexidol, immunomodulator of recombinant human interleukin-2, and a local introduction of fibrin-enriched platelets containing numerous growth factors along the fissure of mandible fracture, or recombinant bone morphogenetic protein-2 in more complicated cases. The improvement of reparative processes was in 58 patients. In any case there was no need to carry out additional surgical interventions for osteosynthesis or bone «grafting». The basic program on care of patients with a delayed consolidation of mandible fractures should affect all pathogenesis components of this complication: it should include osteotropic drugs, antioxidants and immunomodulators. Involvement of platelet-rich fibrin in the integrated therapy positively affects the quality of bone regenerate and treatment terms, ensuring the normalization of clinical and laboratory parameters up to the day 21. The best optimization of reparative osteogenesis in the complex therapy of delayed consolidation is facilitated by the additional injection of recombinant human bone morphogenetic protein-2. This tactic allowed to ensure its favorable course by the type of initially delayed adhesion in all patients (8 out of 8).
Garrison KR, Shemit I, Donell S, Ryder JJ, Mug¬ford M, Harvey I, et al. Bone morphogenetic protein (BMP) for fracture healing in adults. Cochrane Database Syst Rev. 2010 Jun;16(6):CD006950. doi: https://doi.org/10.002/14651858. CD006950.pub.2
Emara KM, Diab RA, Emara AK. Recent biological trends in management of fracture non-union. World J Orthop. 2015 Sep;6(8):623-8. doi: https://doi.org/10.5312/wjo.v6.i8.623
Cameron JA, Milner DJ, Lee JS, Cheng J, Fang NX, Jasiuk IM. Employing the biology of successful fracture repair to heal critical size bone. Curr Top Microbiol Immunol. 2013;367:113-32. doi: https://doi.org/10.1007/82_2012_291.
Gaihre B, Uswatta S, Jayasuriya AC. Reconstruction of Craniomaxillofacial Bone Defects Using Tissue-Engineering Strategies with Injectable and Non-Injectable Scaffolds. J Funct Biomater. 2017;8(4):1-19. doi: https://doi.org/10.3390/jfb8040049
Gudaryan OO, Іdashkіna NG, Nekhanevich ZM. Effectiveness of morphogenetic protein rhBMP-2 use in atypical third mandibular molars extraction. Medicni perspektivi. 2020;25(2):137-144 doi: https://doi.org/10.26641/2307-0404.2020.2.206789
Hankenson KD, Zimmerman G, Marcucio R. Biological perspectives of delayed fracture healing. Injury. 2014;45(02):8-15. doi: https://doi.org/10.1016/j.injury.2014.04.003
Herford AS. The use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in maxillofacial trauma. Chin J Traumatolog. 2017;20(1):1-3. doi: https://doi.org/10.1016/j.cjtee.2016.05.004
Herford AS, Miller M, Signorino F. Maxillofacial Defects and the Use of Growth Factors. Oral Maxillofacial Surg Clinics North America. 2017;29(1):75-88. doi: https://doi.org/10.1016/j.coms.2016.08.006
Hurell MJL, David MC, Batstone MD. Patient compliance and mandible fractures: a prospective study. Int J Maxillofac Surg. 2019. pii: S0901-5027(18)30452-1. doi: https://doi.org/10.1016/j.ijom.2018.11.011
Huang W, Hasegawa T, Imai Y, Takeda D, Akashi M, Komori T. Low-intensity pulsed ultrasound enhan¬ces bone morphogenetic protein expression of human mandibular fracture haematoma-derived cells. Int J Oral Maxillofac Surg. 2015;44(7):929-35. doi: https://doi.org/10.1016/j.ijom.2015.03.001
Pickrell BB, Serebrakian AT, Maricevich RS. Mandible Fractures. Semin Plast Surg. 2017;31(2):100-7. doi: https://doi.org/10.1055/s-0037-1601374
Rouwkema J, Rivron NC, Blitterswijk C. Vascularization in tissue engineering. Trends Biotech. 2008;26:434–441. doi: https://doi.org/10.1016/j.tibtech.2008.04.009
Sánchez-Duffhuesa G, Hiepen C, Knaus P, Dijkea P. Bone morphogenetic protein signaling in bone homeostasis. Bone. 2015;80:43-59. doi: https://doi.org/10.1016/j.coms.2016.08.006
Abou Neel EA, Chrzanowski W, Salih VM, Kim HW, Knowles JC. Tissue engineering in dentistry. J Dent. 2014 Aug;42(8):915-28. doi: https://doi.org/10.1016/j.jdent.2014.05.008
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