Regeneration of mandibular ameloblastoma defect with the help of autologous dental pulp stem cells and buccal pad of fat stromal vascular fraction

Abstract

Ameloblastoma is benign odontogenic tumor, which is locally aggressive in behavior. Till date, the treatment of choice is resection and reconstruction using a variety of modalities. Inadequate resection may lead to many complications such as bone deformity and dysfunction. This report is about a 14-year-old male with ameloblastoma treated with autologous dental pulp stem cells (DPSCs) and stromal vascular fraction (SVF) and evidence of bone regeneration. Marsupialization was performed; tooth was extracted and sent for DPSC cultivation. On the day of surgery, SVF was processed from buccal pad of fat, and platelet-rich fibrin (PRF) was prepared from patient's peripheral blood. During the procedure, labial plate resection and curating of tumor lining were done. After which, a mesh packed with SyboGraft T-plug, prepared SVF, DPSCs, and PRF were placed over lingual cortex and pressure dressing was done. After the 1st month of surgery the postoperative course was uneventful, the wound shrinkage led to exposure of mesh in the intraoral region. Removal of exposed mesh was done. The correction surgery with removal of part of mesh and primary closure was achieved with SyboGraft plug, SVF and PRF. Enhanced bone formation was seen in post-operative OPG and CT Scan after 10th month. In this article, we propose an innovative approach to manage these cases by using a combination of autologous DPSC and buccal pad of fat SVF to regenerate a mandibular defect left by the resection of an ameloblastoma with 1.5 year follow-up. We were able to demonstrate bone regeneration using this technique with no recurrence of tumor.

Cross-Talk Between Mesenchymal Stromal Cells (MSCs) and Endothelial Progenitor Cells (EPCs) in Bone Regeneration

“…Bone regeneration was confirmed through medical imaging. The authors observed no recurrence during the one and a half year follow-ups (Manimaran et al, 2016). Two patients suffering from medication-related osteonecrosis of the jaw (MRONJ) were treated with a combination of L-PRF and fresh SVF in a one-step procedure.…”

“…Since then, MSCs have been studied in numerous clinical studies for representative diseases, including organ transplantation, diabetes, inflammatory, hematological, cardiovascular, autoimmune, cartilage, and bone disease (Squillaro et al, 2016). Clinical studies promoted non-union fracture healing (Hernigou et al, 2015), accelerated fracture healing (Kim et al, 2009) or bone regeneration in bone tissue defect (Pavan Kumar et al, 2016) and other pathological conditions (Manimaran et al, 2014(Manimaran et al, , 2016Bouland et al, 2020). The clinical applications of the different sources of MSCs are detailed in Table 1.…”

“…The authors observed no recurrence during the one and a half year followups. Bone regeneration was confirmed through medical imaging (Manimaran et al, 2016). Since then, different approaches have been studied to improve bone regeneration using DP-MSCs, such as a specific scaffold (Petridis et al, 2015), the cell sheet technique (Fujii et al, 2018), and inflammation (Tomasello et al, 2017).…”

Culture of human dental pulp cells at variable times post-tooth extraction

“…23 Moreover, hDPSCs demonstrated pro-angiogenic capability and are able to exert a positive effect in the regeneration of nerve tissue in vivo. 24 Daily, many live teeth are extracted for many reasons, such as avulsion and exfoliation or during orthodontics and periodontics.…”

Regenerative Models for the Integration and Regeneration of Head Skeletal Tissues

“…This method had an 84% success rate but does not work well with post radio-therapy patients or elderly people who have diminished bone precursor cells [30]. A combination of buccal fat pad stem cells (from the cheek) with iliac bone grafts has been used to treat maxillomandibular atrophy, and a resultant increased bone width was reported in the experimental group [30,31]. Similarly, allogenic chord stem cells or cranial derived bone marrow stem cells combined with alloplastic graft material for mandibular reconstruction has demonstrated some bone regeneration [22,23].…”