Wide Anterior Maxillary Reconstruction with Equine Bone Xenograft: A Case Report of 24-Month Follow-Up

Abstract

Introduction. Orofacial reconstruction plays an important role in the treatment of patients affected by oral and maxillofacial cancers. Improvements in technologies and studies of biomaterials have widely expanded surgical possibilities to achieve good functional and aesthetic outcomes. By the way, xenografting procedures gained great consensus in the last decades, because of their documented reliability and efficacy. We present a case of anterior maxillary chondrosarcoma (CHS) that has undergone surgical ablation followed by reconstruction with an equine-derived bone xenograft. Case Presentation. A 68-year-old woman affected by CHS of the premaxilla underwent surgical ablation involving the four incisors followed by reconstruction using an equine-derived bone substitute. Bony reconstruction was planned to achieve implant and dental prosthetic rehabilitation at a second surgical time. Primary surgery was carried out without complications. Good integration of the graft was confirmed by radiological examination. At 12-month follow-up, the patient refused the implant placement and spontaneously adopted a mobile prosthesis. One year later, plates and screws were removed, because of the exposure of a titanium plate. The graft was finally rejected within 3 weeks. Discussion. Nonantigenic equine-derived biomaterials have shown reliability and a good safety profile. In the presented case, implant insertion should have been performed 12 months after the primary surgery. During the follow-up, until dental mobile prosthesis was applied, clinical and instrumental examinations demonstrated a good integration of the graft. We suppose that a chronic inflammation of the mucosa led to the exposure of the plate, perhaps due to pressure, minimal movements, or imperfect fitting of the mobile prosthesis. Removal of fixation means was performed to prevent grafting failure, without success. On the other hand, missing load could induce the graft to act just like a prosthesis, without a real process of integration. Safety and reliability of equine-derived bone xenografts cannot be currently confirmed if not followed by implant insertion and dental rehabilitation.

Success of Xenografts in Alveolar Ridge Preservation Based on Histomorphometric Outcomes

“…Two of the included studies involved Enamel Matrix Derivative which also has a porcine origin (Alkan et al, 2013) [15], (Mercado et al, 2021) [26]). Seldomly reported studies with an equine origin are also evident in the literature (De Cicco et al, 2020) [31], (Nishimura et al, 2020) [32]. The main findings of the research focused on the two main classifications of xenografts in relation to intra-classifications and we analysed within the bovine xenografts and inter-classifications i.e., between the bovine and porcine xenografts, as well as comparing xenografts to natural healing.…”

Erythropoietin Gel as an adjunct to Xenograft in the Surgical Management of Intrabony Periodontal Defects :A Randomized Controlled Clinical Study

“…Equine-derived particulate xenograft was applied in both groups, because of its osteoconductive property, biocompatibility, and slow rate of resorption. 28 Thus, preventing the collapse of the soft tissue inside the intrabony defect giving enough time for the regeneration to occur. In the test group, a carboxymethyl cellulose-based EPO gel was used as an adjunct to xenograft in the defect.…”