Spontaneous bone healing of the large bone defects in the mandible

doi:10.1016/j.ijom.2008.07.008

International Journal of Oral and Maxillofacial Surgery

Volume 37, Issue 12, December 2008, Pages 1111-1116

https://doi.org/10.1016/j.ijom.2008.07.008 Get rights and content

Abstract

Spontaneous healing of large bone defects in the mandibles of 33 patients was studied. Standard postoperative clinical and radiographic examinations were performed immediately after surgery and after 2, 6 and 12 months. They were analysed using a novel relative bone densitometry method and indexes of relative bone healing were established. Spontaneous bone regeneration occurred in all patients clinically, and the computer analysis of radiographs showed that the mean final bone density in the bone defects was 88% of the bone density of the surrounding healthy bone. In the cases of smaller defects (the greatest diameter on panoramic radiographs was 20–30 mm) the final bone density was 97%, while the larger defects finally healed with 84% of the bone density of the surrounding bone. Increased patient age had a negative influence on healing and the shape of the bone defects was more important for healing than their volume. Spontaneous bone healing occurred even in large bone defects in the mandible, therefore this simple treatment with low economic and biological costs should be the treatment of choice, taking into account the patient's age, surgical principles and time of rehabilitation.

Section snippets

Materials and Methods

33 patients with large BDs after surgical treatment were included in the study, 14 males and 19 females, aged from 5 to 70 years. Predominant were patients with inflammatory odontogenic cysts (radicular and residual) followed by odontogenic keratocysts (15 radicular and 1 residual cysts, 13 odontogenic keratocysts, 2 follicular cysts, 1 ameloblastic fibroma and 1 eosinofil granuloma).

The patients were treated with standard enucleation or radical extended extirpation (cyst walls with part of the

Results

Clinical observations and visual subjective radiographic analysis showed that detectable spontaneous bone regeneration occurred in all patients. No patient had inflammatory or other complications.

Computer analysis of PRs showed that the mean gain of bone density was 7% after 2 months, 27% after 6 months and 46% after 1 year. The values of the indexes of relative bone healing of the observed BD regarding their size on radiographic projections are shown in Fig. 4, Fig. 5 summarizes data about

Discussion

Bone healing in the mandible of BDs 20–50 mm in diameter is better than the authors expected clinically. Computer analysis of PRs showed that the mean final bone density in the BDs was 88% of the bone density of the surrounding bone. In the cases of smaller BDs (20–30 mm) the final bone density was 97%, while BDs of 30–50 mm healed with 84% of normal surrounding bone density after 1 year. These results are similar to those reported by Chiapasco et al.⁵ despite using a different method. It means

References (25)

M.H. Amler
The time sequence of tissue regeneration in human extraction wounds
Oral Surg Oral Med Oral Pathol
(1969)
J.O. Andreasen et al.
Modes of healing histologically after endodontic surgery in 70 cases
Int J Oral Surg
(1972)
R.M. Bloxom et al.
The accurancy of an x-ray film quality-assurance step-wedge test
Oral Surg Oral Med Oral Pathol
(1986)
H. Devlin et al.
A comparison of maxillary and mandibular bone mineral densities
J Prost Dent
(1998)
A.S.H. Duinkerke et al.
Densitometric analysis of experimentally produced periapical radiolucencies
Oral Surg Oral Med Oral Pathol
(1977)
M.B. Guglielmotti et al.
Alveolar Wound Healing and ridge Remodeling After Tooth Extraction in the Rat
J Oral Maxillofac Surg
(1985)
K.O. Henkel et al.
Repair of bone defects by applying biomatrices with and without autologous osteoblasts
J Cran Maxillofac Surg
(2005)
E. Hjørting-Hansen et al.
Incomplete Bone Healing of Experimental Cavities in Dog Mandibles
Br J Oral Surg
(1971)
R. Mitchell
An evaluation of bone healing in cavities in the jaws implanted with collagen matrix
Brit J Oral Maxillofac Surg
(1992)
L. Rimondini et al.
In vivo experimental study on bone regeneration in critical bone defects using an injectable biodegradable PLA/PGA copolymer
Oral Surg Oral Med oral Pathol Oral Radiol Endod
(2005)

S. Srouji et al.

Bone marrow stem cells and biological scaffold for bone repair in aging and disease

Mechanisms Ageing Development

(2005)

D.A. Tyndall et al.

Digital Subtraction Radiography for Detecting Cortical and Cancellous Bone changes in the Periapical Region

J Endod

(1990)

Cited by (87)

Spontaneous recovery of underlying bony erosion following surgical removal of craniofacial dermoid cysts in periatric patients: A prospective study
2023, Journal of Cranio-Maxillofacial Surgery
This study aimed to evaluate the spontaneous recovery of bone deformity after surgical excision of craniofacial dermoid cysts in pediatrics.
Pediatric patients who underwent excision of a dermoid cyst were included in the study. A prospective analysis was conducted to evaluate the amount of bone recovery by comparing the depth of bony concavity in the preoperative and postoperative (6 months) ultrasonography.
In 145 of 187 patients with preoperative imaging available, the mean size of dermoid cysts was 1.4 cm³ (range, 0.1 to 9.5), and 41.4% (60/145 cases) showed cranial bone depression. In the comparison of preoperative and postoperative ultrasonography of 30 patients, the mean depth of bony cavity decreased significantly from 4.0 to 0.9 mm (p<0.001) after a mean of 6.7 months postoperatively. There was 13.3% (4/30) of mild (≤2.0 mm), 40.0% (12/30) of moderate (>2.0 to ≤4.0 mm), and 46.7% (14/30) of severe (>4.0 mm) depression, and the concavity depth significantly decreased in all groups (p = 0.028, mild; p<0.001, moderate; p<0.001 severe).
Within the limitations of the study it seems that significant recovery of cranial bone depression does take place within 6 months after excision of craniofacial dermoid cysts in pediatric patients, saving the need for immediate reconstruction.
A prospective, randomized, single-blind study to compare two methods of treating cystic lesions in the jaw
2023, Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
The study aimed to assess the usefulness of a bovine bone substitute material in treating cystic lesions in the jaw with a maximum diameter of <4 cm.
In this prospective, randomized, single-blind intervention study of 116 patients, 61 underwent cystectomy with a subsequent filling of the defect using a bovine xenograft, and 55 underwent cystectomy alone. Volumetric measurement of the cysts was performed preoperatively and 6 and 12 months postoperatively using the available digital volume tomography data sets. Follow-up appointments were made 14 days and 1, 3, 6, and 12 months postoperatively.
Almost complete regeneration was seen in both treatment groups within 12 months, with no significant difference in absolute volume loss between the 2 groups (P = .521). Examination 14 days after surgery revealed a tendency for more wound healing disorders with the use of a bone substitute (P = .077). It was no longer possible to detect any further differences in later examinations.
Using bovine bone substitute material has no radiologically measurable advantage over cystectomy alone without defect filling regarding bone regeneration. In addition, there was a tendency for more wound-healing disorders to occur in the bone substitute group.
Role of iodoform in jaw lesions: a systematic review
2023, British Journal of Oral and Maxillofacial Surgery
Iodoform formulations are used as packing material following the surgical removal of jaw lesions. The purpose of this review was to explore the evidence and efficacy of iodoform-based dressings. We have systematically reviewed published articles according to the PRISMA statement. The search was conducted in PubMed, Google Scholar, Semantic Scholar, and the Cochrane Library database for articles mentioning the use of iodoform as dressing material for jaw lesions from January 2000 to March 2022. Finally, 92 studies were included. A total of 386 patients whose ages ranged from five months to 86 years (male n = 180, female n = 117). Different formulations of iodoform used were BIPP (n = 67), Whitehead’s varnish (n = 17), iodoform (n = 7) and, iodine (n = 1) for its antiseptic properties. An iodoform impregnated gauze pack was changed once a week, most commonly, for a stipulated duration, until complete healing of the cavity. In the present review, iodoform was used, most commonly, in pathological cavities following surgical treatment of ameloblastoma and odontogenic keratocyst. Toxicity was reported in two studies. Based on the current review, iodoform is relatively safe and can be used in the management of extensive jaw lesions in which secondary healing is expected. Prospective and randomised control trials are recommended to assess the efficacy of various formulations and to delineate the timeframe for patient compliance.
Long-term bone remodeling after definitive decompression for jaw cysts based on a three-dimensional analysis
2023, Journal of Stomatology, Oral and Maxillofacial Surgery
Decompression is an effective treatment for jaw cysts. Many studies have reported its effectiveness as a preliminary treatment followed by secondary enucleation. This study aimed to explore long-term bone remodeling after definitive decompression for jaw cysts based on a three-dimensional (3D) analysis.
This was a retrospective study. The clinical and radiological data of patients with jaw cysts who underwent decompression and were followed up for two years or more at Peking Union Medical College Hospital between January 2015 and December 2020 were reviewed. The 3D radiological data before and after decompression were analyzed to study the long-term reduction in cysts, especially after one year of decompression.
A total of 17 patients with jaw cysts were included in this study. The radiological data showed a mean reduction rate of 78% one year after decompression. At the final examination, which was 36.1 months after decompression on average, the mean reduction rate was 86%. The unossified lesions could still ossify slowly after one year of decompression. The recurrence rate was 5.9% (1/17).
Bone remodeling continued for a long time after decompression. Definitive decompression could be an option for most patients with jaw cysts. Long-term follow-up is required.
Treatment effect analysis of curettage for jaw cysts based on volumetric assessment and image registration
2022, Journal of Cranio-Maxillofacial Surgery
The study was conducted to develop a visual and intuitive quantitative evaluation method for maxillary cystic lesions after curettage. Mimics 16.0 and Geomagic Studio 2013 were used to form a precise reconstruction of the cystic lesion morphology of 60 cases; the average reduction rates and 95% confidence interval were calculated. Computed tomography (CT) registration was performed before and after surgery to observe morphology features of the bone regeneration of the cystic area. The average reduction rates (RR) of the cysts after curettage were (43.56 ± 16.79)%, (54.33 ± 17.15)% and (68.53 ± 15.99)% at 3 months, 6 months and 12 months after surgery, respectively. The average monthly reduction rates (MRR) were (12.07 ± 4.35)%, (8.16 ± 2.84)% and (5.35 ± 1.52)% at 3 months, 6 months and 12 months after surgery, respectively. Correlation analysis by comparing with each group showed that the effect of sex and age in the 3-month group and the initial size in the 12-month group on RR and MRR were statistically significant. Within the limitations of the study it seems that the chosen approach for quantitative evaluation of the therapeutic effect of curettage for jaw cystic lesions might facilitate visual and quantitative follow-up of cyst curettage and timely detection of recurrence.
A retrospective risk factor analysis of infection and wound dehiscence following guided bone regeneration in cystectomy defects of the jaws
2022, Journal of Cranio-Maxillofacial Surgery
This study's objective is to determine if the combined use of bone substitutes and collagen membranes is related to worse postoperative outcomes after intra-osseous oral cystectomies. Additional risk factors mentioned in the existing literature were retrospectively analysed by reviewing the medical records and imaging tests of adult patients. Age, gender, smoking habit, cyst location, size, shape, histopathology, perilesional osteosclerosis and associated intracystic third molars were registered. The type of biomaterials applied and the number of bony walls remaining after surgery were also identified. All factors were analysed in relation to wound dehiscence and postoperative infection. Simple and multiple logistic regression analyses were performed to exclude possible confounding effects between the risk factors identified. In a sample of 211 cystectomies, guided bone regeneration was not significantly associated with infection, only the presence of impacted third molars was (p = 0.0219). This finding remained true, even in cysts larger than 25 mm. However, the risk of wound dehiscence was 4.9 times higher when biomaterials were applied (CI 95%, 1.6818–12.8274, p = 0.0014). In accordance with recent studies, these findings suggest that whenever guided bone regeneration might prove useful after cyst enucleation, avoiding chemically cross-linked membranes should be considered.

View all citing articles on Scopus

View full text

Clinical PaperOral SurgerySpontaneous bone healing of the large bone defects in the mandible

Abstract

Section snippets

Materials and Methods

Results

Discussion

Oral Surg Oral Med Oral Pathol

Int J Oral Surg

Oral Surg Oral Med Oral Pathol

J Prost Dent

Oral Surg Oral Med Oral Pathol

J Oral Maxillofac Surg

J Cran Maxillofac Surg

Br J Oral Surg

Brit J Oral Maxillofac Surg

Oral Surg Oral Med oral Pathol Oral Radiol Endod

Mechanisms Ageing Development

J Endod

Clinical Paper
Oral Surgery
Spontaneous bone healing of the large bone defects in the mandible