[Osteoplasty of extensive jaw defects by protected bone regeneration using large pore resorbable implant]

This study was performed to demonstrate a protected bone regeneration method using macroporous resorbable sheets for the treatment of extended lower and upper jaw defects. By applying mechanical protection of bony defects with, e.g. membranes or titanium mesh, soft tissue prolapse as well as pressure on bone transplants which contributes to partial resorption can be avoided. The use of a pressure-resistant, resorbable, macroporous sheet combines the advantage of protected bone regeneration and complete resorption of the implanted sheet. The macroporous structure facilitates capillary ingrowth from the surrounding soft tissue. The sheet is made of 70:30 Poly(L-co-DL)-lactate with thermoplastic character and can be used as a container for autologous spongiosa or other osteoinductive and -conductive bone graft substitutes. In a pilot study, seven patients with lower jaw defects resulting from large cysts or tumor resections, some affecting the continuity of the mandible, were treated with this method. Following a protocol, X-rays were obtained to document the bony regeneration. The positive experience with this pilot study encouraged a multicenter project involving five university hospitals and 50 patients. The application of resorbable sheets in combination with transplantation of mersilized autologous spongiosa is currently being investigated. In future studies, fillings of sheets with osteoconductive and -inductive materials are planned.