Reconstruction of the Mandible Using Preshaped 2.3-mm Titanium Plates, Autogenous Cortical Bone Plates, Particulate Cancellous Bone, and Platelet-Rich Plasma: A Retrospective Analysis of 20 Patients

Purpose: The purpose of this retrospective study was to evaluate a group of 20 patients who underwent a reconstruction of the mandible by use of free bone grafts and platelet-rich plasma (PRP). Materials and Methods: In a period of 8 years, 20 patients underwent a reconstruction of the mandible, by use of preshaped 2.3-mm titanium plates, autogenous cortical bone plates, autogenous particulate bone, PRP, and a special fixation technique. The patients were divided into 3 groups. Group 1 consisted of 10 patients who underwent secondary reconstruction after ablative surgery for malignant tumors. Of these, 4 had preoperative or postoperative radiotherapy. Group 2 comprised 7 patients who underwent primary reconstruction after resections for benign but aggressive odontogenic tumors. Group 3 consisted of 3 patients with severe atrophy and malunion. The defects ranged in size from 8 to 12 cm in groups 1 and 2 and from 2 to 4 cm in group 3, and the follow-up ranged from 1 to 8 years. Results: The initial healing was uneventful in all but 3 patients. In these 3 patients additional bone grafts had to be placed to allow for optimal implant placement. At the time of implant insertion, some areas of granulation tissue were found, possibly because of the rather high dose of PRP used. Continuity in all cases was achieved, and the patients considered the results good in 10 cases and satisfactory in 9 cases. One patient could not be approached for the last assessment. Conclusion: The grafting and fixation technique used proved to be rather reliable. The antimicrobial effect and the proliferation of osteoblasts are likely to be responsible for the results achieved. (C) 2010 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 68:2459-2467, 2010