PMC5116519_01
PMC5116519_02
PMC5116519_03
CT scans of the patient's mandible in the frontal region (a) and within the ramus on the right side (b) prior to the operation and 3, 6, and 12 months after surgery. Arrows indicate nonunions (before operation) and the sites of gene-activated bone substitute implantation.
CRID2016-8648949.001.jpg
PMC5116519_05_CRID2016-8648949.001.jpg
fig1
3 months after surgery, increased density regions were visualized in the zones of the distal and proximal autograft fixation and bone grafting (Figure 1). HU within gene-activated bone substitute implantation area were observed in the frontal region 6 and 12 months after surgery (Figures 1 and 4). However, there was moderate partial resorption in the proximal edge of the bone autotransplant which prevented consolidation and maintained a diastasis.
PMC5116519_04
Intraoperative view: nonunions are removed; mandible fragments and rib autograft are fixed with miniplates; bone defects filled with gene-activated bone substitute.
CRID2016-8648949.002.jpg
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fig2
Bone defects (5-14 mm in the frontal region; 7-9 mm in the distal region of the mandible) within the rib autograft, still present from previous interventions and mandibular fragments, were filled in with the gene-activated bone substitute (Figure 2).
PMC5116519_05
CT scans of the patient's mandible in the frontal region (a) and within the ramus on the right side (b) prior to the operation and 3, 6, and 12 months after surgery. Arrows indicate nonunions (before operation) and the sites of gene-activated bone substitute implantation.
CRID2016-8648949.001.jpg
PMC5116519_05_CRID2016-8648949.001.jpg
fig1
3 months after surgery, increased density regions were visualized in the zones of the distal and proximal autograft fixation and bone grafting (Figure 1). HU within gene-activated bone substitute implantation area were observed in the frontal region 6 and 12 months after surgery (Figures 1 and 4). However, there was moderate partial resorption in the proximal edge of the bone autotransplant which prevented consolidation and maintained a diastasis.
Panoramic radiography, next day after surgery.
CRID2016-8648949.003.jpg
PMC5116519_05_CRID2016-8648949.003.jpg
fig3
Average density in the regions of nonunions (0) and the sites of gene-activated bone substitute implantation in 3, 6, and 12 months after surgery.
CRID2016-8648949.004.jpg
PMC5116519_05_CRID2016-8648949.004.jpg
fig4
The average density of these areas was 402.21 +- 84.40 in the frontal fixation and 447.68 +- 106.75 HU within the distal fixation (Figure 4). HU within gene-activated bone substitute implantation area were observed in the frontal region 6 and 12 months after surgery (Figures 1 and 4). However, there was moderate partial resorption in the proximal edge of the bone autotransplant which prevented consolidation and maintained a diastasis.
The patient's mandible in different time points after bone grafting with the gene-activated bone substitute: (a) before; (b) 6 months; (c) 12 months. Dental CT; 3D reconstruction with volume rendering 250-2000 HU (titanium constructs are excluded).
CRID2016-8648949.005.jpg
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fig5
Heteromorphic newly formed tissues were seen in these areas; the tissues overstretched the bone boarders of the reconstructed mandible outlining to a certain extent the substitute engrafted previously (Figure 5). Meanwhile, the distal edge of the rib autograft was completely integrated with adjacent mandibular ramus on both latest time points which did not allow distinguishing the borders between the mandible fragment, newly formed bone tissue, and rib autograft to segment these regions (Figure 5).