Stem cell therapies have been used successfully in a number of cranio-maxillofacial indications.  Perhaps the most frequently performed surgery of this type is the insertion of dental implants as an alternative to full or partial dentures.  A screw, generally a titanium material coated with hydroxyapatite, is inserted into the bone of the mandible or maxilla, and over several weeks the bone grows into the coating on the titanium.  Once securely anchored into the bone, an artificial tooth is attached to the screw.

Use of cells is not frequently required for implants placed in the mandible, the bone that supports the lower teeth, but many older patients have erosion of the bone of the maxilla, the bone that supports the upper teeth.  If there is insufficient bony material to hold the implant screw, it is necessary to perform a sinus lift procedure which is designed to thicken the bone of the maxilla such that the screw can be securely attached to the bone.

Case Study

The patient shown in the following case had been treated for cancer of the throat with a series of radiation treatments.  While the radiation has the desired effect and killed the cancerous cells, it had the unintended effect of destroying most of the blood vessels that perfused the right side of the patient's face.  The patient presented with a cystic lesion of the mandible that progressed to a complete pathological fracture.  Loss of teeth on both the upper and lower side is evident.

The patient underwent surgery where the surgeon placed a metal fixation device to stabilize the fracture, and then stem cells encapsulated in a crushed bone matrix was introduced around the fracture line.

Following surgery, the bone healed sufficiently to allow the anchoring of implant screws.  The metal fixation and two implant screws are visible on the x-ray image taken just before the prosthetic teeth were attached.

The gadolinium enhanced MRI image below shows new collateral circulation in the affected region.  Before and after skin histology shows that nearly 50% of the skin in the before image was dead (shown by white area) while in the after image 100% of the skin was vital.