Nobuyuki Mizuki

A carrier for clinical use of recombinant human BMP-2: dehydrothermally cross-linked composite of fibrillar and denatured atelocollagen sponge

The clinical applicability of a dehydrothermally cross-linked composite of fibrillar and denatured atelocollagen sponge (DCFD-AS), as a carrier of recombinant human bone morphogenetic protein-2 (rhBMP-2) was evaluated in the rat subcutaneous pouch. After four weeks, DCFD-AS with rhBMP-2 formed compact bone, without undergoing significant changes in shape and size, by means of intramembranous ossification. The ultimate size, shape and location of induced new bone was accurately controlled by the carrier. Low antigenicity of soluble atelocollagen, cross-linking without chemicals, the combination of gelatin with fibrillar collagen, and the spongy structure probably all contributed to new bone formation through intramembranous ossification without inducing an inflammatory response. Atelocollagen sponge is easily sterilized, can be stored at room temperature, and can act as a rhBMP-2 carrier without the need for complex procedures.

A newly developed collagen/silicone bilayer membrane as a mucosal substitute: a preliminary report

A new bilayer membrane proved effective as a mucosal substitute. The membrane is composed of an outer layer of silicone and an inner layer of dehydrothermally cross linked composites of fibrillar and denatured collagen sponge. The membrane was placed on oral mucosal defects of five patients after operations for cancer. Ten to 14 days after application the outer silicone sheet was removed, leaving only the inner collagen sponge layer into which cellular tufts of fibroblasts and capillaries had infiltrated. The infiltrated collagen matrix became a new connective tissue that epithelialised rapidly by migration of peripheral epithelium 4-5 weeks after application. In all cases the postoperative course was unremarkable and the repair was effective.

Vertical distraction of a free vascularized osteocutaneous scapular flap in the reconstructed mandible for implant therapy

This paper describes a case of vertical distraction osteogenesis of a free vascularized osteocutaneous scapular flap in the reconstructed mandible before implant therapy. The patient was a 67-year-old woman with squamous cell carcinoma of the right lower gingiva. She underwent segmental mandibulectomy for tumor ablation and reconstruction with an osteocutaneous scapular flap. The distraction protocol, clinical course and implant therapy are presented. Through this procedure, the bone height of the scapular graft increased by 10mm. Implants with adequate length could be placed in the distracted area. Two years after masticatory loading, the condition of these implants was stable. Vertical distraction osteogenesis of the scapular flap was considered effective when performed before implant therapy, to facilitate postoperative functional and esthetic restoration after tumor resection.

Management considerations in reconstruction of postablative defects of the mandible: vertical distraction of a scapular bone flap and removable lip support: a case report

OBJECTIVE To describe vertical distraction osteogenesis of a scapular flap and removable lip support for oral rehabilitation after surgical creation of an ablative defect of the mandible. CASE REPORT A 70-year-old man who was diagnosed with squamous cell carcinoma of the left lower gingiva underwent segmental mandibulectomy for tumor ablation and reconstruction with a scapular bone flap. To augment bone height of this flap, vertical distraction osteogenesis was performed. After denture fabrication, a removable lip support was placed between the implant-supported denture and the lower lip. RESULTS The bone height of the scapular bone flap increased by 9 mm. Implants with adequate length could be placed in the distracted bone. The lip support was effective. Two years after masticatory loading, the implants remained stable. CONCLUSION Vertical distraction osteogenesis of the scapular bone flap was suitable to facilitate postoperative functional and esthetic restoration after tumor resection. A removable lip support was also useful as a supplementary tool for oral rehabilitation.

Modified Sagittal Splitting Ramus Osteotomy by Epker's Method. Comparison with Obwegeser-Dal Pont's Method.

Since 1989, modified sagittal splitting ramus osteotomy, as modified by Epker in 1977: for surgical correction of mandibular skeletal deformities, has been used at our hospital. Advantages of this procedure are safety, capability of rotating the distal segment horizontally, and maintaining a blood supply to the proximal segment. Compared with Obwegeser-Dal Ponts method, there were no obvious differences in operating time and hemorrhage dose, but the frequency of mental nerve paresthesia was decreased by Epkers method. Minimized soft tissue dissection and short lingual cut of the medial ramus can reduce many complications and simplify the operative procedure. It was suggested that modified sagittal splitting osteotomy by Epkers method was very useful for surgical-orthodontic correction of mandibular prognathism.