Reconstructive Surgery in the CMF Complex: A Look at the Past and the Present State with a View to Future Challenges
Reconstructive surgery is the vital link to function and quality of life for patients with facial injuries, defects due to tumors, and facial differences from congenital anomalies. The past century has witnessed tremendous advances in reconstructive surgery and Oral and Maxillofacial Surgery has played a significant role in these advances. Application of technology has been a key to contemporary advances and will be for the foreseeable future. The next phase, however, will focus on the use of technology to regenerate the tissues needed for these reconstructive endeavors in hopes of improving the quality of the reconstructions while reducing morbidity and the length of hospital stays. This session will highlight these advances in reconstructive surgery, some of the hurdles on the horizon for regenerative techniques, and the promise they represent.
Clinical Associate Professor of Dentistry, Associate Professor of Surgery, Oral and Maxillofacial Surgery/Hospital Dentistry, University of Michigan Ann Arbor, Michigan, USA
Dr. Edwards received his dental degree from Dalhousie University in Halifax, Nova Scotia. He then came to the University of Michigan where he completed his medical degree and residency training in oral and maxillofacial surgery. He then completed fellowship training in pediatric cleft and craniofacial surgery at the University of Pittsburgh. A second fellowship in head and neck oncologic surgery and microvascular surgery brought him back to the University of Michigan where he has since remained as faculty.
Professionally, Dr. Edwards is the Chief of Pediatric Oral and Maxillofacial Surgery at C.S. Mott Children’s Hospital and the Associate Chair for Research in the Section of Oral and Maxillofacial Surgery. His research has focused on cleft and craniofacial care and sleep disorders, their genesis, and treatment. Dr. Edwards serves on many regional, national, and international committees, has served as a section editor for the International Journal of Oral and Maxillofacial Surgery, and reviews for many journals.
Moving from Bone Grafting to Bone Growing: The Ex-Nihilo Procedures
Bone regeneration has greatly evolved over the last decades. Up until three decades ago, the leading method for the reconstruction of bone defects was native bone transferring, vascularized or non-vascularized, for reconstruction of the defect. This method has significant biological advantages; however, it also carries a high price tag, in the form of longer surgery, an additional surgical site, prolonged pain and discomfort, and greater rates of complications and morbidity. In recent decades, various materials have been developed, including allografts, xenografts, and alloplasts, in an attempt to promote bone regeneration without native bone transfer. However, these materials do not allow for the construction of high quality bone, nor are they appropriate for large defects or for many additional indications. The lecture will review 20 years of experience of both basic science and clinical work in the development and implementation of biological methods for high quality bone regeneration in various types of bone defects without the need for native bone transfer. The concept of bone growing will be presented, and the biological bone regeneration algorithm will be offered.
Professor and Chairman, Department of Oral and Maxillofacial Surgery, Hebrew University-Hadassah Faculty of Dental Medicine, Jerusalem, Israel
After completion of his residency program in Oral and Maxillofacial Surgery at the Hadassah Medical Center, Prof. Casap spent two years in the department of Oral and Maxillofacial Surgery at the University of California, San Francisco.
Prof. Casap is a past chairman of the Israeli Association of Oral and Maxillofacial Surgery and the Israel chancellor of the International Association of Oral and Maxillofacial Surgery. He is an active member of the Israel Dental Association Scientific Committee, Chairman of the Israeli Maxillofacial Professional Committee, and Chairman of the National Accreditation Committee for Dental Specialization Programs.
Prof. Casap is a member of the editorial boards of the Journal of Oral and Maxillofacial Surgery, Quintessence International, and numerous others. He has authored over 70 peer reviewed publications and book chapters. His main research interests are orthognathic and craniofacial surgery, navigation surgery systems, bone reconstruction, bone morphogenetic proteins, endoscopic surgery, and periosteal distraction.
Biologisation of Bone Substitute Materials and Collagen Membranes to Enhance Regeneration Processes in Oral and CranioMaxillofacial Surgery
Within the last decades multiple bone substitute materials as well as collagen membrane have been introduced. All of them are claimed to be the “ideal” material. While focusing on bone formation within GBR and/or GTR the importance of inflammation and wound healing is neglected. The necessity of understanding the wound healing for a successful bone augmentation is, however, crucial for a success in surgery. Furthermore, the combination of biomaterials with blood concentrates might open an avenue toward biological dentistry.
In the present lecture, the processes during wound healing as well as that after biomaterial implantation will be highlighted. The importance of a physiological reaction as the main column for tissue regeneration will be demonstrated. Collagen membranes, which do not induce a foreign body giant cell reaction, will be shown to be fully integrated within the soft tissues. Bone substitute material with the absence of foreign body reaction will be demonstrated to be contributing to build a hybrid bone, which can serve as an optimal source within the implant bed.
Additionally, the development of blood concentrates for promoting tissue regeneration within oral cavity will be shown. Up to now, however, there has been no systematic approach with regard to how to apply blood concentrates for different applications in dental surgery. In this lecture, the development of PRF (Platelet-Rich-Fibrin) as an autologous blood concentrate and the LSCC (low speed centrifugation concepts) will be introduced. The results of multiple clinical studies for different indications will be shown, in order to highlight the potential of PRF for improving conditions during dental surgery.
Vice Director, Head of research laboratory FORM, Head of Head and Neck Center of UCC (University Center for Cancer Diseases), Medical Center of the Goethe University Frankfurt, Germany, Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery
Prof. Shahram Ghanaati has a triple doctorate in medicine, dentistry, and science (MD, DMD, PhD) from the German universities Johannes Gutenberg University, Mainz, and Johann Wolfgang Goethe University, Frankfurt. From 2007 to 2013, he successfully completed his residency at the Clinic of Oral, Cranio-Maxillofacial and Plastic Surgery, Johann Wolfgang Goethe University, Frankfurt.
Today, he leads the Head and Neck Oncology section at the University Cancer Center, Johann Wolfgang Goethe University, Frankfurt, and is an Associate Professor at the Clinic of Oral, Cranio-Maxillofacial and Plastic Surgery, and a faculty member at the Johann Wolfgang Goethe University Frankfurt.
Prof. Ghanaati has performed a series of translational studies (preclinical and clinical) with special focus on biomaterial-related cellular reaction and regeneration capacity. Since 2005, he has extensively studied the inflammatory pattern and regeneration capacity of biomaterials with respect to different physicochemical properties. He developed a biomaterial-based technique for extraoral skin regeneration, which received 510 (k) in USA in 2017. Presently, he is a research consultant for the world’s leading manufacturer of biomaterials. In 2009 he founded the FORM-Lab (Frankfurt Orofacial Regenerative Medicine) and has led it ever since.
Prof. Ghanaati performed more than 80 lectures at national and international congresses and gave more than 40 courses and workshops on GTR & GBR in Implantology as well as on regenerative concepts and blood concentrates.
Contemporary Tissue Engineered Allogeneic Bone Grafts for Predictable Reconstructionand Regeneration of Maxillofacial Defects
The primary objective in the reconstruction of maxillofacial continuity defects is the restoration of these defects to an appropriate esthetic form and functional capability. The material of choice for osseous grafting has been autologous corticocancellous bone, obtained using a variety of techniques, including traditional iliac crest graft harvest and vascularized free flap transfer. However, a major disadvantage of these approaches has been the potential complications and morbidity resulting from the need for a second surgical site and the extended length of surgery and hospital stay. The advent of tissue engineering was a major achievement in the surgical armamentarium. Perhaps the greatest advantages of tissue-engineered grafts are the improved surgical efficiency and decreased risks associated with graft procurement. This depends on the recruitment and placement of osteocompetent cells into a favorable microenvironment. In general, an environment conducive for osteomigration and osteodifferentiation requires a biologic tissue scaffold and an adequate amount of growth signals without allowing ingrowth of fibrous tissue. Aspiration of bone marrow material, combined with an immediate centrifugation method, provides an effective, low-cost method for harvesting mesenchymal stem cells (MSCs) relatively safely. Allogeneic bone in particulate form can be used as a biologic scaffold, and recombinant human bone morphogenic protein-2 (rhBMP-2) is used to provide the required signaling agents and supporting growth factors. The composite tissue-engineered graft, although used sparingly in the past, is now a mainstay in the reconstruction of maxillomandibular continuity defects resulting from benign pathologic ablation or trauma at our institution (Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center at Houston).
Associate Professor, Department of Oral & Maxillofacial Surgery, Oral, Head & Neck Oncology and Microvascular Reconstructive Surgery, University of Texas Health Science Center at Houston
Dr. Melville earned a bachelor’s degree in biological sciences and history from the University of California Santa Barbara and graduated from the University of Michigan School of Dentistry in 2005. He completed a General Practice Residency at the University of California San Francisco in 2006 and served as assistant professor there until 2007. Dr. Melville then pursued and completed a residency in oral and maxillofacial surgery at the University of Miami/Jackson Memorial Hospital. After his surgical residency, Dr. Melville remained at the University of Miami to complete a two-year fellowship in maxillofacial head and neck oncology and microvascular reconstructive surgery.
Dr. Melville practices and teaches residents at Memorial Hermann Hospital, Ben Taub General Hospital, Houston Methodist Hospital, and Lyndon B. Johnson Hospital. His primary interests include maxillofacial trauma, head and neck oncology, head and neck microvascular surgery, facial reconstruction, bone-grafting, tissue-engineering, medication-related osteonecrosis of the jaw, and osteoradionecrosis of the jaw
He is the author of more than 10 articles in peer-reviewed journals and has authored three chapters in major oral and maxillofacial surgery textbooks.
4 CME credits will be provided for full participation in the program.
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of PeerPoint Medical Education Institute, LLC and Osteo Science Foundation. The PeerPoint Medical Education Institute, LLC is accredited by the ACCME to provide continuing medical education for physicians.
The PeerPoint Medical Education Institute, LLC designates this live activity for a maximum of 4 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Osteo Science Foundation
Nationally Approved PACE Program Provider for FAGD/MAGD credit.
Approval does not imply acceptance by any regulatory authority or AGD endorsement.
7/1/18 to 6/30/21
Provider ID: 370582
4 CDE credits will be provided for full participation in the program. AGD Code 310
Claiming CE Credit
How to Get Your Certificate
During the week of July 1, those who completed the online evaluation and requested CE credit will receive a PDF with the CE certificate and instructions on how to obtain your CME certificate. Because the CME is coordinated through PeerPoint, it is necessary for you to log onto their website to access your CME certificate.
Osteo Science Foundation
1650 Market Street, Suite 3600
Philadelphia, PA 19103
855-891-2877 Toll Free
Osteo Science Foundation is an independent, privately funded 501 (c) (3) non-profit organization.