Sinus augmentation using human mesenchymal stem cells loaded into a β-tricalcium phosphate/hydroxyapatite scaffold

Dental Faculty, Tehran University of Medical Sciences, Tehran, Iran.
Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology (Impact Factor: 1.46). 09/2008; 106(2):203-9. DOI: 10.1016/j.tripleo.2007.12.001
Source: PubMed


Implant placement in the posterior maxilla may often be contraindicated because of insufficient bone volume and presence of the maxillary sinus. In these situations, sinus floor augmentation frequently has been proposed as the best treatment. This clinical study was based on the hypothesis that the clinical effectiveness of adult mesenchymal stem cells (MSCs) loaded to the biphasic scaffold.
In this report, the clinical and radiographic results are presented on 6 consecutively treated patients using MSCs in combination with biphasic hydroxyl apatite/ beta-tricalcium phosphate (HA/TCP) for sinus elevation. All the patients in the study had less than 3 mm initial bone height in the posterior maxillary area (IBH). MSCs were cultured and expanded from bone marrow aspirate for each patient. Three months after sinus elevation, radiographic evaluation was performed for the patients and the secondary bone height was measured (SBH(1)). In the second stage surgery, 30 implants were placed. Trephine bur was used as a pilot drill and a core biopsy was obtained from each implant site. Prosthetic rehabilitation of the patients was performed after 4 months. Secondary bone height was measured 9 months after implant placement (SBH(2)).
Of 30 implants, 28 (93%) were considered clinically successful. Two implants were removed due to mobility at the time of surgical exposure. Histologic evaluation of the biopsy specimens revealed numerous areas of osteoid and bone formation HA/TCP, with no evidence of inflammatory cell infiltrate. Mean bone regenerate was 41.34%. Clinically, no complications were observed, and all implants were considered clinically osseointegrated after 4 months. Mean bone height was measured 3 and 12 months after sinus grafting (mean of SBH(1)= 12.08 mm and mean of SBH(2)= 10.08 mm).
These clinical and histological findings suggest that sinus grafting with HA/TCP in combination with MSCs provide a viable therapeutic alternative for implant placement. The findings suggest that the addition of MSCs to bone derivative/substitute materials may enhance bone formation in the maxillary sinus area. Of course more studies with the control groups are needed for the evaluation of this method as a clinical solution for the patients.

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Available from: Ahad Khoshzaban, Jul 13, 2015
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    • "In vitro culture and osteogenic commitment of MSC on the surface of BCP biomaterials could lead to the production of engineered bone constructs (Yoshikawa et al. 1998). Indeed, these techniques have been proven to be efficient in a large number of preclinical studies (Cowan et al. 2004, van Gaalen et al. 2009) and clinical cases (Kitoh et al. 2004, Morishita et al. 2006, Pradel et al. 2006, Shayesteh et al. 2008). In the present study, we first demonstrated the viability and reliability of the osteogenic commitment process for TBM-derived MSC cultured on BCP. "
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    ABSTRACT: For craniofacial bone defect repair, several alternatives to bone graft (BG) exist, including the combination of biphasic calcium phosphate (BCP) biomaterials with total bone marrow (TBM) and bone marrow-derived mesenchymal stromal cells (MSCs), or the use of growth factors like recombinant human bone morphogenic protein-2 (RhBMP-2) and various scaffolds. Therefore, clinicians might be unsure as to which approach will offer their patients the most benefit. Here, we aimed to compare different clinically relevant bone tissue engineering methods in an "all-in-one" study in rat calvarial defects. TBM, and MSCs committed or not, and cultured in two- or three-dimensions were mixed with BCP and implanted in bilateral parietal bone defects in rats. RhBMP-2 and BG were used as positive controls. After seven weeks, significant de novo bone formation was observed in rhBMP-2 and BG groups, and in a lesser amount, when BCP biomaterials were mixed with TBM or committed MSCs cultured in three-dimensions. Due to the efficacy and safety of the TBM/BCP combination approach, we recommend this one-step procedure for further clinical investigation. Copyright © 2015. Published by Elsevier Ltd.
    Acta biomaterialia 08/2015; 26. DOI:10.1016/j.actbio.2015.08.013 · 6.03 Impact Factor
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    • "Perhaps most promising is the MSCs augmentation of maxillary sinus for dental implants. The MSCs augmentation of sinus floor cause more new bone formation compared to augmentation with hydroxyapatite without MSCs [18] [19] [20]. "

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    • "Perhaps most promising is the MSCs augmentation of maxillary sinus for dental implants. The MSCs augmentation of sinus floor cause more new bone formation compared to augmentation with hydroxyapatite without MSCs [18] [19] [20]. "
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    ABSTRACT: Multipotent mesenchymal stromal cells (MSCs) are primitive cells capable of restoring damaged mesenchyme and with the ability to differentiate into mature cells of bone, cartilage, muscle, fat, nerve or fibrous tissues. MSCs are therefore good candidates for applications in regenerative medicine and cell based therapy. They regenerate through self-renewal, differentiational capacity, immune modulation and secretion of bioactive molecules. Authors present a review of MSCs applications in otorhinolaryngology. The major interest is focused on phonosurgery, sensorineural deafness and reconstruction of large tissue defects with bone, cartilage or soft tissue replacement. Current evidence of MSCs treatment efficacy in otorhinolaryngology is based on animal models. The true impact on clinical treatment will not be known until clinical studies prove functional outcomes in human medicine.
    Medical Hypotheses 03/2014; 82(6):769-773. DOI:10.1016/j.mehy.2014.03.022 · 1.07 Impact Factor
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