Sinus augmentation using human mesenchymal stem cells loaded into a beta-tricalcium phosphate/hydroxyapatite scaffold.
ABSTRACT 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.
SourceAvailable from: Sina Izadi
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ABSTRACT: The objective of this study was to compare differences between Bio-Oss and CORAGRAF in the rate of bone formation during graft replacement by assessing the density of new bone formation around the implant after sinus floor augmentation. We chose a total of nine systemically healthy patients from dental specialist clinics who planned to have bilateral sinus augmentation prior to implant placement. Bilateral sinus floor augmentation (9 × 2 = 18) was performed with the lateral window technique followed by implant placement (9 × 2 = 18). One site used Bio-Oss and the other coral (CORAGRAF) as the graft material. Radiographic imaging was performed periodically (on the day of surgery, and at 1, 3 and 6 months post surgery) using cone beam computed tomography (CBCT) to measure the bone density at the area of augmented sinus in Hounsfield units (HU). The median of bone density (HU) at 1 month, 3 months and 6 months post surgery for Bio-Oss was higher than for Coragraf. The difference between Bio Oss and Coragraf was statistically significant (p < 0.05). Bio-Oss as a bone substitute in sinus augmentation procedures was superior to Coragraf. However, clinically, the use of Coragraf as a bone substitute in sinus augmentation still gives promising results.Journal of Hard Tissue Biology 02/2015; 24(1):43-48. · 0.28 Impact Factor
08/2013; 3(3):159-165. DOI:10.1902/cap.2013.120082