Bone regeneration with adipose stem cells and calcium phosphate ceramics in the human maxillary sinus floor elevation model using a one-step surgical procedure

Abstract

Background: In patients undergoing maxillary sinus floor elevation (MSFE) for dental implant placement, calcium phosphate (CaP) ceramics are used as alternatives for autologous bone. However, these bone substitutes have only osteoconductive properties and lack osteoinductive potential. Objectives: In a phase I study the feasibility and safety of the procedure, and the potential additive effect of freshly isolated autologous stromal vascular fraction (SVF) of adipose tissue (containing stem cells) on bone regeneration in MSFE were evaluated. Methods: From 10 healthy patients, adipose tissue was harvested from the abdominal wall; SVF was procured using automatic processing (Celution), seeded on either beta-tricalcium phosphate (β-TCP; n = 5) or biphasic CaP carriers (n = 5), and used for MSFE in a one-step surgical procedure. All 10 patients received CaP plus SVF on one side, whereas bilaterally treated patients (6/10) received CaP only on the contralateral side. Biopsies were taken from the augmented areas 6 months postoperatively, during dental implant placement, and were assessed by microcomputed tomography and histomorphometrical analysis. Results: No adverse effects were reported during the procedures or during 3-year follow-up. Bone and osteoid percentages were higher in SVF-supplemented biopsies than in control biopsies, in particular in β-TCP treated patients. Paired analysis on six bilaterally treated patients revealed significantly higher bone and osteoid volumes throughout the complete biopsies. Conclusion: This study demonstrated the feasibility, safety, and potential efficacy of SVF seeded on CaP ceramics for MSFE, providing the first step towards a novel treatment concept that might offer broad potential for SVF-based regenerative medicine applications.