Abstract
Background: Although bone tissue engineering for dentistry has been studied for many years, the clinical outcome for severe cases has not been established. Furthermore, there are limited numbers of studies that include long-term follow-up. In this study, the safety and efficacy of bone tissue engineering for patients with a severely atrophic alveolar bone were examined using autogenous bone marrow stromal cells (BMSCs), and the long-term stability was also evaluated. Methods: BMSCs from iliac bone marrow aspirate were cultured and expanded. Then, induced osteogenic cells were transplanted with autogenous platelet-rich plasma (PRP) and β-tricalcium phosphate granules (β-TCP) for maxillary sinus floor and alveolar ridge augmentation. Eight patients (two males and six females) with an average age of 54.2 years underwent cell transplantation. Safety was assessed by monitoring adverse events. Radiographic evaluation and bone biopsies were performed to evaluate the regenerated bone. Results: The major population of transplanted BMSCs belonged to the fraction of CD34−, CD45dim, and CD73+ cells, which was only 0.065% of the total bone marrow cells. Significant deviations were observed in cell growth and alkaline phosphatase activities among individuals. However, bone regeneration was observed in all patients and the average bone area in the biopsy samples was 41.9% 6 months following transplantation, although there were also significant deviations among each case. No adverse events related to the transplants were observed. In the regenerated bone, 27 out of 29 dental implants were integrated. Dental implants and regenerated bone were stable for an average follow-up period of 7 years and 10 months. Conclusions: Although individual variations were observed, the results showed that bone tissue engineering using BMSCs with PRP and β-TCP was feasible for patients with severe atrophic maxilla throughout a long-term follow-up period and was considered safe. However, further studies with a larger number of cases and controls to confirm the efficacy of BMSCs and the development of a protocol to establish a reproducible quality of stem cell-based graft material will be required.
Highlights
The number of patients who wish to have oral rehabilitation with dental implants has increased, many of them do not qualify because of insufficient alveolar bone volume
Sinus floor elevation was performed at nine sites in seven patients, and alveolar ridge augmentation was performed at four sites in three cases
Bone regeneration was achieved and dental implant installation was feasible in all subjects who suffered from severely atrophic maxilla and required bone feasible in all subjects who suffered from severely atrophic maxilla and required bone transplantation
Summary
The number of patients who wish to have oral rehabilitation with dental implants has increased, many of them do not qualify because of insufficient alveolar bone volume. For these patients, an autologous bone graft is considered the gold standard and the procedure has been widely performed. Bone graft substitutes including allografts, xenografts, and artificial bone substitutes, such as hydroxyapatite or tricalcium phosphate, represent other options These bone substitute materials alone can be applied to small or cystic bone defects which are surrounded by bony walls; they cannot repair severely atrophic alveolar bone since these materials have only osteoconductivity and not osteoinductivity [1]. The safety and efficacy of bone tissue engineering for patients with a severely atrophic alveolar bone were examined using autogenous bone marrow stromal cells (BMSCs), and the long-term stability was evaluated
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