Objective
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.
Methods
In this report, the clinical and radiographic results are presented on 6 consecutively
treated patients using MSCs in combination with biphasic hydroxyl apatite/ β-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 (SBH1). 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 (SBH2).
Results
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 SBH1= 12.08 mm and mean of SBH2= 10.08 mm).
Conclusions
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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Article info
Publication history
Published online: April 23, 2008
Accepted:
December 6,
2007
Received in revised form:
November 23,
2007
Received:
September 25,
2007
Identification
Copyright
© 2008 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
