Autologous Periosteum-Derived Micrografts and PLGA/HA Enhance the Bone Formation in Sinus Lift Augmentation

Abstract

Sinus lift augmentation is a procedure required for the placement of a dental implant, whose success can be limited by the quantity or quality of available bone. To this purpose, the first aim of the current study was to evaluate the ability of autologous periosteum-derived micrografts and Poly(lactic-co-glycolic acid) (PLGA) supplemented with hydroxyl apatite (HA) to induce bone augmentation in the sinus lift procedure. Secondly, we compared the micrograft's behavior with respect to biomaterial alone, including Bio-Oss® and PLGA/HA, commercially named Alos. Sinus lift procedure was performed on 24 patients who required dental implants and who, according to the study design and procedure performed, were divided into three groups: group A (Alos + periosteum-derived micrografts); group B (Alos alone); and group C (Bio-Oss® alone). Briefly, in group A, a small piece of periosteum was collected from each patient and mechanically disaggregated by Rigenera® protocol using the Rigeneracons medical device. This protocol allowed for the obtainment of autologous micrografts, which in turn were used to soak the Alos scaffold. At 6 months after the sinus lift procedure and before the installation of dental implants, histological and radiographic evaluations in all three groups were performed. In group A, where sinus lift augmentation was performed using periosteum-derived micrografts and Alos, the bone regeneration was much faster than in the control groups where it was performed with Alos or Bio-Oss® alone (groups B and C, respectively). In addition, the radiographic evaluation in the patients of group A showed a radio-opacity after 4 months, while after 6 months, the prosthetic rehabilitation was improved and was maintained after 2 years post-surgery. In summary, we report on the efficacy of periosteum-derived micrografts and Alos to augment sinus lift in patients requiring dental implants. This efficacy is supported by an increased percentage of vital mineralized tisssue in the group treated with both periosteum-derived micrografts and Alos, with respect to the control group of Alos or Bio-Oss® alone, as confirmed by histological analysis and radiographic evaluations at 6 months from treatment.

Progenitor‐cell‐enriched micrografts as a novel option for the management of androgenetic alopecia

“…In addition, the regenerative potential of the micrografts and the clinical efficacy have been already shown for bone regeneration (Brunelli et al, 2013;Rodriguez et al, 2017), in the treatment of ulcers (De Francesco et al, 2017;Miranda, Farina, & Farina, 2018;Trovato, Failla, Serantoni, & Palumbo, 2016), wound dehiscences (Baglioni, Trovato, Marcarelli, Frenello, & Bocchiotti, 2016;Marcarelli, Trovato, Novarese, Riccio, & Graziano, 2017), pathological scars (Svolacchia, De Francesco, Trovato, Graziano, & Ferraro, 2016), and lastly for cartilage and cardiac regeneration Lampinen, Nummi, Nieminen, Harjula, & Kankuri, 2017;Gentile, Scioli, Bielli, Orlandi, & Cervelli, 2016).…”

Bone Tissue Regeneration in the Oral and Maxillofacial Region: A Review on the Application of Stem Cells and New Strategies to Improve Vascularization

“…Histological analysis showed well-differentiated bone with Haversian system formation in the test site with more bone formation. Baena et al [68] used whole tissue fractions from periosteum tissue seeded on a poly(lactic-co-glycolic acid) (PLGA) scaffold with hydroxyapatite (HA) in maxillary sinus floor elevation surgery. They showed an increased percentage of vital mineralized tissue in the group treated with both periosteumderived stem cells and PGLA/HA, with respect to the control group of PGLA/HA or demineralized bovine bone mineral alone, as confirmed by histological analysis and radiographic evaluations at six months after the treatment.…”

Recent Advances in Nanocomposites Based on Aliphatic Polyesters: Design, Synthesis, and Applications in Regenerative Medicine

“…Random copolymerization of lactide (both L,L-and D,L-lactide forms) and glycolide leads to the synthesis of poly(lactic-co-glycolic) acid (PLGA), which is probably the most studied hydrolyzable polyester in biomedicine. It has been employed in sutures (since 1974 under the trade name Vicryl ® ), drug delivery and scaffolds for tissue regeneration, as it displays very high biocompatibility [29,30]. PLGA-based scaffolds have been produced through a plethora of techniques such as gas foaming, microsphere sintering, porogen leaching, electrospinning, and polymer printing, with the aim of obtaining a unique combination of microstructure and physical/mechanical properties capable of favoring tissue growth [17].…”

“…Since PCL shows very low hydrolysis rate due to its high degree of crystallinity, it has been used since the '70s as a long-term resorbable sutures and implants. PCL is commonly blended with other polyesters and polyethers and PCL-based copolymers are obtained by copolymerizing ε-caprolactone with other cyclic esters with the main purpose of accelerating its hydrolysis [30]. This polyester has been greatly employed in tissue engineering applications: PCL and PCL composites have been explored for bone, ligament, cartilage, skin, nerve, and vascular tissue engineering purposes [11,18,32,33].…”