Injectable Tissue-Engineered Bone Using Autogenous Bone Marrow–Derived Stromal Cells for Maxillary Sinus Augmentation: Clinical Application Report from a 2–6-Year Follow-Up

Abstract

This clinical study used injectable tissue-engineered bone, along with bone marrow-derived stromal cells (BMDSCs) and platelet-rich plasma (PRP), to conduct maxillary sinus floor augmentation by the simultaneous placement of bone graft and dental implants and to examine the state of regenerated bone after functional loading in 16 sinus augmentations in 12 patients whose alveolar crestal bone height was 2-10 mm. We used PRP as an autologous scaffold-which provides signal molecules-with in vitro expanded BMDSCs to enhance osteogenesis. All 41 dental implants prepared with the materials were clinically stable after second-stage surgery. The height of mineralized tissue at 2 years showed the mean increases of 8.8 +/- 1.6 mm compared to preoperative values, and no adverse effects and remarkable bone absorption were seen in the 2-6-year follow-up time. Although these results are preliminary, injectable tissue-engineered bone would stably predict the success of bone formation and dental implants, reduce patient burden, and provide minimally invasive cell therapy for patients.

What is the clinical applicability of regenerative therapies in dentistry?

“…However, recent studies using autologous DPSC, ASC and BMSC have been implemented for the repair of bone tissue in humans, producing encouraging results 8,36,38,40,44 . Follow-up periods of 3 and 6 years demonstrate that this technique can be considered safe for use in humans 8,37 . The use of stem cells of autologous origin is considered a facilitating factor in the use of SC-BT, since they can be obtained from several sites in the patient's oral cavity and do not trigger immune response 44 .…”

“…Another similar study using BMSC, now combined with injectable PRP as a scaffold, also observed favorable results. Even after six years of follow-up no adverse effects were observed, demonstrating safety in the use of cellular therapies 37 . Similar results have been observed with the use of ASC even with the reconstruction of large mandibular defects 40 .…”

“…Regeneration of bone tissue may be an interesting strategy in cases of maxillary corrections after trauma, implant-supported rehabilitation, in regions with atrophic bone tissue, and in the filling of bone defects or in intraosseous pathologies [36][37][38] . Although the incorporation of active compounds into titanium surfaces, for example, may increase biological tissue activity 39 , the direct application of stem cells, mainly from adipose tissue and bone marrow, has produced excellent results [36][37] .…”

“…Although the incorporation of active compounds into titanium surfaces, for example, may increase biological tissue activity 39 , the direct application of stem cells, mainly from adipose tissue and bone marrow, has produced excellent results [36][37] . Most of the studies seeking bone regeneration in the maxillomandibular region have used BMSC from the iliac crest 36 .…”

Various Ways to Enhance the Results of Maxillary Sinus Augmentation Procedures

“…The growth factors are believed to have an osseous regenerative effect on the mesenchymal stem cells and contribute to cellular proliferation, matrix formation, collagen synthesis, and osteoid production (Yamada et al, 2008). Bone morphogenetic proteins are multi-functional growth factors belonging to the transforming growth factor-beta superfamily, and bone morphogenetic proteins are reported to have a variety of functions (Wang et al, 1990;Xiao et al, 2007).…”