Maxillary Sinus Augmentation Combining Bio-Oss with the Bone Marrow Aspirate Concentrate: A Histomorphometric Study in Humans

Abstract

Purpose. To investigate the regenerative results obtained with the association of bone marrow aspirate concentrate using the Bone Marrow Aspirate Concentrate (BMAC) method to a xenogeneic bone graft (Bio-Oss) in sinus floor elevation. Materials and Methods. Using a randomized controlled study design in eight consecutive patients (age of 55.4 ± 9.2 years), 16 sinus floor lift procedures were performed with Bio-Oss alone (control group, CG, n = 8) or combined with bone marrow aspirate concentrate obtained via the BMAC method (test group, TG, n = 8). Six months after the grafting procedures, bone biopsies were harvested during implant placement and were analyzed by histomorphometry. Results. Histomorphometric analysis revealed a significantly higher amount (p < 0.05) of vital mineralized tissue in TG when compared to the CG (55.15 ± 20.91% and 27.30 ± 5.55%, resp.). For nonvital mineralized tissue, TG presented a statistically higher level of Bio-Oss resorption (p < 0.05) when compared with the CG (6.32 ± 12.03% and 22.79 ± 9.60%, resp.). Both groups (TG and CG) showed no significantly different levels (p > 0.05) of nonmineralized tissue (38.53 ± 13.08% and 49.90 ± 7.64%, resp.). Conclusion. The use of bone marrow concentrate obtained by BMAC method increased bone formation in sinus lift procedures.

Cell therapy for orofacial bone regeneration: A systematic review and meta‐analysis

“…This view appears supported by the circumstantial evidence indicating that even application of growth factors, including BMPs—highly potent growth factors for bone regeneration, does not result in considerably different bone densities compared with any other type of augmentation material (Schliephake, ). Even in the present analysis, the significant effect of BTE in SA (after 6 months) was largely due to a single study (Pasquali et al., ), showing a large positive effect over the control intervention. Thus, in retrospect, it may come as no surprise that BTE failed to show similarly remarkable potential in enhancing bone formation in human sinuses, comparing with animals.…”

Maxillary sinus augmentation using chairside bone marrow aspirate concentrates for implant site development: a systematic review of histomorphometric studies

“…of patients (age range)No. of maxillary sinuses evaluatedDonor site for BMACClinical findings/implant survivalTiming of biopsyHistologic outcomesde Oliveira et al [12]SCG (BMAC obtained by single centrifugation and bone graft)DCG (BMAC obtained by double centrifugation and bone graft)Control (xenogenous bone graft alone)15 (mean age 55.4 years)21Posterior iliac crest- 68 implants were placed in the previously grafted sites, and 100% osseointegrated- Loading was applied after 6 months6 monthsVital mineralized tissue:- SCG 38.44%- DCG 34.63%- Control 27.30%- Not statistically differentNon-vital mineralized tissue:- SCG 13.70%- DCG 19.63%- Control 22.79%- Not statistically differentNon-mineralized tissue:- SCG 47.87%- DCG 45.73%- Control 49.90%- Not statistically differentPasquali et al [7]Test (BMAC and xenogenous bone graft)Control (xenogenous bone graft alone)8 (mean age 55.4 years)16Superior posterior iliac crest- At least two implants were placed in each previously grafted sites, and all implants osseointegrated- Loading was applied after a 6-month healing period6 monthsVital mineralized tissue:- Test 55.15%- Control 27.30%- Statistically significantNon-vital mineralized tissue:- Test 6.32%- Control 22.79%- Statistically significantNon-mineralized tissue:- Test 38.53%- Control 49.90%- Not statistically significantPayer et al [2]Test (porous bovine bone mineral together with tibial bone marrow aspirate)Control (bovine bone graft without any additive)6 (mean age 58.2 years)12Tibia- 44 implants were stable and osseointegrated at radiographic and Periotest evaluation3 months6 monthsNewly formed bone:3 months-Test 10.36%- Control 9.45%- Not statistically significant6 months- Test 14.12%- Control 10.41%- Not statistically significant3 and 6 months:- Not statistically significantBone-to-bone substitute contact:3 months-Test 16.40%- Control 15.06%- Not statistically significant6 months- Test 20.26%- Control 17.89%- Not statistically significant3 and 6 months:- Not statistically significantSauerbier et al [11]Open bone marrow-derived mononuclear cell isolation by synthetic poylsaccharide (FICOLL) method with bovine bone mineral (BBM)Closed bone marrow aspirate concentrate (BMAC) system with BBMFICOLL group 4 (mean age 59.5 years)BMAC group 7(mean age 55 years)FICOLL group 6BMAC group 12Superior posterior iliac spine- 50 implants were placed (17 FICOLL group and 33 BMAC group)- Implant survival was evaluated after 1 year- No implant out of 17 was lost in the FICOLL group, before prosthetic loading- 1 implant out of 33 failed in the BMAC group, before prosthetic loading- No implant was lost after loading- All 49 osseointegrated implants were loaded and in function…”

“…The time of 6 months wound healing is a consistent pattern of assessment and should be continued in future studies [2, 7, 12, 15]. …”

The applications of regenerative medicine in sinus lift procedures: A systematic review

“…Studies using MSCs reported a range between 91% and 100% of the implant's survival rate. When only osteointegration was analyzed, 100% of survival rate were described …”

“…15 The 18 studies selected for this systematic review were divided in 11 clinical trials 1,2,14,[28][29][30][31][32][33][34][35] and seven randomized clinical trials. 16,[36][37][38][39][40][41] Eleven studies received bone graft and/or other materials or technical support to be used in the study 14,16,[28][29][30]32,[36][37][38]40,41 ; nine studies were founded through research grant 1,14,16,28,31,32,35,38,40 ; four studies 2,33,34,39 did not report the funding source.…”