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Philip-Alliez C, Fievet L, Serratrice N, Seiler M, Le Gall M, Charavet C, Catherine JH. Cone Beam-CT-Based Bone Volume Assessments of Alveolar Synthetic Bone Graft GlassBONE™ in Cleft Lip and Palate Patients: A Retrospective Study. J Maxillofac Oral Surg 2024; 23:342-352. [PMID: 38601220 PMCID: PMC11001803 DOI: 10.1007/s12663-023-02056-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/26/2023] [Indexed: 04/12/2024] Open
Abstract
Background Clefts of the lip and palate (CLP) are facial deformities that require multiple surgical procedures during childhood. One of these steps consists of filling the alveolar space with bone graft, traditionally removed from the iliac crest. However, this procedure could be invasive in children. Aim Here, we aimed to evaluate the outcomes of GlassBONE™ graft, a bioactive glass used as a bone substitute, as an alternative to the deleterious autologous bone graft in children. Materials & methods Retrospective monocentric study with 17 children aged 7.5 ± 2.2 yo [3.8-13.3 yo] carrying CLP. This technique has been established at La Timone Children hospital (Assistance Publique - Hôpitaux de Marseille) since 2011. Clinical (scar, graft rejection and periodontal status) and radiological (both panoramic radiographs and cone beam-CT) follow-up was conducted one year after the graft. The primary outcome was the reduction of the cleft volume, and secondary was the eruption of the adjacent tooth through the graft. Results GlassBONE™ permitted a significant reduction in the cleft volume by 42.4 ± 27.7% [0.6-81.1%] (p < 0.0001), corresponding to a filling of 57.6 ± 27.7% of the alveolar cleft. GlassBONE™ is well tolerated, ensuring satifactory clinical results (improvement in both scar and periodontal coverage), as well as the physiological evolution of the germs through the biomaterial. GlassBONE™ appears particularly suitable for small volumes, and we were able to determine a minimum volume of approximtely 0.259 + / - 0.155 cc required for a successful bone fusion. Conclusion The bioactive glass GlassBONE™ could be safely used in children with small CLP cases, providing satisfactory clinical and radiological results.
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Affiliation(s)
- C. Philip-Alliez
- Department of Orthodontics, La Timone Hospital (Assistance Publique - Hôpitaux de Marseille), Marseille, France
- UMR-T24 Ifsttar Aix-Marseille Université/Université Gustave Eiffel, Marseille, France
| | - L. Fievet
- Department of Pediatric Surgery, CHU La Réunion, Saint-Denis, France
| | - N. Serratrice
- Department of Neurosurgery, La Timone Hospital (Assistance Publique - Hôpitaux de Marseille), Marseille, France
| | - M. Seiler
- Department of Orthodontics, La Timone Hospital (Assistance Publique - Hôpitaux de Marseille), Marseille, France
| | - M. Le Gall
- Department of Orthodontics, La Timone Hospital (Assistance Publique - Hôpitaux de Marseille), Marseille, France
| | - C. Charavet
- Département d’Orthodontie, Faculté de Chirurgie Dentaire, Université Côte d’Azur, Nice, France
- Unité d’Orthodontie, Institut de Médecine Bucco-Dentaire, CHU de Nice, Nice, France
- Laboratoire MICORALIS UPR 7354, Université Côte d’Azur, Nice, France
| | - J. H. Catherine
- Department of Oral Surgery, La Timone Hospital (Assistance Publique - Hôpitaux de Marseille), Marseille, France
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2
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Ho Nguyen CT, Bui MH, Lam PH. Residual calcified material volume of β-tricalcium phosphate with platelet-rich fibrin in unilateral alveolar bone graft. Maxillofac Plast Reconstr Surg 2024; 46:7. [PMID: 38427143 PMCID: PMC10907557 DOI: 10.1186/s40902-024-00420-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/21/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND This study aimed to evaluate the effectiveness of β-tricalcium phosphate (β-TCP) and platelet-rich fibrin (PRF) in unilateral alveolar bone graft, involving the percentage of residual calcified material and the average labiopalatal thickness of the grafts on cone beam computed tomography at 6 months after surgery, comparing two age groups 12 years and under and over 12 years old. RESULTS The mean preoperative defect volume was 0.93 ± 0.20 cm3, with no significant difference between the two groups (p = 0.652). In the postoperative period, we did not record any abnormal bleeding and no infection was observed. Six months after surgery, the mean percentage of residual calcified material was 63.53 ± 16.48% with a significantly higher difference in the age group 12 and under (p < 0.001), and the mean average labiopalatal thickness of the grafted bone was 5.72 ± 1.09 mm with a significantly higher difference in the age group 12 and under (p = 0.011). CONCLUSION Using β-TCP and PRF in alveolar bone graft surgery has acceptable effectiveness clinically and on CBCT images, with significantly higher differences of the percentage of residual calcified material and the average labiopalatal thickness of the grafted bone in the group 12 years old and younger than in the older group.
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Affiliation(s)
- Chon T Ho Nguyen
- Department of Maxillofacial Surgery, Faculty of Odonto-Stomatology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, 700000, Vietnam.
| | - Minh H Bui
- Department of Maxillofacial Surgery, National Hospital of Odonto-Stomatology Ho Chi Minh City, Ho Chi Minh City, 700000, Vietnam
| | - Phuong H Lam
- My Thien Odonto-Stomatology Hospital, Ho Chi Minh City, 700000, Vietnam
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3
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Vásquez-Álvarez M, Wang Q, Zapata U. The Use of Platelet Concentrates in the Reconstruction of the Alveolar Cleft Defect: A Systematic Review and Meta-Analysis. Cleft Palate Craniofac J 2024:10556656231222076. [PMID: 38196271 DOI: 10.1177/10556656231222076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
OBJECTIVE Evaluate quantitative and qualitative outputs when comparing the incidence of platelet concentrates (PCs) combined with autogenous bone grafts to an autograft control group for the reconstruction of alveolar cleft defects. DESIGN Systematic review and meta-analysis. PATIENTS/PARTICIPANTS Randomized and nonrandomized controlled clinical trials where PCs were used in the reconstruction of alveolar cleft defects. INTERVENTIONS Use of PCs in combination with autogenous bone graft in the experimental group and autogenous bone graft alone in the control group. MAIN OUTCOME MEASURE(S) Average bone formation and bone density were evaluated, mean differences were calculated and pooled by a meta-analysis technique. Additionally, clinical outcomes such as wound dehiscence, closure of the oronasal fistula, pain, swelling, discharges, infections, and bleeding were considered in the qualitative synthesis. RESULTS After an evaluation of forty-nine articles, nineteen were considered for the review. The qualitative assessment of bone density, bone formation, and clinical outcomes showed no differences between groups in most of the included studies. The meta-analysis showed no statistical differences between PCs groups when compared to the control group in bone density at three months (mean difference 45.67 HU, P = .23) and six months (mean difference 48.57 HU, P = .64). Neither were statistical differences in the percentage of regenerated bone volume at six months (mean difference 6.39%, P = .15) and the volume of newly formed bone at 12 months (mean difference 0.37 mm3, P = .99). CONCLUSIONS There were no significant differences in terms of bone formation, bone density, and clinical outputs between groups.
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Affiliation(s)
- Mariana Vásquez-Álvarez
- Mechanical Engineering Department, School of Applied Sciences and Engineering, Eafit University, Medellin, Antioquia, Colombia
| | - Qian Wang
- Biomedical Sciences Department, School of Dentistry, Texas A&M University, Dallas, Texas, USA
| | - Uriel Zapata
- Mechanical Engineering Department, School of Applied Sciences and Engineering, Eafit University, Medellin, Antioquia, Colombia
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Verdier EF, Saloux AL, Azzis OM, Lebullenger RM, Davit-Béal TA, Brézulier DY. Bioglass 45S5, a relevant alternative to autogenous harvesting for secondary alveolar bone grafts in clefts? Retrospective study of one hundred surgeries. J Craniomaxillofac Surg 2024; 52:85-92. [PMID: 38129189 DOI: 10.1016/j.jcms.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 09/26/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
The secondary alveolar bone grafting (SABG) step restores the continuity of the alveolar bone necessary for dentition. Faced with the complications of autografts, synthetic biomaterials such as Bioglass (BG) 45S5 have been proposed. The objective was to evaluate the success rate of SABG with the addition of BG 45S5 and to highlight the prognostic factors. Patients who underwent operation between 2015 and 2021 and had follow-up cone-beam computed tomography (CBCT) were analyzed. Multivariate analysis was performed to determine factors influencing radiographic success. A total of 102 SABG were analyzed. They were unilateral total cleft lip and palate (49, 48.0%). The mean age at surgery was 9.32 ± 3.09 years. Surgeries were performed mainly outside a syndromic context and without a family history after orthodontic preparation. The radiographic success rate at 1 year was 80.4%. Mixed dentition stage (odds ratio [OR] = 7.3, p = 0.024), absence of syndromic context (OR = 20.7, p = 0.024) and female sex (OR = 4.88, p = 0.021) were factors predictive of surgical success. The use of BG 45S5 instead of autograft is relevant for SABG, with a 1-year success rate of over 80%. The stage of mixed dentition, the absence of syndromic context, and female sex were factors for good prognosis.
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Affiliation(s)
| | | | - Olivier M Azzis
- CHU Rennes, Univ Rennes, Service de Chirurgie Pédiatrique, France
| | | | | | - Damien Y Brézulier
- CHU Rennes, Univ Rennes, Pôle Odontologie, France; Univ Rennes, ISCR UMR 6226, France.
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Molnár B, Würsching T, Sólyom E, Pálvölgyi L, Radóczy-Drajkó Z, Palkovics D, Nagy K. Alveolar cleft reconstruction utilizing a particulate autogenous tooth graft and a novel split-thickness papilla curtain flap - A retrospective study. J Craniomaxillofac Surg 2024; 52:77-84. [PMID: 37926606 DOI: 10.1016/j.jcms.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 09/20/2023] [Accepted: 10/15/2023] [Indexed: 11/07/2023] Open
Abstract
During secondary alveolar cleft grafting, the use of autogenous cancellous bone harvested from the iliac crest is still considered the gold standard. Due to the risk of donor-site morbidity and excessive graft resorption, alternative grafting materials (e.g. intraoral bone, xenografts) have been tested. Autogenous tooth bone graft (ATB) is a novel material derived from extracted teeth. ATB has successfully been used in pre-prosthetic and periodontal surgery for hard-tissue reconstruction. Seven patients with unilateral cleft lip and palate were treated with ATB, using their own deciduous teeth for grafting. Defects were accessed utilizing a novel split-thickness papilla curtain flap. Cone-beam computed tomography scans were taken prior to and 3 months following cleft surgery to assess graft integration, graft stability, and the volume of the newly formed hard tissues. Hard-tissue gain, as measured at the 3-month follow-up, averaged 0.65 cm3 ± 0.26 cm3. Results showed acceptable graft integration and stability at the 3-month follow-up, with no adverse effects or excessive resorption of the graft. The use of ATB might be a feasible alternative for alveolar cleft grafting. However, long-term studies using a large sample size are required to derive further conclusions.
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Affiliation(s)
- Bálint Molnár
- Department of Periodontology, Semmelweis University, Budapest, Hungary
| | - Tamás Würsching
- Centre for Facial Reconstruction, Department of Pediatrics, Semmelweis University Budapest, Hungary; Department of Oro-Maxillofacial Surgery and Stomatology, Semmelweis University, Budapest, Hungary.
| | - Eleonóra Sólyom
- Department of Periodontology, Semmelweis University, Budapest, Hungary
| | - Laura Pálvölgyi
- Centre for Facial Reconstruction, Department of Pediatrics, Semmelweis University Budapest, Hungary
| | | | - Dániel Palkovics
- Department of Periodontology, Semmelweis University, Budapest, Hungary
| | - Krisztián Nagy
- Centre for Facial Reconstruction, Department of Pediatrics, Semmelweis University Budapest, Hungary; Cleft and Craniofacial Centre, Division of Maxillo-Facial Surgery, General Hospital St. Jan, Bruges, Belgium; OMFS-IMPATH Research Group, Faculty of Medicine, Department of Imaging AndPathology, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
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6
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Campolo A, Heider C, Verdugo-Paiva MF, Bravo-Jeria R, Morovic CG, Rada G. Use of autologous platelet derivatives for secondary alveoloplasty in patients with cleft lip and palate: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2024; 53:18-27. [PMID: 37730524 DOI: 10.1016/j.ijom.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 08/07/2023] [Accepted: 08/30/2023] [Indexed: 09/22/2023]
Abstract
This study aimed to evaluate the effectiveness of autologous platelet derivatives (APD), specifically platelet-rich plasma (PRP) or platelet-rich fibrin (PRF), combined with autogenous iliac crest bone grafts in secondary alveoloplasty for patients with cleft lip and palate. Electronic databases, relevant journals, and reference lists of included studies were searched until July 2022. Best-evidence synthesis was performed to draw conclusions. After the search strategies, 12 randomized controlled trials were included that provided data on six outcomes: newly formed bone, mean bone loss in height and width, bone density, functionality, and postoperative complications. Two authors independently assessed the risk of bias, and the certainty of evidence was assessed using the GRADE approach. The pooled results suggest that there is uncertainty as to whether the combination of APDs with autogenous iliac crest bone grafts improves the percentage of newly formed bone, as the certainty of the evidence was assessed as very low. It may slightly improve the functionality of patients (with low certainty of the evidence) and probably slightly reduces the incidence of postoperative complications (with moderate certainty of evidence). Further randomized clinical trials with standardized methodologies are required to validate these findings.
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Affiliation(s)
- A Campolo
- Oncologic and Maxillofacial Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - C Heider
- Otolaryngology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - M F Verdugo-Paiva
- UC Evidence Centre, Cochrane Chile Associated Centre, Pontificia Universidad Católica de Chile, Santiago, Chile; Epistemonikos Foundation, Santiago, Chile
| | - R Bravo-Jeria
- UC Evidence Centre, Cochrane Chile Associated Centre, Pontificia Universidad Católica de Chile, Santiago, Chile; Epistemonikos Foundation, Santiago, Chile
| | - C G Morovic
- Paediatric Surgery Department, School of Medicine, Universidad de Chile, Santiago, Chile; Division of Plastic and Reconstructive Surgery, Luis Calvo Mackenna Children's Hospital, Santiago, Chile
| | - G Rada
- UC Evidence Centre, Cochrane Chile Associated Centre, Pontificia Universidad Católica de Chile, Santiago, Chile; Epistemonikos Foundation, Santiago, Chile
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7
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Park JJ, Rochlin DH, Parsaei Y, Shetye PR, Witek L, Leucht P, Rabbani PS, Flores RL. Bone Tissue Engineering Strategies for Alveolar Cleft: Review of Preclinical Results and Guidelines for Future Studies. Cleft Palate Craniofac J 2023; 60:1450-1461. [PMID: 35678607 DOI: 10.1177/10556656221104954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The current standard of care for an alveolar cleft defect is an autogenous bone graft, typically from the iliac crest. Given the limitations of alveolar bone graft surgery, such as limited supply, donor site morbidity, graft failure, and need for secondary surgery, there has been growing interest in regenerative medicine strategies to supplement and replace traditional alveolar bone grafts. Though there have been preliminary clinical studies investigating bone tissue engineering methods in human subjects, lack of consistent results as well as limitations in study design make it difficult to determine the efficacy of these interventions. As the field of bone tissue engineering is rapidly advancing, reconstructive surgeons should be aware of the preclinical studies informing these regenerative strategies. We review preclinical studies investigating bone tissue engineering strategies in large animal maxillary or mandibular defects and provide an overview of scaffolds, stem cells, and osteogenic agents applicable to tissue engineering of the alveolar cleft. An electronic search conducted in the PubMed database up to December 2021 resulted in 35 studies for inclusion in our review. Most studies showed increased bone growth with a tissue engineering construct compared to negative control. However, heterogeneity in the length of follow up, method of bone growth analysis, and inconsistent use of positive control groups make comparisons across studies difficult. Future studies should incorporate a pediatric study model specific to alveolar cleft with long-term follow up to fully characterize volumetric defect filling, cellular ingrowth, bone strength, tooth movement, and implant support.
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Affiliation(s)
- Jenn J Park
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Danielle H Rochlin
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Yassmin Parsaei
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Pradip R Shetye
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Lukasz Witek
- New York University College of Dentistry, New York, NY, USA
| | - Philipp Leucht
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Piul S Rabbani
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Roberto L Flores
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
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Pálvölgyi L, Kesztyűs A, Shujaat S, Jacobs R, Nagy K. Creation of Dimicleft radiological cleft phantom skulls using reversed virtual planning technique. Dentomaxillofac Radiol 2023; 52:20230121. [PMID: 37395648 PMCID: PMC10552124 DOI: 10.1259/dmfr.20230121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/12/2023] [Accepted: 05/17/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVES The aim of this technical report was to develop customized pediatric phantoms for cone-beam computed tomography (CBCT)-related research in cleft patients. METHODS Six human pediatric skulls (age: 5-10 years) were recruited. A cone-beam computed tomography (CBCT) scan was taken for each skull, followed by virtual modeling through the process of segmentation. An artificial cleft was designed and printed to be applied onto the skull for the creation of an artificial cleft. The skulls were covered with non-radiopaque tape and immersed in melted Mix-D soft tissue equivalent material. The resulting phantoms covered with Mix-D were assessed radiologically by two expert radiologists. These phantoms were referred to as Dimicleft pediatric skull phantoms. RESULTS Dimicleft phantoms were able to appropriately mimic in vivo circumstances. No gaps existed between Mix-D and bony tissue. Virtual planning allowed the optimal designing of an artificial cleft onto the phantom. The artificially created cleft was suitable to determine the size, location, and extent of the cleft. CONCLUSIONS Dimicleft phantoms could act as a viable alternative to other commercially available options for assessing image quality and optimizing CBCT protocols in cleft patients for diagnostics and three-dimensional treatment planning.
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Affiliation(s)
- Laura Pálvölgyi
- Center for Facial Reconstruction, 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Artúr Kesztyűs
- Center for Facial Reconstruction, 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | | | | | - Krisztián Nagy
- Center for Facial Reconstruction, 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary
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Tissue Engineering Supporting Regenerative Strategies to Enhance Clinical Orthodontics and Dentofacial Orthopaedics: A Scoping, Perspective Review. Biomedicines 2023; 11:biomedicines11030795. [PMID: 36979774 PMCID: PMC10045353 DOI: 10.3390/biomedicines11030795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/01/2023] [Accepted: 02/20/2023] [Indexed: 03/08/2023] Open
Abstract
The personalized regenerative therapeutic strategies applicable in the structural and functional repair of maxillofacial/dental defects are expected to extend beyond the limits of what is currently possible in the management of dentofacial anomalies and treating malocclusions. The application of undifferentiated stem cells (SCs), including signaling molecule control and individualized tissue engineering based on targeted therapies, has been proposed to overcome therapeutic limitations and complications associated with treatments for craniofacial defects, including severe orthodontic discrepancies. This scoping, prospective review discusses comprehensively the current knowledge and prospects for improving clinical outcomes by the application of novel cell-required and cell-free regenerative strategies in biomedicine. The existing evidence, although scant, suggests that patients receiving an orthodontic treatment could benefit from precise tissue augmentation, allowing enhancement of tooth movement generated by orthognathic forces; faster, more predictable alignment of dental arches; optimal management of periodontal complications; and prevention of external root resorption. Ultimately, enriching orofacial tissues and “customizing” the repair of congenital/acquired defects in the craniofacial region can be vastly enhanced to provide a positive therapeutic outcome and improve patients’ quality of life.
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Möhlhenrich SC, Kniha K, Heitzer M, Magnuska Z, Hermanns-Sachweh B, Gremse F, Chhatwani S, Hölzle F, Modabber A, Danesh G. Correlations between radiological and histological findings of bone remodelling and root resorption in a rodent cleft model. Head Face Med 2022; 18:33. [DOI: 10.1186/s13005-022-00338-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/03/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The evaluation of bone remodelling and dental root resorption can be performed by histological techniques or micro-computed tomography (micro-CT). The present study aimed to evaluate the relationship between these two procedures in the context of cleft repair in a rat model.
Methods
The reconstructed maxillae and the orthodontically-moved first molar of 12 rats were analysed for correlations between the histological and radiological findings retrospectively. The alveolar cleft repairs were performed using bone autografts or (human) xenografts. Four weeks after the operation, the intervention of the first molar protraction was initiated and lasted for eight weeks. The newly formed bone and the root resorption lacunae were determined via histology. In the micro-CT analysis, the average change of bone mineral density (BMD), bone volume fraction (BV/TV), trabecular thickness and trabecular separation of the jaw, as well as the volume of the root resorptions were determined. The Pearson correlation coefficient was applied to study the associations between groups.
Results
Positive correlations were found only between the newly formed bone (histology) and BMD changes (micro-CT) in the autograft group (r = 0.812, 95% CI: 0.001 to 0.979, p = 0.05). The relationship of newly formed bone and BV/TV was similar but not statistically significant (r = 0.691, 95% CI: −0.274 to 0.963, p = 0.013). Regarding root resorption, no significant correlations were found.
Conclusions
Due to the lack of correlation between histological and radiological findings of bone remodelling and the development of root resorptions, both methods should be combined in this cleft model in rats for a comprehensive analysis.
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Alfayez E, Veschini L, Dettin M, Zamuner A, Gaetani M, Carreca AP, Najman S, Ghanaati S, Coward T, Di Silvio L. DAR 16-II Primes Endothelial Cells for Angiogenesis Improving Bone Ingrowth in 3D-Printed BCP Scaffolds and Regeneration of Critically Sized Bone Defects. Biomolecules 2022; 12:biom12111619. [PMID: 36358970 PMCID: PMC9687468 DOI: 10.3390/biom12111619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/28/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022] Open
Abstract
Bone is a highly vascularized tissue and relies on the angiogenesis and response of cells in the immediate environmental niche at the defect site for regeneration. Hence, the ability to control angiogenesis and cellular responses during osteogenesis has important implications in tissue-engineered strategies. Self-assembling ionic-complementary peptides have received much interest as they mimic the natural extracellular matrix. Three-dimensional (3D)-printed biphasic calcium phosphate (BCP) scaffolds coated with self-assembling DAR 16-II peptide provide a support template with the ability to recruit and enhance the adhesion of cells. In vitro studies demonstrated prompt the adhesion of both human umbilical vein endothelial cells (HUVEC) and human mesenchymal stem cells (hMSC), favoring endothelial cell activation toward an angiogenic phenotype. The SEM-EDS and protein micro bicinchoninic acid (BCA) assays demonstrated the efficacy of the coating. Whole proteomic analysis of DAR 16-II-treated HUVECs demonstrated the upregulation of proteins involved in cell adhesion (HABP2), migration (AMOTL1), cytoskeletal re-arrangement (SHC1, TMOD2), immuno-modulation (AMBP, MIF), and morphogenesis (COL4A1). In vivo studies using DAR-16-II-coated scaffolds provided an architectural template, promoting cell colonization, osteogenesis, and angiogenesis. In conclusion, DAR 16-II acts as a proactive angiogenic factor when adsorbed onto BCP scaffolds and provides a simple and effective functionalization step to facilitate the translation of tailored 3D-printed BCP scaffolds for clinical applications.
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Affiliation(s)
- Eman Alfayez
- Faculty of Dentistry, Oral Biology Department, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Faculty of Dentistry, Oral & Craniofacial Sciences King’s College London, London SE1 9RT, UK
| | - Lorenzo Veschini
- Faculty of Dentistry, Oral & Craniofacial Sciences King’s College London, London SE1 9RT, UK
| | - Monica Dettin
- Department of Industrial Engineering, University of Padua, 35131 Padua, Italy
| | - Annj Zamuner
- Department of Civil, Environmental, and Architectural Engineering, University of Padua, 35131 Padua, Italy
| | - Massimiliano Gaetani
- Fondazione Ricerca nel Mediterraneo (Ri.MED) and Department of Laboratory Medicine and Advanced Biotechnologies, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, 90100 Palermo, Italy
- Chemical Proteomics, Department of Medical Biochemistry and Biophysics, Karolinska Institutet and SciLifeLab (Science for Life Laboratory), SE-17 177 Stockholm, Sweden
| | - Anna P. Carreca
- Fondazione Ricerca nel Mediterraneo (Ri.MED) and Department of Laboratory Medicine and Advanced Biotechnologies, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, 90100 Palermo, Italy
| | - Stevo Najman
- Faculty of Medicine, University of Niš, 18000 Niš, Serbia
| | - Shahram Ghanaati
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University, 60323 Frankfurt, Germany
| | - Trevor Coward
- Faculty of Dentistry, Oral & Craniofacial Sciences King’s College London, London SE1 9RT, UK
| | - Lucy Di Silvio
- Faculty of Dentistry, Oral & Craniofacial Sciences King’s College London, London SE1 9RT, UK
- Correspondence: ; Tel.: +44-02-07848-8475
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Testosterone Enanthate: An In Vitro Study of the Effects Triggered in MG-63 Cells. Biomolecules 2022; 12:biom12081159. [PMID: 36009053 PMCID: PMC9406132 DOI: 10.3390/biom12081159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was to investigate the effects of the androgenic hormone testosterone enanthate (TE) on human MG-63 cells. MG-63 were cultured for 24 h in the presence of TE at increasing concentrations to assess its lethal dose. Therefore, the suitable concentration for a prolonged use of TE in vitro was assessed by viability assay over 9 days. Finally, MG-63 were exposed to TE for 14 days and assayed for differentiation by qPCR and Alizarin Red S staining. TE in the amount of 100 µM resulted as the maximum dose tolerated by MG-63 cells after 24 h. However, a prolonged exposure in culture TE in the amount of 100 µM showed a cytostatic effect on cell proliferation. On the contrary, TE 10 µM was tolerated by the cells and did not boost cell proliferation, but did enhance new bone formation, as revealed by COL1A1, ALPL, BGLAP, and IBSP gene expression after 3, 7, and 14 days, and calcium deposition by Alizarin Red S staining after 14 days. Based on the current study, 10 µM is the critical dose of TE that should be used in vitro to support bone differentiation of MG-63 cells.
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Möhlhenrich SC, Kniha K, Magnuska Z, Chhatwani S, Hermanns-Sachweh B, Gremse F, Hölzle F, Danesh G, Modabber A. Development of root resorption during orthodontic tooth movement after cleft repair using different grafting materials in rats. Clin Oral Investig 2022; 26:5809-5821. [PMID: 35567639 PMCID: PMC9474460 DOI: 10.1007/s00784-022-04537-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 05/03/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The aim of the present study was to investigate the influence of three grafting materials for cleft repair on orthodontic tooth movement in rats. MATERIALS AND METHODS Artificial alveolar clefts were created in 21 Wistar rats and were repaired 4 weeks later using autografts, human xenografts and synthetic bone substitute (beta-tricalcium phosphate/hydroxyapatite [β-TCP/HA]). A further 4 weeks later, the first molar was moved into the reconstructed maxilla. Microfocus computed tomography (μCT) was performed six times (T0-T5) to assess the tooth movement and root resorption. After 8 weeks, the affected reconstructed jaw was resected for histopathological investigation. RESULTS Total distances reached ranged from 0.82 ± 0.72 mm (β-TCP/HA) to 0.67 ± 0.27 mm (autograft). The resorption was particularly determined at the mesiobuccal root. Descriptive tooth movement slowed and root resorption increased slightly. However, neither the radiological changes during tooth movement (µCT T1 vs. µCT T5: autograft 1.85 ± 0.39 mm3 vs. 2.38 ± 0.35 mm3, p = 0.30; human xenograft 1.75 ± 0.45 mm3 vs. 2.17 ± 0.26 mm3, p = 0.54; β-TCP/HA: 1.52 ± 0.42 mm3 vs. 1.88 ± 0.41 mm3, p = 0.60) nor the histological differences after tooth movement (human xenograft: 0.078 ± 0.05 mm2; β-TCP/HA: 0.067 ± 0.049 mm2; autograft: 0.048 ± 0.015 mm2) were statistically significant. CONCLUSION The autografts, human xenografts or synthetic bone substitute used for cleft repair seem to have a similar effect on the subsequent orthodontic tooth movement and the associated root resorptions. CLINICAL RELEVANCE Development of root resorptions seems to have a secondary role in choosing a suitable grafting material for cleft repair.
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Affiliation(s)
| | - Kristian Kniha
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Zuzanna Magnuska
- Institute for Experimental Molecular Imaging, Department of Nanomedicine and Theragnostic, RWTH Aachen University, Forckenbeckstraße 55, 52074, Aachen, Germany
| | - Sachin Chhatwani
- Department of Orthodontics, University of Witten/Herdecke, Alfred-Herrhausen Str. 45, 58455, Witten, Germany
| | | | - Felix Gremse
- Institute for Experimental Molecular Imaging, Department of Nanomedicine and Theragnostic, RWTH Aachen University, Forckenbeckstraße 55, 52074, Aachen, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Gholamreza Danesh
- Department of Orthodontics, University of Witten/Herdecke, Alfred-Herrhausen Str. 45, 58455, Witten, Germany
| | - Ali Modabber
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
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Alghamdi HS. Editorial for Special Issue on " In Vivo Animal Models for Bone Tissue Regeneration". Tissue Eng Part C Methods 2022; 28:177-178. [PMID: 35588364 DOI: 10.1089/ten.tec.2022.29031.hsa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hamdan S Alghamdi
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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Alfayez E, Alghamdi F. Clinical Application of Stem Cell Therapy in Reconstructing Maxillary Cleft Alveolar Bone Defects: A Systematic Review of Randomized Clinical Trials. Cureus 2022; 14:e23111. [PMID: 35425680 PMCID: PMC9002340 DOI: 10.7759/cureus.23111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2022] [Indexed: 11/25/2022] Open
Abstract
An alveolar cleft is the most common congenital bone defect. This systematic review aimed to investigate the use of stem cells for alveolar cleft repair and summarize the outcomes of clinical research studies. The electronic databases PubMed, Scopus, Web of Sciences, and Google Scholar were utilized to search the literature for relevant studies after administering specific inclusion and exclusion criteria. The search included articles that were published from 2011 to 2021 and specific keywords were used in the databases. The search was completed by two independent reviewers following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Only four studies satisfied both the inclusion and exclusion criteria and were included in this systematic review. These studies investigated different aspects of bone reconstruction in the maxillary alveolar bone by stem cells, including cell types, clinical applications, biomaterial scaffolds, and follow-up period. The accumulated evidence in this systematic review is limited and insufficient to support the role of stem cell use in bone regeneration of maxillary alveolar bone defects. The outcome of using stem cells was studied only in 57 subjects from the four included studies. Although the noninvasive methods of isolating stem cells make them attractive resources for bone regeneration, more research is required in order to standardize and investigate stem cell therapy. This should be done beforehand in adults in less invasive procedures such as bone defect repair in dentistry prior to considering this type of therapy in this vulnerable patient population.
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Kouhestani F, Aghandeh P, Isamorad F, Akbari S, Tanbakuchi B, Motamedian S. Efficacy of Application of Periodontal Ligament Stem Cells in Bone Regeneration: A Systematic Review of Animal Studies. DENTAL HYPOTHESES 2022. [DOI: 10.4103/denthyp.denthyp_136_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Sales PHDH, Oliveira-Neto OB, de Lima FJC, Carvalho ADAT, Leão JC. Effectiveness of rhBMP-2 versus iliac autogenous bone graft in reconstructive surgery of cleft patients: an umbrella review. Br J Oral Maxillofac Surg 2021; 60:723-730. [PMID: 35184916 DOI: 10.1016/j.bjoms.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/11/2021] [Accepted: 12/02/2021] [Indexed: 12/13/2022]
Abstract
The objective of this umbrella review was to determine the effectiveness of rhBMP-2 in the reconstructive surgery of cleft patients through an evaluation of bone filling and volume of newly formed bone in the cleft area. A systematic search was carried out in PubMed/ Medline, Scopus, Cochrane Database of Abstracts of Reviews of Effects (DARE), Latin American and Caribbean Health Sciences Literature (LILACS), and the System for Information on Grey Literature in Europe (SIGLE) via Open Grey, until June 2020. Risk of bias was assessed using the ROBIS tool. A total of 2739 articles were identified and, based on the inclusion and exclusion criteria, six were included for final evaluation. The bone filling rate was 74.23% in the rhBMP-2 group and 72.38% in the autogenous group. Regarding the risk of bias, none of the articles had a low risk, four had an uncertain risk, and two a high risk. The results of this umbrella review show that the studies had high and uncertain risks of bias, and high heterogeneity. There was a lack of evidence regarding the possible complications offered by this therapy. The recommendation to use BMP-2 for alveolar cleft reconstruction, especially in a paediatric population, should be viewed with caution. New primary studies are needed to assess this variable and safely determine the use of rhBMP-2 in reconstructive surgery for cleft patients.
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Affiliation(s)
- Pedro Henrique da Hora Sales
- Department of Prosthesis and Oral and Maxillofacial Surgery, Dental School, Federal University of Pernambuco, Recife, Brazil.
| | | | | | | | - Jair Carneiro Leão
- Department of Clinical and Preventive Dentistry, Dental School, Federal University of Pernambuco, Recife, Brazil
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Shanbhag S, Suliman S, Mohamed-Ahmed S, Kampleitner C, Hassan MN, Heimel P, Dobsak T, Tangl S, Bolstad AI, Mustafa K. Bone regeneration in rat calvarial defects using dissociated or spheroid mesenchymal stromal cells in scaffold-hydrogel constructs. Stem Cell Res Ther 2021; 12:575. [PMID: 34776000 PMCID: PMC8591809 DOI: 10.1186/s13287-021-02642-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/22/2021] [Indexed: 12/20/2022] Open
Abstract
Background Three-dimensional (3D) spheroid culture can promote the osteogenic differentiation of bone marrow mesenchymal stromal cells (BMSC). 3D printing offers the possibility to produce customized scaffolds for complex bone defects. The aim of this study was to compare the potential of human BMSC cultured as 2D monolayers or 3D spheroids encapsulated in constructs of 3D-printed poly-L-lactide-co-trimethylene carbonate scaffolds and modified human platelet lysate hydrogels (PLATMC-HPLG) for bone regeneration. Methods PLATMC-HPLG constructs with 2D or 3D BMSC were assessed for osteogenic differentiation based on gene expression and in vitro mineralization. Subsequently, PLATMC-HPLG constructs with 2D or 3D BMSC were implanted in rat calvarial defects for 12 weeks; cell-free constructs served as controls. Bone regeneration was assessed via in vivo computed tomography (CT), ex vivo micro-CT and histology. Results Osteogenic gene expression was significantly enhanced in 3D versus 2D BMSC prior to, but not after, encapsulation in PLATMC-HPLG constructs. A trend for greater in vitro mineralization was observed in constructs with 3D versus 2D BMSC (p > 0.05). In vivo CT revealed comparable bone formation after 4, 8 and 12 weeks in all groups. After 12 weeks, micro-CT revealed substantial regeneration in 2D BMSC (62.47 ± 19.46%), 3D BMSC (51.01 ± 24.43%) and cell-free PLATMC-HPLG constructs (43.20 ± 30.09%) (p > 0.05). A similar trend was observed in the histological analysis. Conclusion Despite a trend for superior in vitro mineralization, constructs with 3D and 2D BMSC performed similarly in vivo. Regardless of monolayer or spheroid cell culture, PLATMC-HPLG constructs represent promising scaffolds for bone tissue engineering applications. Supplementary Information The online version contains supplementary material available at 10.1186/s13287-021-02642-w.
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Affiliation(s)
- Siddharth Shanbhag
- Center for Translational Oral Research (TOR), Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway. .,Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway.
| | - Salwa Suliman
- Center for Translational Oral Research (TOR), Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway
| | - Samih Mohamed-Ahmed
- Center for Translational Oral Research (TOR), Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway
| | - Carina Kampleitner
- Core Facility Hard Tissue and Biomaterial Research/Karl Donath Laboratory, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Traumatology, The research center in cooperation with AUVA, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Mohamed Nageeb Hassan
- Center for Translational Oral Research (TOR), Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway
| | - Patrick Heimel
- Core Facility Hard Tissue and Biomaterial Research/Karl Donath Laboratory, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Traumatology, The research center in cooperation with AUVA, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Toni Dobsak
- Core Facility Hard Tissue and Biomaterial Research/Karl Donath Laboratory, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Stefan Tangl
- Core Facility Hard Tissue and Biomaterial Research/Karl Donath Laboratory, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Anne Isine Bolstad
- Center for Translational Oral Research (TOR), Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway
| | - Kamal Mustafa
- Center for Translational Oral Research (TOR), Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway.
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The Use of Dual Energy X-Ray Bone Density Scan in Assessment of Alveolar Cleft Grafting Using Bone Marrow Stem Cells Concentrate/Platelet-Rich Fibrin Regenerative Technique. J Craniofac Surg 2021; 32:e780-e783. [PMID: 34727454 DOI: 10.1097/scs.0000000000007772] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To determine the densitometric quality of regenerated bone at the site of bone marrow and platelet-rich membrane grafting technique at unilateral alveolar cleft region using dual energy x-ray bone density scan (DEXA). METHODS The present prospective cohort study included 16 unilateral alveolar cleft patients who were selected randomly from the outpatient maxillofacial surgery clinic and suffered from unilateral alveolar cleft. Bone marrow aspirate and platelet-rich fibrin (PRF) (bone marrow stem cells + PRF) were used as the grafting material. Six months of follow-up have been conducted for all patients' including clinical and radiographic assessments with (DEXA scan). RESULTS Sixteen unilateral patients with a mean age of 12.56 ± 1.71 years were included in the sample and the majority of patients were females with a frequency of 56.2 percent. The current research revealed no infection or wound dehiscence. After surgery, the pain and edema scores were reasonable. Our findings showed that, after 6 months of regenerative graft, the average bone mineral density of the cleft side DEXA scan value was 1.56 ± 0.32 gm/cm2, compared to 1.51 ± 0.488 gm/cm2 on the normal side of the noncleft scan. There was no statistically significant difference in DEXA bone mineral content measurements between the cleft and standard sides (P = 0.461). CONCLUSIONS The bone marrow stem cells + PRF regenerative graft technique has been successfully integrated, and the DEXA scan approach for measuring regenerated grafted bone mineral content was found to be appropriate for simple and inexpensive follow-up of alveolar cleft lip patients.
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Kesztyűs A, Würsching T, Nemes B, Pálvölgyi L, Nagy K. Evaluation of 3D visualization, planning and printing techniques in alveolar cleft repair, and their effect on patients' burden. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:484-489. [PMID: 34678495 DOI: 10.1016/j.jormas.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/10/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUNDS The aim of this study was to describe our auxiliary surgical techniques in alveolar cleft reconstruction and evaluate the patients burden after 3 years of surgical experience. METHODS At the Cleft center, Semmelweis University Budapest, 28 patients underwent alveolar bone grafting between September 2017 and September 2020. We have used CBCT scans and computer software to perform 3D simulation of the alveolar defect and planning of patient- and defect specific grafts. An individual graft mold was designed for each alveolar defect and 3D printed for intra-operative use. During the surgical intervention, the mold was used to harvest the most appropriate amount and precise shape of graft material. We used cancellous iliac crest graft. After performing a descriptive statistical analysis of our patient group, we used a quality-of-life questionnaire to measure the patient's self-perception. RESULTS In all cases the treatment sequence could be applied, planning and surgery was successful and uneventful. Patients did not experience more pain, bleeding or any feeding impairment. No inflammatory or wound healing reactions were observed. There were no major adverse effects causing permanent problems. CONCLUSIONS Our follow-up and patient satisfaction questionnaire showed that our treatment sequence with auxiliary techniques brought no further burden to the patients care and hospitalization, even though it is more complex. Efficacy of this treatment method and improvement in graft integration has yet to be determined.
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Affiliation(s)
- Artúr Kesztyűs
- The Cleft Centre, 1st Department of Pediatrics, Semmelweis University Budapest, Hungary, OMFS-IMPATH Research Group, Faculty of Medicine, Department of Imaging and Pathology, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - Tamás Würsching
- The Cleft Centre, 1st Department of Pediatrics, Semmelweis University Budapest, Hungary, Department of Oro-Maxillofacial Surgery and Stomatology, Semmelweis University Budapest, Hungary.
| | - Bálint Nemes
- Department of Paediatric Dentistry and Orthodontics, Semmelweis University Faculty of Dentistry, Budapest, Hungary
| | - Laura Pálvölgyi
- The Cleft Centre, 1st Department of Pediatrics, Semmelweis University Budapest, Hungary
| | - Krisztián Nagy
- The Cleft Centre, 1st Department of Pediatrics, Semmelweis University Budapest, Hungary, OMFS-IMPATH Research Group, Faculty of Medicine, Department of Imaging and Pathology, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; The Cleft Centre, 1st Department of Pediatrics, Semmelweis University Budapest, Hungary, Department of Oro-Maxillofacial Surgery and Stomatology, Semmelweis University Budapest, Hungary; The Cleft Centre, 1st Department of Pediatrics, Semmelweis University Budapest, Hungary; OMFS-IMPATH Research Group, Faculty of Medicine, Department of Imaging and Pathology, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium, Cleft and Craniofacial Centre, Division of Maxillo-Facial Surgery, General Hospital St. Jan, Bruges, Belgium.
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21
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Starch-Jensen T, Bruun NH. Patient's perception of recovery after sinus membrane elevation and blood coagulum compared with 1:1 mixture of autogenous bone graft and deproteinized porcine bone mineral. Secondary outcomes from a single-blinded randomized controlled trial. Clin Oral Implants Res 2021; 33:65-77. [PMID: 34608673 DOI: 10.1111/clr.13866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 07/12/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective was to assess patient's perception of recovery after maxillary sinus membrane elevation (MSME) and blood coagulum (test) compared with maxillary sinus floor augmentation (MSFA) and 1:1 mixture of autogenous bone graft from the buccal antrostomy and deproteinized porcine bone mineral (DPBM) (control). MATERIALS AND METHODS Forty healthy patients were randomly allocated to test or control. Oral health-related quality of life (OHRQoL) was evaluated by Oral Health Impact Profile-14 (OHIP-14) at enrollment and 1 week postsurgical. Recovery was estimated by questionnaires and visual analog scale assessing pain, social and working isolation, physical appearance, eating and speaking ability, diet variations, sleep impairment, and discomfort after 1 week and 1 month. Mean differences were expressed with 95% confidence interval (CI). Association between OHRQoL and recovery was estimated. p-value below .05 was considered statistically significant. RESULTS Maxillary sinus membrane elevation revealed 2.1 less days of pain (p = .03, 95% CI: 0.2-4.1) and 1.2 days of sick leave (p = .01, 95% CI: 0.3-2.1) compared with MSFA. No significant difference was observed in eating and speaking ability, physical appearance, work performance, and sleep impairment. No significant association between impaired OHRQoL and recovery was observed. Females reported 4.77 higher OHIP-14 score compared with males (p = .01, 95% CI: 1.60-7.94), while association between age and OHIP-14 was -0.10 (p = .28, 95% CI: -0.28 to 0.08). CONCLUSION Maxillary sinus membrane elevation revealed significantly less days of pain and sick leave compared with MSFA. Harvesting of autogenous bone graft seems, therefore, to have a significant impact on perception of recovery.
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Affiliation(s)
- Thomas Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital and Department of Clinical Medicine, The Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Niels Henrik Bruun
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
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Starch-Jensen T, Ahmad M, Bruun NH, Becktor JP. Patient's perception of recovery after maxillary sinus floor augmentation with autogenous bone graft compared with composite grafts: a single-blinded randomized controlled trial. Int J Implant Dent 2021; 7:99. [PMID: 34595577 PMCID: PMC8633212 DOI: 10.1186/s40729-021-00379-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 06/17/2021] [Indexed: 11/16/2022] Open
Abstract
Background Autogenous bone graft is considered as the preferred grafting material for maxillary sinus floor augmentation (MSFA). However, harvesting of extraoral or intraoral autogenous bone graft is associated with risk of donor site morbidity and supplementary surgery. From a clinical and patient perspective, it would therefore be an advantage, if postoperative discomfort could be minimized by diminishing the need for autogenous bone graft harvesting. The objective of the present study was to test the hypothesis of no difference in patient’s perception of recovery after MSFA with autogenous bone graft from the zygomatic buttress (control) compared with 1:1 mixture of autogenous bone graft and deproteinized porcine bone mineral (DPBM) (Test I) or biphasic bone graft material (BBGM) (Test II). Sixty healthy patients were randomly allocated to either control or test groups. Oral Health-related Quality of Life (OHRQoL) was evaluated by Oral Health Impact Profile-14 (OHIP-14) at enrollment. Recovery was estimated by self-administrated questionnaires and visual analog scale assessing pain, social and working isolation, physical appearance, eating and speaking ability, diet variations, sleep impairment and discomfort after 1 week and 1 month. Descriptive statistics was expressed as mean with standard deviation (SD). Correlation between OHRQoL at enrollment and recovery were assessed by linear regression. p-value below 0.05 was considered significant.
Results Treatment satisfaction and willingness to undergo similar surgery were high in all groups. Average numbers of days with pain and sick leave were 3.5 (SD 3.9) and 0.5 (SD 1.2), respectively, with no significant difference between groups. Moreover, no significant difference in eating and speaking ability, physical appearance, work performance and sleep impairment were seen between groups. Mean OHIP-14 score at enrollment was 9.30 (SD 9.25) (control), 9.95 (SD 7.96) (Test I) and 8.15 (SD 9.37) (Test II), with no significant differences between groups. Impaired OHRQoL, gender or age seems not to predispose for delayed recovery or increased postoperative discomfort. Conclusions MSFA with diminutive autogenous bone graft harvesting is associated with high patient satisfaction, limited postoperative discomfort and willingness to undergo similar surgery. Presurgical OHRQoL, gender or age seems not to be associated with impaired patient’s perception of recovery.
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Affiliation(s)
- Thomas Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, 18-22 Hobrovej, 9000, Aalborg, Denmark. .,Department of Clinical Medicine, The Faculty of Medicine, Aalborg University, Aalborg, Denmark.
| | - Marianne Ahmad
- Department of Oral and Maxillofacial Surgery and Oral Medicine, Malmö University, Malmö, Sweden
| | - Niels Henrik Bruun
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Jonas Peter Becktor
- Department of Oral and Maxillofacial Surgery and Oral Medicine, Malmö University, Malmö, Sweden
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Evaluation of different grafting materials for alveolar cleft repair in the context of orthodontic tooth movement in rats. Sci Rep 2021; 11:13586. [PMID: 34193933 PMCID: PMC8245488 DOI: 10.1038/s41598-021-93033-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/09/2021] [Indexed: 12/05/2022] Open
Abstract
To minimize the postoperative risks posed by grafting autologous transplants for cleft repair, efforts are being made to improve grafting materials for use as potential alternatives. The aim of this study was to compare the bone graft quality of different bone substitutes including the gold standard autografts during the healing processes after cleft repair in the context of orthodontic treatment. In 21 Wistar rats, a complete, continuity-interrupting cleft was created. After 4 weeks, cleft repair was performed using autografts from the hips’ ischial tuberosity, human xenografts, or synthetic bone substitutes [beta-tricalcium phosphate (β-TCP)/hydroxyapatite (HA)]. After another 4 weeks, the first molar movement was initiated in the reconstructed jaw for 8 weeks. The bone remodeling was analyzed in vivo using micro-computed tomography (bone mineral density and bone volume fraction) and histology (new bone formation). All the grafting materials were statistically different in bone morphology, which changed during the treatment period. The β-TCP/HA substitute demonstrated less resorption compared to the autologous and xenogeneic/human bone, and the autografts led to a stronger reaction in the surrounding bone. Histologically, the highest level of new bone formation was found in the human xenografts, and the lowest was found in the β-TCP/HA substitute. The differences between the two bone groups and the synthetic materials were statistically significant. Autografts were confirmed to be the gold standard in cleft repair with regard to graft integration. However, parts of the human xenograft seemed comparable to the autografts. Thus, this substitute could perhaps be used as an alternative after additional tissue-engineered modification.
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Gaitán-Salvatella I, López-Villegas EO, González-Alva P, Susate-Olmos F, Álvarez-Pérez MA. Case Report: Formation of 3D Osteoblast Spheroid Under Magnetic Levitation for Bone Tissue Engineering. Front Mol Biosci 2021; 8:672518. [PMID: 34235178 PMCID: PMC8255365 DOI: 10.3389/fmolb.2021.672518] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/03/2021] [Indexed: 12/12/2022] Open
Abstract
Skeletal reconstruction is necessary in cases of bone defects created by tumors, trauma, and abnormalities. Regeneration of bone defects remains a critical problem, and current approaches are based on biocompatible scaffolds. Spheroids represent a simple 3D system since no supporting material is required for cell growth. Different techniques are used to generate spheroids, such as hanging drop, low-attachment plates, and magnetic nanoparticles. The idea of using magnetic nanoparticles is to cross-link through cell membrane overnight to create complex 3D cellular spheroid by using magnets to guide the cellular response. Herein, the current study aimed to achieve 3D human fetal osteoblast (hFOB) spheroid under magnetic levitation. Formation of 3D spheroid culture under magnetic levitation was evaluated by cell viability at 3, 7, and 14 days. Morphology of the 3D hFOB spheroid was analyzed by SEM and fluorescence microscopy and the differentiation towards mineralized lineage by ALP assay, qPCR, and alizarin red staining. The cell viability indicated that the 3D hFOB spheroid still viable after 14 days of culture. ALP assay, qPCR analysis expression of Col1, ALP, and Itg-β1 molecules, and calcium deposition with alizarin red showed a high level of bioactivity of the 3D hFOB spheroid. SEM images allowed the morphological analysis of the 3D microtissue-like spheroid with the presence of matrix deposition. These results indicate that magnetic levitation culture enables 3D stable osteoblast spheroids and could be a promising strategy for engineering application in the 3D construct in surgery regeneration of mineralized tissue.
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Affiliation(s)
- Iñigo Gaitán-Salvatella
- Tissue Bioengineering Laboratory, Postgraduate Studies and Research Division, Faculty of Dentistry, National Autonomous University of Mexico (UNAM), México City, Mexico
| | | | - Patricia González-Alva
- Tissue Bioengineering Laboratory, Postgraduate Studies and Research Division, Faculty of Dentistry, National Autonomous University of Mexico (UNAM), México City, Mexico
| | | | - Marco Antonio Álvarez-Pérez
- Tissue Bioengineering Laboratory, Postgraduate Studies and Research Division, Faculty of Dentistry, National Autonomous University of Mexico (UNAM), México City, Mexico
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Dissaux C, Ruffenach L, Bruant-Rodier C, George D, Bodin F, Rémond Y. Cleft Alveolar Bone Graft Materials: Literature Review. Cleft Palate Craniofac J 2021; 59:336-346. [PMID: 33823625 DOI: 10.1177/10556656211007692] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Since the early stages of alveolar bone grafting development, multiple types of materials have been used. Iliac cancellous bone graft (ICBG) remains the gold standard. DESIGN/METHODS A review of literature is conducted in order to describe the different bone filling possibilities, autologous or not, and to assess their effectiveness compared to ICBG. This review focused on studies reporting volumetric assessment of the alveolar cleft graft result (by computed tomography scan or cone beam computed tomography). RESULTS Grafting materials fall into 3 types: autologous bone grafts, ICBG supplementary material, and bone substitutes. Among autologous materials, no study showed the superiority of any other bone origin over iliac cancellous bone. Yet ICBG gives inconsistent results and presents donor site morbidity. Concerning supplementary material, only 3 studies could show a benefit of adding platelet-rich fibrin (1 study) or platelet-rich plasma (2 studies) to ICBG, which remains controversial in most studies. There is a lack of 3-dimensional (3D) assessment in most articles concerning the use of scaffolds. Only one study showed graft improvement when adding acellular dermal matrix to ICBG. Looking at bone substitutes highlights failures among bioceramics alone, side-effects with bone morphogenetic protein-2 composite materials, and difficulties in cell therapy setup. Studies assessing cell therapy-based substitutes show comparable efficacy with ICBG but remain too few. CONCLUSION This review highlights the lack of 3D assessments in the alveolar bone graft materials field. Nothing dethroned ICBG from its position as the gold standard treatment at this time.
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Affiliation(s)
- Caroline Dissaux
- Maxillofacial and Plastic Surgery Department, Cleft Competence Center, 36604Strasbourg University Hospital, Strasbourg, France.,Laboratoire ICUBE, Département Mécanique UMR 7357 CNRS, 36604Université de Strasbourg, Strasbourg, France
| | - Laetitia Ruffenach
- Maxillofacial and Plastic Surgery Department, Cleft Competence Center, 36604Strasbourg University Hospital, Strasbourg, France
| | - Catherine Bruant-Rodier
- Maxillofacial and Plastic Surgery Department, Cleft Competence Center, 36604Strasbourg University Hospital, Strasbourg, France
| | - Daniel George
- Laboratoire ICUBE, Département Mécanique UMR 7357 CNRS, 36604Université de Strasbourg, Strasbourg, France
| | - Frédéric Bodin
- Maxillofacial and Plastic Surgery Department, Cleft Competence Center, 36604Strasbourg University Hospital, Strasbourg, France
| | - Yves Rémond
- Laboratoire ICUBE, Département Mécanique UMR 7357 CNRS, 36604Université de Strasbourg, Strasbourg, France
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Gelatin Methacryloyl-Riboflavin (GelMA-RF) Hydrogels for Bone Regeneration. Int J Mol Sci 2021; 22:ijms22041635. [PMID: 33561941 PMCID: PMC7915045 DOI: 10.3390/ijms22041635] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/09/2021] [Accepted: 02/03/2021] [Indexed: 12/16/2022] Open
Abstract
Gelatin methacryloyl (GelMA) is a versatile biomaterial that has been used in various biomedical fields. UV light is commonly used to photocrosslink such materials; however, its use has raised several biosafety concerns. We investigated the mechanical and biological properties of a visible-wavelength (VW)-light-crosslinked gelatin-based hydrogel to evaluate its viability as a scaffold for bone regeneration in bone-destructive disease treatment. Irgacure2959 or riboflavin was added as a photoinitiator to create GelMA solutions. GelMA solutions were poured into a mold and exposed to either UV or VW light. KUSA-A1 cell-laden GelMA hydrogels were crosslinked and then cultured. Mechanical characterization revealed that the stiffness range of GelMA-RF hydrogel was suitable for osteoblast differentiation. KUSA-A1 cells encapsulated in GelMA hydrogels photopolymerized with VW light displayed significantly higher cell viability than cells encapsulated in hydrogels photopolymerized with UV light. We also show that the expression of osteogenesis-related genes at a late stage of osteoblast differentiation in osteoblasts encapsulated in GelMA-RF hydrogel was markedly increased under osteoblast differentiation-inducing conditions. The GelMA-RF hydrogel served as an excellent scaffold for the encapsulation of osteoblasts. GelMA-RF hydrogel-encapsulated osteoblasts have the potential not only to help regenerate bone mass but also to treat complex bone defects associated with bone-destructive diseases such as periodontitis.
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Osorio CC, Escobar LM, González MC, Gamboa LF, Chambrone L. Evaluation of density, volume, height and rate of bone resorption of substitutes of autologous bone grafts for the repair of alveolar clefts in humans: A systematic review. Heliyon 2020; 6:e04646. [PMID: 32954025 PMCID: PMC7484540 DOI: 10.1016/j.heliyon.2020.e04646] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/14/2020] [Accepted: 08/03/2020] [Indexed: 11/17/2022] Open
Abstract
Objective To assess clinical studies that compare synthetic or enriched natural materials to autologous osseous grafts among individuals with cleft lip and palate to determine which would be the substitute to autologous bone graft for alveolar cleft repair in humans. Materials and methods Randomized and controlled clinical trials on alveolar clefts treated with synthetic bone substitutes and autogenous bone grafts combined with osteoinductive factors compared with autogenous bone grafts alone (with ≥4-month follow-up and reporting clinical/radiographic data) were considered eligible. MEDLINE, EMBASE, and Central databases were searched for articles published until February 2020. Results Of 73 eligible articles, 15 were included. Some inductive factors along with iliac crest bone decreased bone reabsorption, preserved the generated bone height/width, and reduced the required autologous bone graft volume. Bone morphogenetic protein (BMP2) as an autologous bone graft substitute, demonstrated satisfactory alveolar defect healing, by avoiding autograft use. Many materials did not yield better outcomes than did autologous grafts; however, hydroxyapatite and collagen complex, hydroxyapatite agarose composite gel, acellular dermal matrix film, fibrin glue, platelet-rich plasma, and deproteinized bovine bone showed similar bone healing outcomes, being an alternative alveolar defect treatment. Conclusions BMP2, as an osteoinductive factor along with a synthetic matrix, yields satisfactory bone healing and avoids the need for autologous bone grafts. However, high-quality RCTs are necessary to determine the most effective and safe concentration and protocol of BMP2 utilization as a substitute for the autologous iliac crest bone grafting.
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Affiliation(s)
- Catalina Colorado Osorio
- Unit of Integral Management of Craniofacial Anomalies (UMIMC), School of Dentistry, Universidad El Bosque, Colombia
| | - Lina María Escobar
- Unit of Integral Management of Craniofacial Anomalies (UMIMC), School of Dentistry, Universidad El Bosque, Colombia
| | - María Clara González
- Unit of Integral Management of Craniofacial Anomalies (UMIMC), School of Dentistry, Universidad El Bosque, Colombia
| | - Luis Fernamdo Gamboa
- Unit of Integral Management of Craniofacial Anomalies (UMIMC), School of Dentistry, Universidad El Bosque, Colombia
| | - Leandro Chambrone
- Unit of Integral Management of Craniofacial Anomalies (UMIMC), School of Dentistry, Universidad El Bosque, Colombia.,Unit of Basic Oral Investigation (UIBO), School of Dentistry, Universidad El Bosque, Colombia
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Francisco I, Fernandes MH, Vale F. Platelet-Rich Fibrin in Bone Regenerative Strategies in Orthodontics: A Systematic Review. MATERIALS 2020; 13:ma13081866. [PMID: 32316144 PMCID: PMC7216087 DOI: 10.3390/ma13081866] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 04/12/2020] [Accepted: 04/13/2020] [Indexed: 02/05/2023]
Abstract
Preservation of the alveolar bone is a determinant in the outcome of orthodontic treatment. Alveolar bone defects or a decrease of their height and width may occur due to common reasons such as inflammation, tooth extraction, or cleft lip and palate. The aim of this systematic review was to investigate and appraise the quality of the most up to date available evidence regarding the applications and effects of platelet-rich fibrin (PRF) in orthodontics. This study was carried out according to preferred reporting items for systematic reviews and meta-analyses guidelines using the following databases: Medline via PubMed, Cochrane Library, Web of Science Core Collection and EMBASE. The qualitative assessment of the included studies was performed using Cochrane Risk of Bias tool and ROBINS-I guidelines. Results: From a total of 489 studies, nine studies were selected. The majority of the included studies demonstrate that autogenous anterior iliac graft with PRF had a higher amount of newly formed bone. Furthermore, this review also suggests that the application of platelet derivatives in the extraction socket can accelerate orthodontic tooth movement. Despite the limitations in the included studies, this systematic review suggested that PRF can improve alveolar cleft reconstruction and orthodontic tooth movement.
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Affiliation(s)
- Inês Francisco
- Institute of Orthodontics, Faculty of Medicine of the University of Coimbra, 3000-075 Coimbra, Portugal;
| | - Maria Helena Fernandes
- Faculty of Dental Medicine, University of Porto, 4200-393 Porto, Portugal
- LAQV/REQUIMTE, U. Porto, 4160-007 Porto, Portugal
- Correspondence: (M.H.F.); (F.V.)
| | - Francisco Vale
- Institute of Orthodontics, Faculty of Medicine of the University of Coimbra, 3000-075 Coimbra, Portugal;
- Correspondence: (M.H.F.); (F.V.)
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Korn P, Ahlfeld T, Lahmeyer F, Kilian D, Sembdner P, Stelzer R, Pradel W, Franke A, Rauner M, Range U, Stadlinger B, Lode A, Lauer G, Gelinsky M. 3D Printing of Bone Grafts for Cleft Alveolar Osteoplasty - In vivo Evaluation in a Preclinical Model. Front Bioeng Biotechnol 2020; 8:217. [PMID: 32269989 PMCID: PMC7109264 DOI: 10.3389/fbioe.2020.00217] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 03/04/2020] [Indexed: 12/12/2022] Open
Abstract
One of the most common hereditary craniofacial anomalies in humans are cleft lip and cleft alveolar bone with or without cleft palate. Current clinical practice, the augmentation of the persisting alveolar bone defect by using autologous bone grafts, has considerable disadvantages motivating to an intensive search for alternatives. We developed a novel therapy concept based on 3D printing of biodegradable calcium phosphate-based materials and integration of osteogenic cells allowing fabrication of patient-specific, tissue-engineered bone grafts. Objective of the present study was the in vivo evaluation of implants in a rat alveolar cleft model. Scaffolds were designed according to the defect's geometry with two different pore designs (60° and 30° rotated layer orientation) and produced by extrusion-based 3D plotting of a pasty calcium phosphate cement. The scaffolds filled into the artificial bone defect in the palate of adult Lewis rats, showing a good support. Half of the scaffolds were colonized with rat mesenchymal stromal cells (rMSC) prior to implantation. After 6 and 12 weeks, remaining defect width and bone formation were quantified histologically and by microCT. The results revealed excellent osteoconductive properties of the scaffolds, a significant influence of the pore geometry (60° > 30°), but no enhanced defect healing by pre-colonization with rMSC.
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Affiliation(s)
- Paula Korn
- Department of Oral and Maxillofacial Surgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Tilman Ahlfeld
- Centre for Translational Bone, Joint and Soft Tissue Research, University Hospital “Carl Gustav Carus”, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Franziska Lahmeyer
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine “Carl Gustav Carus”, Technische Universität Dresden, Dresden, Germany
| | - David Kilian
- Centre for Translational Bone, Joint and Soft Tissue Research, University Hospital “Carl Gustav Carus”, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Philipp Sembdner
- Institute of Machine Elements and Machine Design, Technische Universität Dresden, Dresden, Germany
| | - Ralph Stelzer
- Institute of Machine Elements and Machine Design, Technische Universität Dresden, Dresden, Germany
| | - Winnie Pradel
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine “Carl Gustav Carus”, Technische Universität Dresden, Dresden, Germany
| | - Adrian Franke
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine “Carl Gustav Carus”, Technische Universität Dresden, Dresden, Germany
| | - Martina Rauner
- Division of Endocrinology, Diabetes, and Bone Diseases, Department of Medicine III and Center for Healthy Aging, Faculty of Medicine “Carl Gustav Carus”, Technische Universität Dresden, Dresden, Germany
| | - Ursula Range
- Institute for Medical Informatics and Biometry, Faculty of Medicine “Carl Gustav Carus”, Technische Universität Dresden, Dresden, Germany
| | - Bernd Stadlinger
- Clinic of Cranio-Maxillofacial and Oral Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anja Lode
- Centre for Translational Bone, Joint and Soft Tissue Research, University Hospital “Carl Gustav Carus”, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Günter Lauer
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine “Carl Gustav Carus”, Technische Universität Dresden, Dresden, Germany
| | - Michael Gelinsky
- Centre for Translational Bone, Joint and Soft Tissue Research, University Hospital “Carl Gustav Carus”, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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Uribe F, Alister JP, Zaror C, Olate S, Fariña R. Alveolar Cleft Reconstruction Using Morphogenetic Protein (rhBMP-2): A Systematic Review and Meta-Analysis. Cleft Palate Craniofac J 2019; 57:589-598. [PMID: 31698953 DOI: 10.1177/1055665619886142] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study aimed to review the existing evidence regarding reconstruction of the alveolar cleft using recombinant human bone morphogenetic protein-2 (rhBMP-2) in terms of bone volume and bone height. DESIGN Systematic review and meta-analysis. PATIENTS—PARTICIPANTS A systematic search was done. Randomized and nonrandomized clinical trials, where rhBMP-2 was used in the reconstruction of human alveolar cleft were included. INTERVENTIONS Reconstruction of alveolar cleft with rhBMP-2. MAIN OUTCOME MEASURES Average bone volume formation and average bone height formation in the alveolar cleft. Mean difference was calculated and pooled by meta-analysis. RESULTS Of 709 identified articles, 5 studies met the inclusion criteria. The average bone volume formation was higher in the rhBMP-2 group than in the control group (61.11% vs 59.12%). The average bone height formation was higher in the control group compared to the rhBMP-2 group (75.4% vs 61.5%). The risk of bias in the selected articles was high. The meta-analysis showed that rhBMP-2 treatment may benefit bone formation compared to iliac crest graft (low certainty evidence; mean difference: -208.76; 95% confidence interval: -253.59 to -163.93; -I2 = 0%). CONCLUSIONS The results obtained in primary articles are promising but have a high risk of bias and have low quality of evidence; therefore, it is necessary to conduct controlled clinical trials with a greater number of patients to recommend the use of rhBMP-2 in the treatment of the alveolar cleft. PROSPERO registration number: CRD42018077741.
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Affiliation(s)
- Francisca Uribe
- Doctorate Program in Medical Sciences, Faculty of Medicine, Universidad de la Frontera, Temuco, Chile.,Faculty of Dentistry, Division of Oral, Facial and Maxillofacial Surgery, Universidad de La Frontera, Temuco, Chile.,Center of Excellence in Surgical and Morphological Studies (CEMyQ), Universidad de La Frontera, Temuco, Chile
| | - Juan Pablo Alister
- Faculty of Dentistry, Division of Oral, Facial and Maxillofacial Surgery, Universidad de La Frontera, Temuco, Chile.,Center of Excellence in Surgical and Morphological Studies (CEMyQ), Universidad de La Frontera, Temuco, Chile
| | - Carlos Zaror
- Center for Research in Epidemiology, Economics and Oral Public Health (CIEESPO), Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile.,Faculty of Dentistry, Universidad San Sebastian, Puerto Montt, Chile
| | - Sergio Olate
- Faculty of Dentistry, Division of Oral, Facial and Maxillofacial Surgery, Universidad de La Frontera, Temuco, Chile.,Center of Excellence in Surgical and Morphological Studies (CEMyQ), Universidad de La Frontera, Temuco, Chile
| | - Rodrigo Fariña
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Universidad de Chile, Santiago, Chile.,Oral and Maxillofacial Surgery Unit, Hospital del Salvador, Santiago, Chile
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Shanbhag S, Suliman S, Pandis N, Stavropoulos A, Sanz M, Mustafa K. Cell therapy for orofacial bone regeneration: A systematic review and meta-analysis. J Clin Periodontol 2019; 46 Suppl 21:162-182. [DOI: 10.1111/jcpe.13049] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/17/2018] [Accepted: 10/26/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Siddharth Shanbhag
- Department of Clinical Dentistry; Center for Clinical Dental Research; University of Bergen; Bergen Norway
| | - Salwa Suliman
- Department of Clinical Dentistry; Center for Clinical Dental Research; University of Bergen; Bergen Norway
| | - Nikolaos Pandis
- Department of Orthodontics and Dentofacial Orthopedics; University of Bern; Bern Switzerland
| | - Andreas Stavropoulos
- Department of Periodontology; Faculty of Odontology; Malmö University; Malmö Sweden
| | - Mariano Sanz
- Section of Periodontology; Faculty of Odontology; University Complutense of Madrid; Madrid Spain
| | - Kamal Mustafa
- Department of Clinical Dentistry; Center for Clinical Dental Research; University of Bergen; Bergen Norway
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Zhang Q, Wu W, Qian C, Xiao W, Zhu H, Guo J, Meng Z, Zhu J, Ge Z, Cui W. Advanced biomaterials for repairing and reconstruction of mandibular defects. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 103:109858. [PMID: 31349473 DOI: 10.1016/j.msec.2019.109858] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/26/2019] [Accepted: 06/02/2019] [Indexed: 02/07/2023]
Abstract
Mandibles are the largest and strongest bone in the human face and are often severely compromised by mandibular defects, compromising the quality of life of patients. Mandibular defects may result from trauma, inflammatory disease and benign or malignant tumours. The reconstruction of mandibular defect has been a research hotspot in oral and maxillofacial surgery. Although the principles and techniques of mandibular reconstruction have made great progress in recent years, the development of biomedical materials is still facing technical bottleneck, and new materials directly affect technological breakthroughs in this field. This paper reviews the current status of research and application of various biomaterials in mandibular defects and systematically elaborates different allogeneic biomaterial-based approaches. It is expected that various biomaterials, in combination with new technologies such as digital navigation and 3D printing, could be tuned to build new types of scaffold with more precise structure and components, addressing needs of surgery and post-reconstruction. With the illustration and systematization of different solutions, aims to inspire the development of reconstruction biomaterials.
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Affiliation(s)
- Qiang Zhang
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Yangzhou University, Yangzhou University, 368 Hanjiang Middle Road, Yangzhou, Jiangsu 225000, PR China; Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Soochow University, Soochow University, 188 Shizi St, Suzhou, Jiangsu 215006, PR China
| | - Wei Wu
- Department of General Surgery, The Affiliated Hospital of Yangzhou University, Yangzhou University, 368 Hanjiang Middle Road, Yangzhou, Jiangsu 225000, PR China
| | - Chunyu Qian
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Soochow University, Soochow University, 188 Shizi St, Suzhou, Jiangsu 215006, PR China
| | - Wanshu Xiao
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Soochow University, Soochow University, 188 Shizi St, Suzhou, Jiangsu 215006, PR China
| | - Huajun Zhu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Soochow University, Soochow University, 188 Shizi St, Suzhou, Jiangsu 215006, PR China
| | - Jun Guo
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Yangzhou University, Yangzhou University, 368 Hanjiang Middle Road, Yangzhou, Jiangsu 225000, PR China
| | - Zhibing Meng
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Yangzhou University, Yangzhou University, 368 Hanjiang Middle Road, Yangzhou, Jiangsu 225000, PR China
| | - Jinyue Zhu
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Yangzhou University, Yangzhou University, 368 Hanjiang Middle Road, Yangzhou, Jiangsu 225000, PR China
| | - Zili Ge
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Soochow University, Soochow University, 188 Shizi St, Suzhou, Jiangsu 215006, PR China.
| | - Wenguo Cui
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, PR China.
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da Rosa WLDO, da Silva TM, Galarça AD, Piva E, da Silva AF. Efficacy of rhBMP-2 in Cleft Lip and Palate Defects: Systematic Review and Meta-analysis. Calcif Tissue Int 2019; 104:115-129. [PMID: 30367200 DOI: 10.1007/s00223-018-0486-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/15/2018] [Indexed: 01/21/2023]
Abstract
The aim of this study was to analyze the efficacy of using rhBMP-2 (recombinant human morphogenetic protein-2) in the treatment of patients with cleft lip and palate defects (CLPD). Seven databases were screened: PubMed (Medline), Lilacs, Ibecs, Web of Science, BBO, Scopus, and The Cochrane Library. Clinical trials that evaluated the use of bioactive treatment with rhBMP-2 in the treatment of patients with CLPD were included. Statistical analyses were performed by comparing the standardized mean difference of bone formation volume and bone filling percentage (p = 0.05). Ten studies compared the use of rhBMP-2 and iliac crest bone graft (ICBG). The global analysis for bone formation volume and bone filling percentage showed that bioactive materials were similar to ICBG with a standardized mean difference of respectively 0.07 (95% CI - 0.41 to 0.56) and 0.24 (95% CI - 0.32 to 0.80). The available literature suggested that use of rhBMP-2 presented similar bone formation results to those of ICBG in secondary alveolar bone grafting for patients with CLPD.
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Affiliation(s)
| | - Tiago Machado da Silva
- Department of Restorative Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - Arthur Dias Galarça
- Department of Restorative Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - Evandro Piva
- Department of Restorative Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - Adriana Fernandes da Silva
- Department of Restorative Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil.
- Department of Restorative Dentistry, Faculty of Dentistry, Federal University of Pelotas, Gonçalves Chaves St., 457, Room 503, Pelotas, RS, 96015-560, Brazil.
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Bioactive glass 45S5 ceramic for alveolar cleft reconstruction, about 58 cases. J Craniomaxillofac Surg 2018; 46:1772-1776. [DOI: 10.1016/j.jcms.2018.07.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 06/11/2018] [Accepted: 07/19/2018] [Indexed: 11/22/2022] Open
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Kamal M, Ziyab AH, Bartella A, Mitchell D, Al-Asfour A, Hölzle F, Kessler P, Lethaus B. Volumetric comparison of autogenous bone and tissue-engineered bone replacement materials in alveolar cleft repair: a systematic review and meta-analysis. Br J Oral Maxillofac Surg 2018; 56:453-462. [PMID: 29859781 DOI: 10.1016/j.bjoms.2018.05.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 05/02/2018] [Indexed: 12/11/2022]
Abstract
The goal of reconstruction of the alveolar cleft in patients with cleft lip and palate is to improve the quality of tissue, the structural stability, and increase the volume of bone. This study is a systematic review with meta-analysis of volumetric bony filling using autogenous bone and various tissue-engineered bone substitutes. We made an electronic search on MEDLINE, EMBASE, SCOPUS, WEB OF SCIENCE, "grey" publications (materials and research produced by organisations outside traditional channels for commercial or academic publishing and distribution), and relevant cross references according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies that reported the outcomes of volumetric grafting were included in the meta-analysis. Of 1276 studies, 26 were included in the meta-analysis. Pooled analysis of 25 studies that used autogenous bone showed a significant reduction in the volume of the cleft equivalent to 62.0% bone fill (95% CI 54.3 to 69.6), in contrast to 10 studies that used a tissue-engineered material and reported bone filling of 68.7% (95% CI 54.5 to 82.8). The estimated sizes of pooled effects across studies showed that there was no significant difference between the two major intervention groups (p value 0.901). Our statistical analysis showed that autogenous bone grafts did not differ significantly from tissue-engineered materials in their ability to fill clefts. Systematic review registration: International Prospective Register of Systematic Reviews, PROSPERO (CRD42017065045).
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Affiliation(s)
- M Kamal
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University, Aachen, Germany; Department of Cranio-Maxillofacial Surgery and GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - A H Ziyab
- Department of Community Medicine and Behavioral Sciences, Kuwait University, Kuwait
| | - A Bartella
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University, Aachen, Germany
| | - D Mitchell
- Maxillofacial Unit, Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - A Al-Asfour
- Department of Surgical Sciences, Faculty of Dentistry, Kuwait University, Kuwait
| | - F Hölzle
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University, Aachen, Germany
| | - P Kessler
- Department of Cranio-Maxillofacial Surgery and GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - B Lethaus
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University, Aachen, Germany
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Wu C, Pan W, Feng C, Su Z, Duan Z, Zheng Q, Hua C, Li C. Grafting materials for alveolar cleft reconstruction: a systematic review and best-evidence synthesis. Int J Oral Maxillofac Surg 2018; 47:345-356. [DOI: 10.1016/j.ijom.2017.08.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 05/30/2017] [Accepted: 08/09/2017] [Indexed: 10/18/2022]
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Kamal M, Andersson L, Tolba R, Al-Asfour A, Bartella AK, Gremse F, Rosenhain S, Hölzle F, Kessler P, Lethaus B. Bone regeneration using composite non-demineralized xenogenic dentin with beta-tricalcium phosphate in experimental alveolar cleft repair in a rabbit model. J Transl Med 2017; 15:263. [PMID: 29274638 PMCID: PMC5742260 DOI: 10.1186/s12967-017-1369-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 12/15/2017] [Indexed: 01/24/2023] Open
Abstract
Background Alveolar cleft repair is performed via bone grafting procedure to restore the dental arch continuity. A suitable bone substitute materials should possess osteoinductive and osteoconductive properties, to promote new bone formation, along with a slowly resorbable scaffold that is subsequently replaced with functionally viable bone. Calcium phosphate biomaterials have long proved their efficacy as bone replacement materials. Dentin in several forms has also demonstrated its possibility to be used as bone graft replacement material in several studies. The purpose of this study was to evaluate bone regeneration pattern and quantify bone formation after grafting pre-established experimental alveolar clefts defects model in rabbits using composite xenogenic dentin and β-TCP in comparison to β-TCP alone. Methods Unilateral alveolar cleft defects were created in 16 New Zealand rabbits according to previously described methodology. Alveolar clefts were allowed 8 weeks healing period. 8 defects were filled with β-TCP, whereas 8 defects filled with composite xenogenic dentin with β-TCP. Bone regeneration of the healed defects was compared at the 8 weeks after intervention. Quantification of bone formation was analyzed using micro-computed tomography (µCT) and histomorphometric analysis. Results µCT and histomorphometric analysis revealed that defects filled with composite dentin/β-TCP showed statistically higher bone volume fraction, bone mineral density and percentage residual graft volume when compared to β-TCP alone. An improved surgical handling of the composite dentin/β-TCP graft was also noted. Conclusions Composite xenogenic dentin/β-TCP putty expresses enhanced bone regeneration compared to β-TCP alone in the reconstruction of rabbit alveolar clefts defects.
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Affiliation(s)
- Mohammad Kamal
- Department of Cranio-Maxillofacial Surgery and GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, P. Debyelaan, Postbus 5800, 6202 AZ, Maastricht, The Netherlands. .,Department of Oral and Maxillofacial Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Lars Andersson
- Department of Surgical Sciences, Health Sciences Center, Kuwait University, 13110, Safat, Kuwait
| | - Rene Tolba
- Institute for Laboratory Animal Science and Experimental Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Adel Al-Asfour
- Department of Surgical Sciences, Health Sciences Center, Kuwait University, 13110, Safat, Kuwait
| | - Alexander K Bartella
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Felix Gremse
- Department of Experimental Molecular Imaging, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Stefanie Rosenhain
- Department of Experimental Molecular Imaging, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Peter Kessler
- Department of Cranio-Maxillofacial Surgery and GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, P. Debyelaan, Postbus 5800, 6202 AZ, Maastricht, The Netherlands
| | - Bernd Lethaus
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
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Elschner C, Korn P, Hauptstock M, Schulz MC, Range U, Jünger D, Scheler U. Assessing agreement between preclinical magnetic resonance imaging and histology: An evaluation of their image qualities and quantitative results. PLoS One 2017; 12:e0179249. [PMID: 28666026 PMCID: PMC5493293 DOI: 10.1371/journal.pone.0179249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 05/28/2017] [Indexed: 11/19/2022] Open
Abstract
One consequence of demographic change is the increasing demand for biocompatible materials for use in implants and prostheses. This is accompanied by a growing number of experimental animals because the interactions between new biomaterials and its host tissue have to be investigated. To evaluate novel materials and engineered tissues the use of non-destructive imaging modalities have been identified as a strategic priority. This provides the opportunity for studying interactions repeatedly with individual animals, along with the advantages of reduced biological variability and decreased number of laboratory animals. However, histological techniques are still the golden standard in preclinical biomaterial research. The present article demonstrates a detailed method comparison between histology and magnetic resonance imaging. This includes the presentation of their image qualities as well as the detailed statistical analysis for assessing agreement between quantitative measures. Exemplarily, the bony ingrowth of tissue engineered bone substitutes for treatment of a cleft-like maxillary bone defect has been evaluated. By using a graphical concordance analysis the mean difference between MRI results and histomorphometrical measures has been examined. The analysis revealed a slightly but significant bias in the case of the bone volume [Formula: see text] and a clearly significant deviation for the remaining defect width [Formula: see text] But the study although showed a considerable effect of the analyzed section position to the quantitative result. It could be proven, that the bias of the data sets was less originated due to the imaging modalities, but mainly on the evaluation of different slice positions. The article demonstrated that method comparisons not always need the use of an independent animal study, additionally.
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Affiliation(s)
- Cindy Elschner
- Leibniz Institute of Polymer Research Dresden, Dresden, Germany
| | - Paula Korn
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine »Carl Gustav Carus«, Technische Universität Dresden, Dresden, Germany
| | - Maria Hauptstock
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine »Carl Gustav Carus«, Technische Universität Dresden, Dresden, Germany
| | - Matthias C. Schulz
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine »Carl Gustav Carus«, Technische Universität Dresden, Dresden, Germany
| | - Ursula Range
- Institute for Medical Informatics and Biometry, Faculty of Medicine »Carl Gustav Carus«, Technische Universität Dresden, Dresden, Germany
| | - Diana Jünger
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine »Carl Gustav Carus«, Technische Universität Dresden, Dresden, Germany
| | - Ulrich Scheler
- Leibniz Institute of Polymer Research Dresden, Dresden, Germany
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Kamal M, Andersson L, Tolba R, Bartella A, Gremse F, Hölzle F, Kessler P, Lethaus B. A rabbit model for experimental alveolar cleft grafting. J Transl Med 2017; 15:50. [PMID: 28235419 PMCID: PMC5326493 DOI: 10.1186/s12967-017-1155-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 02/21/2017] [Indexed: 12/15/2022] Open
Abstract
Objectives The purpose of the present study was to develop an animal model for creating alveolar cleft defects with properly simulated clinical defect environment for tissue-engineered bone-substitute materials testing without compromising the health of the animal. Cleft creation surgery was aimed at creating a complete alveolar cleft with a wide bone defect with an epithelial lining (oral mucosa) overlying the cleft defect. Methods A postmortem skull of a New Zealand White (NZW) rabbit skull (Oryctolagus cuniculus) underwent an osteological and imaging survey. A pilot postmortem surgery was conducted to confirm the feasability of a surgical procedure and the defect was also radiologically confirmed and illustrated with micro-computed tomography. Then, a surgical in vivo model was tested and evaluated in 16 (n = 16) 8-week-old NZW rabbits to create in vivo alveolar cleft creation surgery. Results Clinical examination and imaging analysis 8 weeks after cleft creation surgery revealed the establishment of a wide skeletal defect extending to the nasal mucosa simulating alveolar clefts in all of the rabbits. Conclusions Our surgical technique was successful in creating a sizable and predictable model for bone grafting material testing. The model allows for simulating the cleft site environment and can be used to evaluate various bone grafting materials in regard to efficacy of osteogenesis and healing potential without compromising the health of the animal.
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Affiliation(s)
- Mohammad Kamal
- Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, P. Debyelaan, Postbus 5800, 6202 AZ, Maastricht, The Netherlands. .,Department of Oral and Maxillofacial Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Lars Andersson
- Department of Surgical Sciences, Faculty of Dentistry, Health Sciences Center, Kuwait University, 13110, Safat, Kuwait
| | - Rene Tolba
- Institute for Laboratory Animal Science and Experimental Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Alexander Bartella
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Felix Gremse
- Department of Experimental Molecular Imaging, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Peter Kessler
- Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, P. Debyelaan, Postbus 5800, 6202 AZ, Maastricht, The Netherlands
| | - Bernd Lethaus
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
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The angiogenic variation of skeletal site-specific human BMSCs from same alveolar cleft patients: a comparative study. J Mol Histol 2016; 47:153-68. [DOI: 10.1007/s10735-016-9662-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 01/22/2016] [Indexed: 12/22/2022]
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Bittermann GKP, de Ruiter AP, Janssen NG, Bittermann AJN, van der Molen AM, van Es RJJ, Rosenberg AJWP, Koole R. Management of the premaxilla in the treatment of bilateral cleft of lip and palate: what can the literature tell us? Clin Oral Investig 2015; 20:207-17. [PMID: 26374747 PMCID: PMC4762918 DOI: 10.1007/s00784-015-1589-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 09/01/2015] [Indexed: 11/26/2022]
Abstract
Objective In the treatment of bilateral cleft lip and palate (BCLP) patients, there is discussion about the management of the position of the premaxilla. This literature analysis summarises the literature on managing this condition. Materials and methods A PubMed, Embase and Cochrane Library search was conducted resulting in 4465 articles which were screened on title and abstract. Results Seventy-one articles were available in full text, 16 of which were included in this literature analysis. We searched on keywords timing and technique, complications, growth of the maxilla and results after bone grafting the alveolar process. This literature analysis has shown that there are various ways to correct the position of the premaxilla. These can be divided into primary, early, late secondary and tertiary intervention before the age of 8 years, between the ages of 8 and 12 years and older than 12 years. Correction is done with surgery, orthodontics or a combination, with or without bone grafting. Conclusions An osteotomy of the premaxilla in combination with secondary alveolar bone grafting appears to be the most successful technique. Combining early secondary alveolar bone grafting with osteotomy creates more room to ensure a watertight closure of the nasal mucosa resulting in fewer postoperative complications. Before surgery, the orthodontist should try to optimise the position of the premaxilla for its surgical correction prior to bone grafting. Clinical relevance The treatment of BCLP patients is still based on experience and expert opinions. This literature analysis tries to give a summery on how to handle the protruded and displaced premaxilla.
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Affiliation(s)
- Gerhard K P Bittermann
- Department of Oral and Maxillofacial Surgery, University Medical Centre Utrecht, G05.129, Heidelberglaan 100, Utrecht, 3584 CX, Utrecht, The Netherlands.
| | - Ad P de Ruiter
- Department of Oral and Maxillofacial Surgery, University Medical Centre Utrecht, G05.129, Heidelberglaan 100, Utrecht, 3584 CX, Utrecht, The Netherlands
| | - Nard G Janssen
- Department of Oral and Maxillofacial Surgery, University Medical Centre Utrecht, G05.129, Heidelberglaan 100, Utrecht, 3584 CX, Utrecht, The Netherlands
| | - Arnold J N Bittermann
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Aebele M van der Molen
- Department of Plastic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Robert J J van Es
- Department of Oral and Maxillofacial Surgery, University Medical Centre Utrecht, G05.129, Heidelberglaan 100, Utrecht, 3584 CX, Utrecht, The Netherlands
| | - Antoine J W P Rosenberg
- Department of Oral and Maxillofacial Surgery, University Medical Centre Utrecht, G05.129, Heidelberglaan 100, Utrecht, 3584 CX, Utrecht, The Netherlands
| | - R Koole
- Department of Oral and Maxillofacial Surgery, University Medical Centre Utrecht, G05.129, Heidelberglaan 100, Utrecht, 3584 CX, Utrecht, The Netherlands
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Regenerative medicine in the treatment of alveolar cleft defect: A systematic review of the literature. J Craniomaxillofac Surg 2015; 43:1608-13. [PMID: 26302939 DOI: 10.1016/j.jcms.2015.06.041] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 06/04/2015] [Accepted: 06/29/2015] [Indexed: 02/07/2023] Open
Abstract
Despite a possible risk of donor site morbidity, autogenous bone grafting is considered the gold standard treatment for human alveolar cleft defect. Tissue engineering methods have recently been investigated with the aim of minimizing donor site morbidities. Here we systematically review the various tissue engineering methods applied to human alveolar cleft defects. An electronic search was conducted in the PubMed database up to March 2014. Tissue engineering studies on human alveolar subjects were included, and experiments that did not report quality or quantity of new regenerated bone were excluded. Twenty human experiments were included in our review. Regenerative techniques for alveolar cleft bone reconstruction were divided into cell therapy, growth factor application, and a combination of both cell therapy and growth factor. Using these three regenerative methods, a wide range of new bone formation percentages were reported. Due to insufficient evidence and controlled clinical trials, the treatment efficacy of tissue engineering in alveolar cleft bone defects could not be determined. Well-designed controlled studies are needed so that detailed outcomes can be properly compared.
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Gładysz D, Hozyasz KK. Stem cell regenerative therapy in alveolar cleft reconstruction. Arch Oral Biol 2015; 60:1517-32. [PMID: 26263541 DOI: 10.1016/j.archoralbio.2015.07.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 05/23/2015] [Accepted: 07/04/2015] [Indexed: 12/17/2022]
Abstract
Achieving a successful and well-functioning reconstruction of craniofacial deformities still remains a challenge. As for now, autologous bone grafting remains the gold standard for alveolar cleft reconstruction. However, its aesthetic and functional results often remain unsatisfactory, which carries a long-term psychosocial and medical sequelae. Therefore, searching for novel therapeutic approaches is strongly indicated. With the recent advances in stem cell research, cell-based tissue engineering strategies move from the bench to the patients' bedside. Successful stem cell engineering employs a carefully selected stem cell source, a biodegradable scaffold with osteoconductive and osteoinductive properties, as well as an addition of growth factors or cytokines to enhance osteogenesis. This review highlights recent advances in mesenchymal stem cell tissue engineering, discusses animal models and case reports of stem cell enhanced bone regeneration, as well as ongoing clinical trials.
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Affiliation(s)
- Dominika Gładysz
- Department of Pediatrics, Institute of Mother and Child, Warsaw, Poland
| | - Kamil K Hozyasz
- Department of Pediatrics, Institute of Mother and Child, Warsaw, Poland.
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Enhancement of the repair of dog alveolar cleft by an autologous iliac bone, bone marrow-derived mesenchymal stem cell, and platelet-rich fibrin mixture. Plast Reconstr Surg 2015; 135:1405-1412. [PMID: 25835246 DOI: 10.1097/prs.0000000000001166] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Autologous bone graft has been regarded as the criterion standard for the repair of alveolar cleft. However, the most prominent issue in alveolar cleft treatment is the high absorption rate of the bone graft. The authors' objective was to investigate the effects of an autologous iliac bone, bone marrow-derived mesenchymal stem cell, and platelet-rich fibrin mixture on the repair of dog alveolar cleft. METHODS Twenty beagle dogs with unilateral alveolar clefts created by surgery were divided randomly into four groups: group A underwent repair with an autologous iliac bone, bone marrow-derived mesenchymal stem cell, and platelet-rich fibrin mixture; group B underwent repair with autologous iliac bone and bone marrow-derived mesenchymal stem cells; group C underwent repair with autologous iliac bone and platelet-rich fibrin; and group D underwent repair with autologous iliac bone as the control. One day and 6 months after transplantation, the transplant volumes and bone mineral density were assessed by quantitative computed tomography. All of the transplants were harvested for hematoxylin and eosin staining 6 months later. RESULTS Bone marrow-derived mesenchymal stem cells and platelet-rich fibrin transplants formed the greatest amounts of new bone among the four groups. The new bone formed an extensive union with the underlying maxilla in groups A, B, and C. Transplants with the bone marrow-derived mesenchymal stem cells, platelet-rich fibrin, and their mixture retained the majority of their initial volume, whereas the transplants in the control group showed the highest absorption rate. Bone mineral density of transplants with the bone marrow-derived mesenchymal stem cells, platelet-rich fibrin, and their mixture 6 months later was significantly higher than in the control group (p < 0.05), and was the highest in bone marrow-derived mesenchymal stem cells and platelet-rich fibrin mixed transplants. Hematoxylin and eosin staining showed that the structure of new bones formed the best in group A. CONCLUSION Both bone marrow-derived mesenchymal stem cells and platelet-rich fibrin are capable of improving the repair of dog alveolar cleft, and the mixture of them is more potent than each one of them used singly for enhancing new bone regeneration.
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Kaigler D, Avila-Ortiz G, Travan S, Taut AD, Padial-Molina M, Rudek I, Wang F, Lanis A, Giannobile WV. Bone Engineering of Maxillary Sinus Bone Deficiencies Using Enriched CD90+ Stem Cell Therapy: A Randomized Clinical Trial. J Bone Miner Res 2015; 30:1206-16. [PMID: 25652112 DOI: 10.1002/jbmr.2464] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/12/2015] [Accepted: 01/20/2015] [Indexed: 01/05/2023]
Abstract
Bone engineering of localized craniofacial osseous defects or deficiencies by stem cell therapy offers strong prospects to improve treatment predictability for patient care. The aim of this phase 1/2 randomized, controlled clinical trial was to evaluate reconstruction of bone deficiencies of the maxillary sinus with transplantation of autologous cells enriched with CD90+ stem cells and CD14+ monocytes. Thirty human participants requiring bone augmentation of the maxillary sinus were enrolled. Patients presenting with 50% to 80% bone deficiencies of the maxillary sinus were randomized to receive either stem cells delivered onto a β-tricalcium phosphate scaffold or scaffold alone. Four months after treatment, clinical, radiographic, and histologic analyses were performed to evaluate de novo engineered bone. At the time of alveolar bone core harvest, oral implants were installed in the engineered bone and later functionally restored with dental tooth prostheses. Radiographic analyses showed no difference in the total bone volume gained between treatment groups; however, density of the engineered bone was higher in patients receiving stem cells. Bone core biopsies showed that stem cell therapy provided the greatest benefit in the most severe deficiencies, yielding better bone quality than control patients, as evidenced by higher bone volume fraction (BVF; 0.5 versus 0.4; p = 0.04). Assessment of the relation between degree of CD90+ stem cell enrichment and BVF showed that the higher the CD90 composition of transplanted cells, the greater the BVF of regenerated bone (r = 0.56; p = 0.05). Oral implants were placed and restored with functionally loaded dental restorations in all patients and no treatment-related adverse events were reported at the 1-year follow-up. These results provide evidence that cell-based therapy using enriched CD90+ stem cell populations is safe for maxillary sinus floor reconstruction and offers potential to accelerate and enhance tissue engineered bone quality in other craniofacial bone defects and deficiencies (Clinicaltrials.gov NCT00980278).
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Affiliation(s)
- Darnell Kaigler
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Center for Oral Health Research, Ann Arbor, MI, USA.,Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Gustavo Avila-Ortiz
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Suncica Travan
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Center for Oral Health Research, Ann Arbor, MI, USA
| | - Andrei D Taut
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Miguel Padial-Molina
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Ivan Rudek
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Feng Wang
- Center for Oral Health Research, Ann Arbor, MI, USA
| | | | - William V Giannobile
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Center for Oral Health Research, Ann Arbor, MI, USA.,Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, MI, USA
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Berger M, Probst F, Schwartz C, Cornelsen M, Seitz H, Ehrenfeld M, Otto S. A concept for scaffold-based tissue engineering in alveolar cleft osteoplasty. J Craniomaxillofac Surg 2015; 43:830-6. [DOI: 10.1016/j.jcms.2015.04.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 04/23/2015] [Accepted: 04/23/2015] [Indexed: 02/06/2023] Open
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Clinical Application of Mesenchymal Stem Cells and Novel Supportive Therapies for Oral Bone Regeneration. BIOMED RESEARCH INTERNATIONAL 2015; 2015:341327. [PMID: 26064899 PMCID: PMC4443638 DOI: 10.1155/2015/341327] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 04/07/2015] [Accepted: 04/14/2015] [Indexed: 02/06/2023]
Abstract
Bone regeneration is often needed prior to dental implant treatment due to the lack of adequate quantity and quality of the bone after infectious diseases, trauma, tumor, or congenital conditions. In these situations, cell transplantation technologies may help to overcome the limitations of autografts, xenografts, allografts, and alloplastic materials. A database search was conducted to include human clinical trials (randomized or controlled) and case reports/series describing the clinical use of mesenchymal stem cells (MSCs) in the oral cavity for bone regeneration only specifically excluding periodontal regeneration. Additionally, novel advances in related technologies are also described. 190 records were identified. 51 articles were selected for full-text assessment, and only 28 met the inclusion criteria: 9 case series, 10 case reports, and 9 randomized controlled clinical trials. Collectively, they evaluate the use of MSCs in a total of 290 patients in 342 interventions. The current published literature is very diverse in methodology and measurement of outcomes. Moreover, the clinical significance is limited. Therefore, the use of these techniques should be further studied in more challenging clinical scenarios with well-designed and standardized RCTs, potentially in combination with new scaffolding techniques and bioactive molecules to improve the final outcomes.
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49
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Marolt D, Rode M, Kregar-Velikonja N, Jeras M, Knezevic M. Primary human alveolar bone cells isolated from tissue samples acquired at periodontal surgeries exhibit sustained proliferation and retain osteogenic phenotype during in vitro expansion. PLoS One 2014; 9:e92969. [PMID: 24667745 PMCID: PMC3965505 DOI: 10.1371/journal.pone.0092969] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 02/27/2014] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Bone tissue regeneration requires a source of viable, proliferative cells with osteogenic differentiation capacity. Periodontal surgeries represent an opportunity to procure small amounts of autologous tissues for primary cell isolation. Our objective was to assess the potential of human alveolar bone as a source of autologous osteogenic cells for tissue engineering and biomaterials and drug testing studies. MATERIALS AND METHODS Alveolar bone tissue was obtained from 37 patients undergoing routine periodontal surgery. Tissue harvesting and cell isolation procedures were optimized to isolate viable cells. Primary cells were subcultured and characterized with respect to their growth characteristics, gene expression of osteogenic markers, alkaline phosphatase activity and matrix mineralization, under osteogenic stimulation. RESULTS Alveolar bone cells were successfully isolated from 28 of the 30 samples harvested with bone forceps, and from 2 of the 5 samples obtained by bone drilling. The yield of cells in primary cultures was variable between the individual samples, but was not related to the site of tissue harvesting and the patient age. In 80% of samples (n = 5), the primary cells proliferated steadily for eight subsequent passages, reaching cumulative numbers over 10(10) cells. Analyses confirmed stable gene expression of alkaline phosphatase, osteopontin and osteocalcin in early and late cell passages. In osteogenic medium, the cells from late passages increased alkaline phosphatase activity and accumulated mineralized matrix, indicating a mature osteoblastic phenotype. CONCLUSIONS Primary alveolar bone cells exhibited robust proliferation and retained osteogenic phenotype during in vitro expansion, suggesting that they can be used as an autologous cell source for bone regenerative therapies and various in vitro studies.
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Affiliation(s)
- Darja Marolt
- Blood Transfusion Center of Slovenia, Ljubljana, Slovenia
- Educell d.o.o., Trzin, Slovenia
- * E-mail:
| | - Matjaz Rode
- Community Health Center, Ljubljana, Slovenia
| | | | - Matjaz Jeras
- Blood Transfusion Center of Slovenia, Ljubljana, Slovenia
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
- Celica d.o.o. Biomedical Centre, Ljubljana, Slovenia
| | - Miomir Knezevic
- Blood Transfusion Center of Slovenia, Ljubljana, Slovenia
- Educell d.o.o., Trzin, Slovenia
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Kagami H, Agata H, Inoue M, Asahina I, Tojo A, Yamashita N, Imai K. The use of bone marrow stromal cells (bone marrow-derived multipotent mesenchymal stromal cells) for alveolar bone tissue engineering: basic science to clinical translation. TISSUE ENGINEERING PART B-REVIEWS 2014; 20:229-32. [PMID: 24494719 DOI: 10.1089/ten.teb.2013.0578] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Bone tissue engineering is a promising field of regenerative medicine in which cultured cells, scaffolds, and osteogenic inductive signals are used to regenerate bone. Human bone marrow stromal cells (BMSCs) are the most commonly used cell source for bone tissue engineering. Although it is known that cell culture and induction protocols significantly affect the in vivo bone forming ability of BMSCs, the responsible factors of clinical outcome are poorly understood. The results from recent studies using human BMSCs have shown that factors such as passage number and length of osteogenic induction significantly affect ectopic bone formation, although such differences hardly affected the alkaline phosphatase activity or gene expression of osteogenic markers. Application of basic fibroblast growth factor helped to maintain the in vivo osteogenic ability of BMSCs. Importantly, responsiveness of those factors should be tested under clinical circumstances to improve the bone tissue engineering further. In this review, clinical application of bone tissue engineering was reviewed with putative underlying mechanisms.
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Affiliation(s)
- Hideaki Kagami
- 1 Tissue Engineering Research Group, Division of Molecular Therapy, The Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo , Tokyo, Japan
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