Immediate Stem Cell Therapy in Human Maxillary Sinus Grafting

Objectives: Deficit bone volume of posterior maxilla usually requires sinus grafting to facilitate dental implant rehabilitation. Autologous bone marrow aspirate concentrate (BMAC) has currently been applied as immediate clinical stem cell therapy. This study aimed to evaluate bone regeneration capacity and graft retention of BMAC mixed with bovine bone mineral (BBM) in maxillary sinus grafting compared with autogenous bone (AB) and BBM alone.
Methods: Maxillary sinus graftings were carried out in 2 patient groups depending on their grafting requirement. Bilateral maxillary sinus grafting was conducted in a split mouth manner and randomly allocated BBM or BBM+BMAC to individual sinus. In unilateral maxillary sinus grafting, BBM+BMAC or AB was randomly assigned to each patient. Bone marrow samples were evaluated for quantification of nucleated cells and stem cells as well as the differentiation capability of the stem cells. Micro-architectural analysis of bone biopsy was assessed using histological examination and micro-CT scanning. Cone beam CT scan was utilized to evaluate graft volume and height at 1-2 weeks, 3 and 6 months. Patients’ satisfaction, pain score, and morbidity were recorded. This preliminary study analyzed the data by combining patients from both groups. Level of significance (α) was set at 0.05.
.
Results: Nineteen sinuses from thirteen patients were enrolled (BMAC=9, BBM=4 and AB=6). The quantity of nucleated cells and stem cells in BMAC was significantly increased at a factor of 4.43 and 106.88, respectively, and multi-potent differentiation capability of stem cells was proven. BBM (75.95±8.08%) and BBM+BMAC (70.90±8.88%) groups showed a greater Graft volume/Tissue volume (GV/TV) than AB (49.00±13.76%). New bone fraction in BBM+BMAC (75.83±6.85%) was higher than BBM (62.39±1.59%). Graft height of all 3 types of graft did not change over time.
Conclusions: Immediate stem cells transplantation using BMAC mixed with BBM showed a better graft retention than AB and higher new bone fraction than BBM alone.