Skip to main content
Top
Published in: International Journal of Implant Dentistry 1/2020

01-12-2020 | Research

Efficacy of stem cell allograft in maxillary sinus bone regeneration: a randomized controlled clinical and blinded histomorphometric study

Authors: Josh Whitt, Mohanad Al-Sabbagh, Dolphus Dawson, Ehab Shehata, Moly Housley-Smith, Alejandro Tezanos, Ahmad Kutkut

Published in: International Journal of Implant Dentistry | Issue 1/2020

Login to get access

Abstract

Purpose

This study aimed to evaluate the quality and quantity of newly generated bone in the maxillary sinus grafted with stem cell-based allograft material.

Methods

This study was a single site, prospective, blinded, randomized, and controlled clinical trial. Eleven subjects with 18 edentulous posterior maxillary sites requiring sinus augmentation for delayed implant placement using a lateral window approach were enrolled. At the time of sinus augmentation, test sinus was grafted with stem cell-based allograft (Osteocel Plus; NuVasive Therapeutics), while the control sinus was grafted with conventional cortico-cancellous allograft (alloOss; ACE Surgical). Cone beam computer tomography (CBCT) scan was taken before and 14 weeks post-sinus augmentation procedure, i.e., 2 weeks before implant placement. Thirty-six trephined core bone biopsies were harvested from the anterior and posterior grafted lateral-window osteotomy sites at the time of implant placement.

Results

The results showed a statistically significant difference in the vital bone percentage between the test and the control groups at the posterior grafted sites (p = 0.03). There was no significant difference in the percentage of vital bone between the anterior and posterior grafted sites within the test and control groups (p > .05). The CBCT analysis showed that the maxillary sinuses at the posterior grafted sites were statistically wider than those at the anterior grafted sites in both groups (p < .05).

Conclusions

Different allograft bone materials can be used in the maxillary sinus augmentation procedures. Stem cell allograft has more osteogenic potential with a better outcome in the wide posterior sinus.
Appendix
Available only for authorised users
Literature
1.
go back to reference Greenstein GC, J. Mapping the maxillary sinus. Decisions in Dentistry. 2016. Greenstein GC, J. Mapping the maxillary sinus. Decisions in Dentistry. 2016.
2.
go back to reference Al-Salman WT, Almas K. Maxillary sinus, and success of dental implants: an update. Gen Dent. 2015;63(4):47–54.PubMed Al-Salman WT, Almas K. Maxillary sinus, and success of dental implants: an update. Gen Dent. 2015;63(4):47–54.PubMed
3.
go back to reference Sharan A, Madjar D. Maxillary sinus pneumatization following extractions: a radiographic study. Int J Oral Maxillofac Implants. 2008;23(1):48–56.PubMed Sharan A, Madjar D. Maxillary sinus pneumatization following extractions: a radiographic study. Int J Oral Maxillofac Implants. 2008;23(1):48–56.PubMed
4.
go back to reference Iasella JM, Greenwell H, Miller RL, et al. Ridge preservation with freeze-dried bone allograft and a collagen membrane compared to extraction alone for implant site development: a clinical and histologic study in humans. J Periodontol. 2003;74(7):990–9.CrossRefPubMed Iasella JM, Greenwell H, Miller RL, et al. Ridge preservation with freeze-dried bone allograft and a collagen membrane compared to extraction alone for implant site development: a clinical and histologic study in humans. J Periodontol. 2003;74(7):990–9.CrossRefPubMed
5.
go back to reference Schropp L, Wenzel A, Kostopoulos L, Karring T. Bone healing and soft tissue contour changes following single-tooth extraction: a clinical and radiographic 12-month prospective study. Int J Periodontics Restorative Dent. 2003;23(4):313–23.PubMed Schropp L, Wenzel A, Kostopoulos L, Karring T. Bone healing and soft tissue contour changes following single-tooth extraction: a clinical and radiographic 12-month prospective study. Int J Periodontics Restorative Dent. 2003;23(4):313–23.PubMed
6.
go back to reference Leblebicioglu B, Salas M, Ort Y, et al. Determinants of alveolar ridge preservation differ by anatomic location. J Clin Periodontol. 2013;40(4):387–95.CrossRefPubMedPubMedCentral Leblebicioglu B, Salas M, Ort Y, et al. Determinants of alveolar ridge preservation differ by anatomic location. J Clin Periodontol. 2013;40(4):387–95.CrossRefPubMedPubMedCentral
7.
go back to reference Jakobsen C, Sorensen JA, Kassem M, Thygesen TH. Mesenchymal stem cells in oral reconstructive surgery: a systematic review of the literature. J Oral Rehabil. 2013;40(9):693–706.CrossRefPubMed Jakobsen C, Sorensen JA, Kassem M, Thygesen TH. Mesenchymal stem cells in oral reconstructive surgery: a systematic review of the literature. J Oral Rehabil. 2013;40(9):693–706.CrossRefPubMed
8.
go back to reference Yamada Y, Ueda M, Hibi H, Nagasaka T. Translational research for injectable tissue-engineered bone regeneration using mesenchymal stem cells and platelet-rich plasma: from basic research to a clinical case study. Cell transplantation. 2004;13(4):343–55.CrossRefPubMed Yamada Y, Ueda M, Hibi H, Nagasaka T. Translational research for injectable tissue-engineered bone regeneration using mesenchymal stem cells and platelet-rich plasma: from basic research to a clinical case study. Cell transplantation. 2004;13(4):343–55.CrossRefPubMed
9.
go back to reference Springer IN, Nocini PF, Schlegel KA, et al. Two techniques for the preparation of cell-scaffold constructs suitable for sinus augmentation: steps into clinical application. Tissue Eng. 2006 Sep;12(9):2649–56.CrossRefPubMed Springer IN, Nocini PF, Schlegel KA, et al. Two techniques for the preparation of cell-scaffold constructs suitable for sinus augmentation: steps into clinical application. Tissue Eng. 2006 Sep;12(9):2649–56.CrossRefPubMed
10.
go back to reference El Haj AJ, Cartmell SH. Bioreactors for bone tissue engineering. Proceedings of the Institution of Mechanical Engineers Part H, Journal of engineering in medicine. 2010;224(12):1523–32.CrossRefPubMed El Haj AJ, Cartmell SH. Bioreactors for bone tissue engineering. Proceedings of the Institution of Mechanical Engineers Part H, Journal of engineering in medicine. 2010;224(12):1523–32.CrossRefPubMed
11.
go back to reference Katagiri W, Osugi M, Kawai T, Ueda M. Novel cell-free regeneration of bone using stem cell-derived growth factors. Int J Oral Maxillofac Implants. 2013;28(4):1009–16.CrossRefPubMed Katagiri W, Osugi M, Kawai T, Ueda M. Novel cell-free regeneration of bone using stem cell-derived growth factors. Int J Oral Maxillofac Implants. 2013;28(4):1009–16.CrossRefPubMed
12.
go back to reference Tare RS, Kanczler J, Aarvold A, Jones AM, Dunlop DG, Oreffo RO. Skeletal stem cells and bone regeneration: translational strategies from bench to clinic. Proceedings of the Institution of Mechanical Engineers Part H, Journal of engineering in medicine. 2010;224(12):1455–70.CrossRefPubMed Tare RS, Kanczler J, Aarvold A, Jones AM, Dunlop DG, Oreffo RO. Skeletal stem cells and bone regeneration: translational strategies from bench to clinic. Proceedings of the Institution of Mechanical Engineers Part H, Journal of engineering in medicine. 2010;224(12):1455–70.CrossRefPubMed
13.
go back to reference Seong JM, Kim BC, Park JH, Kwon IK, Mantalaris A, Hwang YS. Stem cells in bone tissue engineering. Biomedical materials (Bristol, England). 2010;5(6):062001. Seong JM, Kim BC, Park JH, Kwon IK, Mantalaris A, Hwang YS. Stem cells in bone tissue engineering. Biomedical materials (Bristol, England). 2010;5(6):062001.
14.
go back to reference Tatum H Jr. Maxillary and sinus implant reconstructions. Dent Clin North Am. 1986;30(2):207–29.PubMed Tatum H Jr. Maxillary and sinus implant reconstructions. Dent Clin North Am. 1986;30(2):207–29.PubMed
15.
go back to reference Starch-Jensen T, Aludden H, Hallman M, Dahlin C, Christensen AE, Mordenfeld A. A systematic review and meta-analysis of long-term studies (five or more years) assessing maxillary sinus floor augmentation. Int J Oral Maxillofac Surg. 2018;47(1):103–16.CrossRefPubMed Starch-Jensen T, Aludden H, Hallman M, Dahlin C, Christensen AE, Mordenfeld A. A systematic review and meta-analysis of long-term studies (five or more years) assessing maxillary sinus floor augmentation. Int J Oral Maxillofac Surg. 2018;47(1):103–16.CrossRefPubMed
16.
go back to reference Ting M, Rice JG, Braid SM, Lee CYS, Suzuki JB. Maxillary sinus augmentation for dental implant rehabilitation of the edentulous ridge: a comprehensive overview of systematic reviews. Implant Dent. 2017;26(3):438–64.CrossRefPubMed Ting M, Rice JG, Braid SM, Lee CYS, Suzuki JB. Maxillary sinus augmentation for dental implant rehabilitation of the edentulous ridge: a comprehensive overview of systematic reviews. Implant Dent. 2017;26(3):438–64.CrossRefPubMed
17.
go back to reference Danesh-Sani SA, Engebretson SP, Janal MN. Histomorphometric results of different grafting materials and the effect of healing time on bone maturation after sinus floor augmentation: a systematic review and meta-analysis. J Periodontal Res. 2017;52(3):301–12.CrossRefPubMed Danesh-Sani SA, Engebretson SP, Janal MN. Histomorphometric results of different grafting materials and the effect of healing time on bone maturation after sinus floor augmentation: a systematic review and meta-analysis. J Periodontal Res. 2017;52(3):301–12.CrossRefPubMed
18.
go back to reference Corbella S, Taschieri S, Weinstein R, Del Fabbro M. Histomorphometric outcomes after lateral sinus floor elevation procedure: a systematic review of the literature and meta-analysis. Clin Oral Implants Res. 2016;27(9):1106–22.CrossRefPubMed Corbella S, Taschieri S, Weinstein R, Del Fabbro M. Histomorphometric outcomes after lateral sinus floor elevation procedure: a systematic review of the literature and meta-analysis. Clin Oral Implants Res. 2016;27(9):1106–22.CrossRefPubMed
19.
go back to reference Handschel J, Simonowska M, Naujoks C, et al. A histomorphometric meta-analysis of sinus elevation with various grafting materials. Head & face medicine. 2009;5:12.CrossRef Handschel J, Simonowska M, Naujoks C, et al. A histomorphometric meta-analysis of sinus elevation with various grafting materials. Head & face medicine. 2009;5:12.CrossRef
20.
go back to reference Favato MN, Vidigal BC, Cosso MG, Manzi FR, Shibli JA, Zenobio EG. Impact of human maxillary sinus volume on grafts dimensional changes used in maxillary sinus augmentation: a multislice tomographic study. Clin Oral Implants Res. 2015;26(12):1450–5.CrossRefPubMed Favato MN, Vidigal BC, Cosso MG, Manzi FR, Shibli JA, Zenobio EG. Impact of human maxillary sinus volume on grafts dimensional changes used in maxillary sinus augmentation: a multislice tomographic study. Clin Oral Implants Res. 2015;26(12):1450–5.CrossRefPubMed
21.
go back to reference Zijderveld SA, Schulten EA, Aartman IH, ten Bruggenkate CM. Long-term changes in graft height after maxillary sinus floor elevation with different grafting materials: radiographic evaluation with a minimum follow-up of 4.5 years. Clin Oral Implants Res. 2009;20(7):691–700.CrossRefPubMed Zijderveld SA, Schulten EA, Aartman IH, ten Bruggenkate CM. Long-term changes in graft height after maxillary sinus floor elevation with different grafting materials: radiographic evaluation with a minimum follow-up of 4.5 years. Clin Oral Implants Res. 2009;20(7):691–700.CrossRefPubMed
22.
go back to reference Kutkut AM, Andreana S, Kim HL, Monaco E. Clinical recommendation for treatment planning of sinus augmentation procedures by using presurgical CAT scan images: a preliminary report. Implant Dent. 2011;20:413–7.CrossRefPubMed Kutkut AM, Andreana S, Kim HL, Monaco E. Clinical recommendation for treatment planning of sinus augmentation procedures by using presurgical CAT scan images: a preliminary report. Implant Dent. 2011;20:413–7.CrossRefPubMed
23.
go back to reference Avila G, Wang HL, Galindo-Moreno P, et al. The influence of the Bucco-palatal distance on sinus augmentation outcomes. J Periodontol. 2010;81:1041–50.CrossRefPubMed Avila G, Wang HL, Galindo-Moreno P, et al. The influence of the Bucco-palatal distance on sinus augmentation outcomes. J Periodontol. 2010;81:1041–50.CrossRefPubMed
24.
go back to reference Bergh van den JPA, Bruggenkate ten CM, Disch FJM, et al. Anatomical aspects of sinus floor elevations. Clin Oral Implants Res 2000;11:256–265. Bergh van den JPA, Bruggenkate ten CM, Disch FJM, et al. Anatomical aspects of sinus floor elevations. Clin Oral Implants Res 2000;11:256–265.
25.
go back to reference Rios HF, Avila G, Galindo-Moreno P, et al. The influence of remaining alveolar bone upon lateral window sinus augmentation implant survival. Implant Dent. 2009;18:402–12.CrossRefPubMed Rios HF, Avila G, Galindo-Moreno P, et al. The influence of remaining alveolar bone upon lateral window sinus augmentation implant survival. Implant Dent. 2009;18:402–12.CrossRefPubMed
26.
go back to reference McGowan DA, Baxter PW, James J. The maxillary sinus and its dental implications. Oxford, England: Butter worth Heinemann; 1993. p. 1–39. McGowan DA, Baxter PW, James J. The maxillary sinus and its dental implications. Oxford, England: Butter worth Heinemann; 1993. p. 1–39.
27.
go back to reference Flanagan D. Arterial supply of maxillary sinus and potential for bleeding complication during lateral approach sinus elevation. Implant Dent. 2005;14: 336–339. 28. Flanagan D. Arterial supply of maxillary sinus and potential for bleeding complication during lateral approach sinus elevation. Implant Dent. 2005;14: 336–339. 28.
28.
go back to reference Elian N, Wallace S, Cho SC. Distribution of the maxillary artery as it relates to sinus floor augmentation. Int J Oral Maxillofac Implants. 2005;20:784–7.PubMed Elian N, Wallace S, Cho SC. Distribution of the maxillary artery as it relates to sinus floor augmentation. Int J Oral Maxillofac Implants. 2005;20:784–7.PubMed
29.
go back to reference Margolin MD, Cogan AG, Taylor M, et al. Maxillary sinus augmentation in the non-human primate: a comparative radiographic and histologic study between recombinant human osteogenic protein-1 and natural bone mineral. J Periodontol. 1998;69:911–9.CrossRefPubMed Margolin MD, Cogan AG, Taylor M, et al. Maxillary sinus augmentation in the non-human primate: a comparative radiographic and histologic study between recombinant human osteogenic protein-1 and natural bone mineral. J Periodontol. 1998;69:911–9.CrossRefPubMed
30.
go back to reference Artzi Z, Kozlovsky A, Nemcovsky CE, et al. The amount of newly formed bone in sinus grafting procedures depends on tissue depth as well as the type and residual amount of the grafted material. J Clin Periodontol. 2005;32:193–9.CrossRefPubMed Artzi Z, Kozlovsky A, Nemcovsky CE, et al. The amount of newly formed bone in sinus grafting procedures depends on tissue depth as well as the type and residual amount of the grafted material. J Clin Periodontol. 2005;32:193–9.CrossRefPubMed
Metadata
Title
Efficacy of stem cell allograft in maxillary sinus bone regeneration: a randomized controlled clinical and blinded histomorphometric study
Authors
Josh Whitt
Mohanad Al-Sabbagh
Dolphus Dawson
Ehab Shehata
Moly Housley-Smith
Alejandro Tezanos
Ahmad Kutkut
Publication date
01-12-2020
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Implant Dentistry / Issue 1/2020
Electronic ISSN: 2198-4034
DOI
https://doi.org/10.1186/s40729-020-00222-w

Other articles of this Issue 1/2020

International Journal of Implant Dentistry 1/2020 Go to the issue