A comparative study of the effect of Bio‐Oss® in combination with concentrated growth factors or bone marrow‐derived mesenchymal stem cells in canine sinus grafting

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The placement of dental implants in the posterior maxilla is still a challenge in clinical practice. The resorption of alveolar crest and ongoing maxillary sinus pneumatization after tooth extraction 1 usually result in inadequate residual bone height, which precludes insertion of a dental implant. Maxillary sinus floor augmentation (MSFA) has been considered a predictable and effective method for increasing the vertical bone volume.
Various types of grafting materials including autogenic, xenogeneic, allogeneic, and alloplastic materials have been selected to fill the subsinus cavity for bone augmentation 2. Among these, Bio‐Oss® (Geistlich Pharma, Wolhusen, Switzerland) is a well‐documented grafting material, and its effect for MSFA has been investigated in clinical and animal studies 3. However, using this usually requires more healing time due to its low resorbability 4.
To improve the effect of bone regeneration, bone tissue engineering and regenerative medicine has attracted attention. New bone formation has been enhanced by means of loading seed cells and/or growth factors on grafting materials 5. Bone marrow‐derived mesenchymal stem cells (BMSCs) are multipotential cells that are able to differentiate into osteoblasts, chondrocytes, adipocytes, and myoblasts, which has been considered as a readily available source of seed cells for bone tissue engineering applications 6. However, low cell number, donor site morbidity, and age‐related decrease in self‐renewal capacity limited its clinical application.
Utilization of selected growth factors is another strategy to enhance bone formation 7. Unfortunately, the high cost, insecurity, and unpredictable efficacy of exogenous growth factors are major problems in clinical application.
Concentrated growth factors (CGFs) is the newest generation platelet concentrate, which is obtained by a specially programmed centrifuge 8. It contains a variety of growth factors known to be important for the bone regeneration, such as platelet‐derived growth factors (PDGF), transforming growth factors‐β (TGF‐β), vascular endothelial growth factors (VEGF), and insulin‐like growth factors (IGF). The mixture of these growth factors may exert synergistic effects on bone formation after grafting because these factors are endogenous and have optimum physiological proportions. Additionally, CGFs forms a denser and larger 3D fibrin network during centrifugation in a manner similar to natural polymerization in vivo. This fibrin matrix may act as a reservoir of growth factors and support for cell migration and proliferation.
Previous studies have reported the results of using platelet concentrates in bone regeneration. Some show that they may promote new bone formation 9, but others have failed to find similar findings 12. Because these previously inconsistent results were mainly on the first‐generation (platelet‐rich plasma, PRP) and the second‐generation platelet concentrates (platelet‐rich fibrin, PRF), evaluating the regenerative effect of CGFs is needed.
In this study, we compared the effect of composite of CGFs/Bio‐Oss® with the construct of BMSCs/Bio‐Oss® and Bio‐Oss® alone on bone regeneration in MSFA in a canine model.
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