Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Michigan.
Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Michigan, Ann Arbor, Michigan.
Clin Implant Dent Relat Res. 2017 Oct;19(5):793-801. doi: 10.1111/cid.12506. Epub 2017 Jun 28.
Stem cell therapy with bone marrow-derived mesenchymal stem cells is a promising tissue engineering strategy to promote regeneration of craniofacial bone.
To determine whether cell therapy with ex vivo expanded stem cell populations would be safe and efficacious in the regeneration of large alveolar defects in patients with a history of cleft palate or craniofacial trauma.
Eighteen patients (10 patients with traumatic injury and 8 patients with cleft palate) presenting with missing teeth associated with horizontal alveolar bone deficiencies were included in this randomized controlled clinical trial. Patients were randomized to receive either conventional autogenous block grafts or stem cell therapy. After a healing period of 4 months the treated sites were re-entered and the bone width re-assessed prior to implant placement. Implant stability was evaluated through torque testing of the implant upon insertion and at 6 months postloading.
The mean gain in bone width was 1.5 ± 1.5 mm in the stem cell therapy group and 3.3 ± 1.4 mm in the control group. Overall, bone gain was higher in trauma patients as compared to patients with cleft palate, for both the control and the stem cell therapy groups. Most postoperative complications were wound dehiscences and incision line openings. Implants were placed successfully in 5 out of 10 patients in the stem cell therapy group and in all 8 patients in the control group. One implant from the control/cleft palate group failed before loading, while the rest of the implants were loaded successfully and remained stable at 6 months. The patients who did not receive implants were re-treated with autogenous block bone graft.
The ability of stem cells to treat large alveolar defects is safe, yet, their ability to completely reconstitute large alveolar defects is limited. This approach requires further optimization to meet the outcomes seen using current methods to treat large defects, particularly those resultant of cleft palate.
骨髓间充质干细胞的干细胞治疗是一种很有前途的组织工程策略，可促进颅面骨的再生。
确定体外扩增的干细胞群体的细胞治疗在伴有腭裂或颅面创伤病史的患者中是否安全有效，能否促进大的牙槽骨缺损的再生。
本随机对照临床试验纳入了 18 名患者（10 名创伤患者和 8 名腭裂患者），这些患者均存在缺失牙，并伴有水平牙槽骨缺损。患者被随机分为接受常规自体块状移植物或干细胞治疗。在 4 个月的愈合期后，重新进入治疗部位，并在植入前再次评估骨宽度。通过在植入时和加载后 6 个月时对植入物进行扭矩测试来评估植入物的稳定性。
在干细胞治疗组中，骨宽度的平均增加为 1.5±1.5mm，在对照组中为 3.3±1.4mm。总体而言，与腭裂患者相比，创伤患者的骨量增加更高，无论是对照组还是干细胞治疗组均如此。大多数术后并发症是伤口裂开和切口线张开。在干细胞治疗组中，有 5 名患者中的 10 名患者和对照组中的所有 8 名患者成功植入了植入物。对照组/腭裂组的 1 个植入物在加载前失败，而其余的植入物成功加载并在 6 个月时保持稳定。未接受植入物的患者用自体块状骨移植物重新治疗。
干细胞治疗大牙槽骨缺损是安全的，但它们完全重建大牙槽骨缺损的能力有限。这种方法需要进一步优化，以达到使用当前方法治疗大缺损（尤其是腭裂所致的大缺损）的结果。
