Department of Clinical Dentistry, Center for Clinical Dental Research, University of Bergen, Bergen, Norway.
Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland.
J Clin Periodontol. 2019 Jun;46 Suppl 21:162-182. doi: 10.1111/jcpe.13049.
The objective of the present review was to answer the focused question: what is the effect of cell therapy in terms of orofacial bone regeneration compared to grafting with only biomaterial scaffolds and/or autogenous bone?
Electronic databases were searched for relevant controlled clinical and pre-clinical (large-animal) studies. Separate meta-analyses of quantitative data regarding histological or radiographic new bone formation were performed.
Forty-seven eligible clinical and 57 pre-clinical studies were included. Clinical studies were categorized based on the use of "minimally manipulated" whole tissues (e.g., bone marrow) or ex vivo expanded cells from "uncommitted" (bone marrow, adipose tissue) or "committed" sources (periosteum, bone). Based on limited and heterogeneous clinical evidence, implantation of cells (mostly whole bone marrow), in combination with biomaterial scaffolds results in bone regeneration which is (a) superior compared to implantation of scaffolds alone in sinus and horizontal ridge augmentation, and (b) comparable to autogenous bone in alveolar cleft repair.
Although current evidence points to the benefits of cell therapy in certain clinical indications, it is unclear whether the use of ex vivo expanded cells, either uncommitted or committed, is superior to whole tissue fractions in terms of bone regeneration. The relatively larger effect sizes in favour of cell therapy observed in pre-clinical studies are diminished in clinical trials. Future controlled studies should include cost-effectiveness analyses to guide clinical decision-making.
本综述的目的是回答聚焦问题：细胞治疗在颌骨再生方面的效果如何，与仅使用生物材料支架和/或自体骨相比？
电子数据库中检索了相关的对照临床和临床前（大动物）研究。分别对组织学或影像学新骨形成的定量数据进行了荟萃分析。
纳入了 47 项合格的临床研究和 57 项临床前研究。临床研究基于使用“最小处理”的整个组织（例如骨髓）或来自“未分化”（骨髓、脂肪组织）或“分化”来源（骨膜、骨）的体外扩增细胞进行分类。基于有限且异质的临床证据，细胞（主要是整个骨髓）与生物材料支架的植入可促进骨再生，这在（a）窦和水平牙槽嵴增高方面优于单独植入支架，（b）在牙槽裂修复方面与自体骨相当。
尽管目前的证据表明细胞治疗在某些临床适应证中具有益处，但尚不清楚体外扩增的细胞（未分化或分化）在骨再生方面是否优于整个组织片段。在临床前研究中观察到的有利于细胞治疗的较大效应大小在临床试验中有所减弱。未来的对照研究应包括成本效益分析，以指导临床决策。
