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Naros A, Bayazeed B, Schwarz U, Nagursky H, Reinert S, Schmelzeisen R, Sauerbier S. A prospective histomorphometric and cephalometric comparison of bovine bone substitute and autogenous bone grafting in Le Fort I osteotomies. J Craniomaxillofac Surg 2018; 47:233-238. [PMID: 30591394 DOI: 10.1016/j.jcms.2018.11.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 11/01/2018] [Accepted: 11/29/2018] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The aim of the present study was the histomorphometric and cephalometric comparison of autogenous bone grafting of the anterior iliac crest and the application of bovine bone substitute concerning new bone formation and postoperative stability in patients undergoing orthognathic Le Fort I osteotomy. PATIENTS AND METHODS Twenty-five patients requiring orthognathic surgery with Le Fort I osteotomy were included in this study. Patients were randomly divided into three groups receiving either autogenous iliac crest BONE grafting (BONE; n = 8) or xenogenic bovine bone grafting (Bio-Oss®) in INTER (n = 12) or in ONLAY (n = 5) position. Histomorphometric analysis was performed using trephine bone biopsies from the autogenous, respectively xenogenic bone grafting region. Postoperative stability was evaluated using teleradiographies of three different timepoints. RESULTS All groups showed comparable mineralized fractions in bone biopsies of 50.2% (±13.2%) INTER, 46.48% (±12.3%) ONLAY and 57.1% (±20.6%) BONE as well as comparable percentage of connective tissue. Patients in the INTER-group revealed the lowest relapse rate of 20.5% (INTER) compared to 30.3% (ONLAY) and 33.0% (BONE). All groups underwent comparable maxillary advancement and healing time. CONCLUSIONS Present results indicate that block shaped bovine bone substitute is a promising alternative to autogenous bone grafting to bridge the Le Fort I osteotomy gap in orthognathic surgery.
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Affiliation(s)
- Andreas Naros
- Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. Dr. Siegmar Reinert, MD, DMD, PhD), University Hospital Tuebingen, Osianderstrasse 2-8, 72076 Tuebingen, Germany.
| | - Bassem Bayazeed
- Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. Dr. Rainer Schmelzeisen, MD, DMD, PhD), University Hospital Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Ulrich Schwarz
- Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. Dr. Rainer Schmelzeisen, MD, DMD, PhD), University Hospital Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Heiner Nagursky
- Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. Dr. Rainer Schmelzeisen, MD, DMD, PhD), University Hospital Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Siegmar Reinert
- Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. Dr. Siegmar Reinert, MD, DMD, PhD), University Hospital Tuebingen, Osianderstrasse 2-8, 72076 Tuebingen, Germany
| | - Rainer Schmelzeisen
- Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. Dr. Rainer Schmelzeisen, MD, DMD, PhD), University Hospital Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Sebastian Sauerbier
- Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. Dr. Siegmar Reinert, MD, DMD, PhD), University Hospital Tuebingen, Osianderstrasse 2-8, 72076 Tuebingen, Germany; Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. Dr. Rainer Schmelzeisen, MD, DMD, PhD), University Hospital Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
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Wildburger A, Bubalo V, Magyar M, Nagursky H, Jakse N, Schmelzeisen R, Sauerbier S. Sinus Floor Augmentation Comparing an In Situ Hardening Biphasic Calcium Phosphate (Hydroxyapatite/β-Tricalcium Phosphate) Bone Graft Substitute with a Particulate Biphasic Calcium Phosphate (Hydroxyapatite/β-Tricalcium Phosphate) Bone Graft Substitute: An Experimental Study in Sheep. Tissue Eng Part C Methods 2018; 23:404-411. [PMID: 28605989 DOI: 10.1089/ten.tec.2016.0549] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of the present split-mouth study in sheep was to assess the influence of in situ hardening properties of a biphasic calcium phosphate (BCP) bone graft substitute (BGS) (ratio hydroxyapatite/β-tricalcium phosphate = 60/40) compared with a particulate BGS with the same biphasic core-granule composition without in situ hardening properties on sinus floor augmentation. MATERIALS AND METHODS Therefore, bilateral sinus floor augmentation was performed in eight sheep. Poly(lactide-co-glycolide) (PLGA)-coated, in situ hardening biphasic BGS (PLGA-NMP [N-Methyl-2-pyrrolidone]-BCP) was placed at the test site, and a particulate biphasic BGS without PLGA coating (BCP) was used for the contralateral site as a control. Animals were sacrificed after 21 weeks. Sinus augmentation sites were analyzed histologically. The volume was analyzed by computed tomography. Histomorphometric parameters were assessed for the 12 and 21 weeks' time points. Slopes of new bone formation over time were compared with a linear growth regression model. RESULTS Bone formation after 12 and 21 weeks of healing was 8.94% (±3.74) and 19.82% (±6.29) for PLGA-NMP-BCP and 7.00% (±2.58) and 14.38% (±4.51) for BCP, respectively. The bone growth rate for PLGA-NMP-BCP was higher than the growth rate for BCP (probability 97.5%). The total fraction of calcified hard tissue (% bone fraction + % biomaterial) was around 46% for both tested biomaterials, 21 weeks after sinus floor augmentation. CONCLUSION The in situ hardening BGS (PLGA-NMP-BCP) performed better than the particulate material (BCP) in terms of bone formation rate. The in situ hardening properties of the PLGA-NMP-BCP material mediated by the PLGA coating and NMP solution as plasticizer had no negative influence on the bone formation.
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Affiliation(s)
- Angelika Wildburger
- 1 Department of Oral Surgery and Orthodontics, School of Dentistry, Medical University of Graz , Graz, Austria
| | - Vladimir Bubalo
- 2 Division of Biomedical Research, Medical University of Graz , Graz, Austria
| | - Marton Magyar
- 3 Department of Radiology, Medical University Graz , Graz, Austria
| | - Heiner Nagursky
- 4 Hard Tissue Research Laboratory, Department of Oral and Maxillofacial Surgery, University Hospital of Freiburg , Freiburg, Germany
| | - Norbert Jakse
- 1 Department of Oral Surgery and Orthodontics, School of Dentistry, Medical University of Graz , Graz, Austria
| | - Rainer Schmelzeisen
- 5 Department of Oral and Maxillofacial Surgery, University Hospital of Freiburg , Freiburg, Germany
| | - Sebastian Sauerbier
- 6 Department of Oral and Maxillofacial Surgery, University Hospital of Tübingen , Tübingen, Germany .,7 Private Practitioner and Consultant for Oral and Maxillofacial Surgery, at Municipal Hospital Fulda , Fulda, Germany
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Seelbach RJ, Fransen P, Pulido D, D'Este M, Duttenhoefer F, Sauerbier S, Freiman TM, Niemeyer P, Albericio F, Alini M, Royo M, Mata A, Eglin D. Injectable Hyaluronan Hydrogels with Peptide-Binding Dendrimers Modulate the Controlled Release of BMP-2 and TGF-β1. Macromol Biosci 2015; 15:1035-44. [DOI: 10.1002/mabi.201500082] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/10/2015] [Indexed: 12/24/2022]
Affiliation(s)
- Ryan J. Seelbach
- AO Research Institute Davos; Clavadelerstrasse 8 7270 Davos Platz Switzerland
- Universitat de Barcelona; Martí i Franquès 1 08028 Barcelona Spain
| | - Peter Fransen
- Institute of Research in Biomedicine; Baldiri Reixac 10-12 08028 Barcelona Spain
- Biomedical Research Networking Center in Bioengineering; Biomaterials and Nanomedicine; Baldiri Reixac 10-12 08028 Barcelona Spain
| | - Daniel Pulido
- Biomedical Research Networking Center in Bioengineering; Biomaterials and Nanomedicine; Baldiri Reixac 10-12 08028 Barcelona Spain
| | - Matteo D'Este
- AO Research Institute Davos; Clavadelerstrasse 8 7270 Davos Platz Switzerland
| | | | | | - Thomas M. Freiman
- Universitätsklinikum Goethe Universität; Schleusenweg 2-16 D-60538 Frankfurt am Main Germany
| | - Philipp Niemeyer
- Universitätsklinik Freiburg; Hugstetter Str. 55 D-79106 Freiburg Germany
| | - Fernando Albericio
- Institute of Research in Biomedicine; Baldiri Reixac 10-12 08028 Barcelona Spain
- Biomedical Research Networking Center in Bioengineering; Biomaterials and Nanomedicine; Baldiri Reixac 10-12 08028 Barcelona Spain
| | - Mauro Alini
- AO Research Institute Davos; Clavadelerstrasse 8 7270 Davos Platz Switzerland
| | - Miriam Royo
- Biomedical Research Networking Center in Bioengineering; Biomaterials and Nanomedicine; Baldiri Reixac 10-12 08028 Barcelona Spain
- Combinatorial Chemistry Unit; Barcelona Science Park; Baldiri Reixac 10-12 08028 Barcelona Spain
| | - Alvaro Mata
- Queen Mary; University of London; Mile End Road E1 4NS London UK
| | - David Eglin
- AO Research Institute Davos; Clavadelerstrasse 8 7270 Davos Platz Switzerland
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Seelbach RJ, Fransen P, Peroglio M, Pulido D, Lopez-Chicon P, Duttenhoefer F, Sauerbier S, Freiman T, Niemeyer P, Semino C, Albericio F, Alini M, Royo M, Mata A, Eglin D. Multivalent dendrimers presenting spatially controlled clusters of binding epitopes in thermoresponsive hyaluronan hydrogels. Acta Biomater 2014; 10:4340-50. [PMID: 24993802 DOI: 10.1016/j.actbio.2014.06.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 05/21/2014] [Accepted: 06/18/2014] [Indexed: 01/08/2023]
Abstract
The controlled presentation of biofunctionality is of key importance for hydrogel applications in cell-based regenerative medicine. Here, a versatile approach was demonstrated to present clustered binding epitopes in an injectable, thermoresponsive hydrogel. Well-defined multivalent dendrimers bearing four integrin binding sequences and an azido moiety were covalently grafted to propargylamine-derived hyaluronic acid (Hyal-pa) using copper-catalyzed alkyne-azide cycloaddition (CuAAC), and then combined with pN-modified hyaluronan (Hyal-pN). The dendrimers were prepared by synthesizing a bifunctional diethylenetriamine pentaacetic acid core with azido and NHBoc oligo(ethylene glycol) aminoethyl branches, then further conjugated with solid-phase synthesized RGDS and DGRS peptides. Azido terminated pN was synthesized by reversible addition-fragmentation chain transfer polymerization and reacted to Hyal-pa via CuAAC. Nuclear magnetic resonance (NMR), high performance liquid chromatography, size exclusion chromatography and mass spectroscopy proved that the dendrimers had well-defined size and were disubstituted. NMR and atomic absorption analysis confirmed the hyaluronan was affixed with dendrimers or pN. Rheological measurements demonstrated that dendrimers do not influence the elastic or viscous moduli of thermoresponsive hyaluronan compositions at a relevant biological concentration. Finally, human mesenchymal stromal cells were encapsulated in the biomaterial and cultured for 21days, demonstrating the faculty of this dendrimer-modified hydrogel as a molecular toolbox for tailoring the biofunctionality of thermoresponsive hyaluronan carriers for biomedical applications.
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Affiliation(s)
- Ryan J Seelbach
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos Platz, Switzerland; Universitat de Barcelona, Martí i Franquès 1, 08028 Barcelona, Spain
| | - Peter Fransen
- Institute for Research in Biomedicine, Baldiri Reixac 10-12, 08028 Barcelona, Spain; Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Baldiri Reixac 10-12, 08028 Barcelona, Spain
| | - Marianna Peroglio
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos Platz, Switzerland
| | - Daniel Pulido
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Baldiri Reixac 10-12, 08028 Barcelona, Spain; Combinatorial Chemistry Unit, Barcelona Science Park, Baldiri Reixac 10-12, 08028 Barcelona, Spain
| | | | | | | | - Thomas Freiman
- Universitätsklinikum Goethe Universität, Schleusenweg 2-16, D-60538 Frankfurt am Main, Germany
| | - Philipp Niemeyer
- Universitätsklinik Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany
| | - Carlos Semino
- Institute de Quimica de Sarría, Via Augusta 390, 08017 Barcelona, Spain
| | - Fernando Albericio
- Institute for Research in Biomedicine, Baldiri Reixac 10-12, 08028 Barcelona, Spain; Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Baldiri Reixac 10-12, 08028 Barcelona, Spain
| | - Mauro Alini
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos Platz, Switzerland
| | - Miriam Royo
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Baldiri Reixac 10-12, 08028 Barcelona, Spain; Combinatorial Chemistry Unit, Barcelona Science Park, Baldiri Reixac 10-12, 08028 Barcelona, Spain
| | - Alvaro Mata
- Queen Mary, University of London, Mile End Road, E1 4NS London, UK
| | - David Eglin
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos Platz, Switzerland.
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Duttenhoefer F, Mertens ME, Vizkelety J, Gremse F, Stadelmann VA, Sauerbier S. Magnetic resonance imaging in zirconia‐based dental implantology. Clin Oral Implants Res 2014; 26:1195-202. [DOI: 10.1111/clr.12430] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Fabian Duttenhoefer
- Department of Oral and Craniomaxillofacial Surgery University Hospital Freiburg Freiburg Germany
| | - Marianne E. Mertens
- Department of Experimental Molecular Imaging Helmholtz‐Institute for Biomedical Engineering RWTH‐Aachen University Aachen Germany
| | - Josef Vizkelety
- Department of Oral and Craniomaxillofacial Surgery University Hospital Freiburg Freiburg Germany
| | - Felix Gremse
- Department of Experimental Molecular Imaging Helmholtz‐Institute for Biomedical Engineering RWTH‐Aachen University Aachen Germany
| | | | - Sebastian Sauerbier
- Department of Oral and Craniomaxillofacial Surgery University Hospital Freiburg Freiburg Germany
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Duttenhoefer F, Hieber SF, Stricker A, Schmelzeisen R, Gutwald R, Sauerbier S. Follow-up of implant survival comparing ficoll and bone marrow aspirate concentrate methods for hard tissue regeneration with mesenchymal stem cells in humans. Biores Open Access 2014; 3:75-6. [PMID: 24804168 PMCID: PMC3995205 DOI: 10.1089/biores.2014.0003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objective: Clinical follow-up of implant survival in 11 patients comparing two different methods for mesenchymal stem cell (MSC) isolation (Ficoll and bone marrow aspirate concentrate [BMAC]) applied in maxillary sinus augmentation. Methods: Mononuclear cells, including MSCs, were concentrated with either Ficoll (control group, n=6 sinus) or BMAC (test group, n=12 sinus) and transplanted in combination with bovine bone mineral. A total of 50 implants were placed in a second surgical intervention (17 Ficoll/33 BMAC) and loaded after 4 months. Overall implant survival was assessed with a Kaplan-Meier model using package survival under R. Results: Implant survival of the Ficoll group was 100% compared with the BMAC group, which had 93.4% survival (95% confidence interval, 0.849–1). The difference between the groups was not significant (p=0.381). Conclusion: The BMAC system is an effective and suitable “chair-side” method for clinical application in hard tissue regeneration.
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Affiliation(s)
- Fabian Duttenhoefer
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg , Freiburg, Germany
| | - Stefan F Hieber
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg , Freiburg, Germany
| | - Andres Stricker
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg , Freiburg, Germany
| | - Rainer Schmelzeisen
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg , Freiburg, Germany
| | - Ralf Gutwald
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg , Freiburg, Germany
| | - Sebastian Sauerbier
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg , Freiburg, Germany
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Sauerbier S, Giessenhagen B, Gutwerk W, Rauch P, Xavier SP, Oshima T, Nagursky H, Gutwald R, Schmelzeisen R. Bone marrow aspirate concentrate used with bovine bone mineral to reconstruct vertical and horizontal mandibular defects: report of two techniques. Int J Oral Maxillofac Implants 2014; 28:e310-4. [PMID: 24066349 DOI: 10.11607/jomi.te13] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Following initial positive reports of the use of bone marrow aspirate concentrate (BMAC) in combination with bovine bone mineral (BBM) in augmentation procedures, the technique was evaluated in patients with mandibular deficiency. MATERIALS AND METHODS Two adult patients required surgical correction of a deficient alveolar ridge (one patient showed horizontal deficiency only, and the other patient presented with horizontal and vertical deficiency) prior to dental implant placement. In both patients, the reconstruction was performed with BBM in combination with mononuclear cells concentrated by the BMAC method using different techniques. RESULTS The patients recovered well from all surgical procedures. Histologically, there was uniform bone formation, which allowed placement of dental implants. CONCLUSION The results suggest that the use of BMAC in combination with BBM, without autogenous bone, has the potential to restore horizontal and vertical mandibular alveolar defects, providing a functional bone structure and allowing dental implant placement for subsequent prosthetic rehabilitation.
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Duttenhoefer F, Fuessinger MA, Ahne S, Oshima T, Gutwald R, Schmelzeisen R, Sauerbier S. The effect of gabapentin-lactam hydroxamic acid derivatives on ovine osteoblast proliferation and phenotype: perspectives for tissue engineering application. Int J Oral Maxillofac Implants 2014; 29:e73-80. [PMID: 24451891 DOI: 10.11607/jomi.te45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Modern bone tissue engineering associated with mesenchymal stem cells (MSCs) provides promising treatment alternatives for the loss of bone, one of the foremost challenges in oral and craniofacial surgery today. The effect of gabapentin-lactam (GBP-L) and its analogs on osteogenic differentiated MSCs has not yet been deciphered. Consequently, this study investigates the effect of novel trans-8-tertbutylgabapentin-lactam (trans-8-TB-GBP-L) hydroxamic acid derivatives on metabolism, proliferation, and physiologic mineralization characteristics of ovine osteoblast cells. MATERIALS AND METHODS Osteoblasts were extracted and prepared from sheep femoral heads and cultured in medium enriched with hydroxamic acid derivatives of trans-8-TB-GBP-L. The cell proliferation rate, cell metabolism, cell viability, and basic osteoblastic function were assessed. RESULTS After 3 and 5 days of incubation, no significant increase in DNA content was detected in any of 12 test groups versus the control group. However, after 8 days of incubation, a significant increase of DNA contents in the test groups containing nanomolar concentrations of trans-8-TB-GBP-L hydroxamic acid derivatives was found. No significant aberration in metabolic activity was detected when any of the test substances were applied. ALP displayed similar activity rates among the test groups and the control at all time points. Calcification of osteoblastic cells occurred solely when nanomolar concentrations were used. CONCLUSION Trans-8-TB-GBP-L hydroxamic acid derivatives do not interfere with physiologic function and phenotype of ovine osteoblasts. However, when applied at nanomolar concentrations, the assessed GBP-L derivatives significantly increased the cell proliferation rate after 8 days of incubation, indicating a dose-response curve with the maximum peak at nanomolar concentration and a retarded drug response between 5 and 8 days.
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Duttenhoefer F, Biswas SK, Igwe JC, Sauerbier S, Bierhaus A. Sp1-Dependent Regulation of PPARα in Bone Metabolism. Int J Oral Maxillofac Implants 2014; 29:e107-16. [DOI: 10.11607/jomi.te49] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Oshima T, Duttenhoefer F, Xavier S, Nelson K, Sauerbier S. Can mesenchymal stem cells and novel gabapentin-lactam enhance maxillary bone formation? J Oral Maxillofac Surg 2013; 72:485-95. [PMID: 24528562 DOI: 10.1016/j.joms.2013.10.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 10/30/2013] [Accepted: 10/31/2013] [Indexed: 12/26/2022]
Abstract
PURPOSE Novel gabapentin-lactam (GBP-L) has shown its potency in enhancing new bone formation (NBF) in vitro. The objective of the present preclinical trial was to investigate the in vivo performance of GBP-L. MATERIALS AND METHODS Bilateral sinus floor augmentations in 10 adult sheep were conducted. Bovine bone mineral (BBM) and mesenchymal stem cells (MSCs) combined with novel GBP-L were placed into the test sinus of each sheep. The BBM and MSCs alone served as the control on the contralateral side. Simultaneously, 3 dental implants were inserted in each maxillary sinus. The animals were sacrificed after 8 and 16 weeks, and the amount of NBF was analyzed using histomorphometry. The osteogenic potency of the MSCs was demonstrated using the colony-forming unit and differentiation assay. Statistical evaluation was performed using the Wilcoxon signed rank test and 3-factorial nonparametric analysis of variance. RESULTS The histologic examination showed NBF in tight contact with the original bone in the control and test groups. The NBF was not significantly different between the test and control sites (P > .05). However, a highly significant difference in NBF between the apical and coronal sites in the specimens from the control and test groups was detected (P < .05). GBP-L did not alter the multipotency of the MSCs or impair NBF. CONCLUSIONS Bone formation is initiated from the residual alveolar crest and along the implant. The elected mode of GBP-L application did not induce faster NBF. Alternate forms of application (eg, slow release or systemic administration) might clarify the controversial in vitro findings.
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Affiliation(s)
- Toshiyuki Oshima
- Assistant Professor, Department of Oral and Craniomaxillofacial Surgery, University Medical Center Freiburg, Freiburg, Germany.
| | - Fabian Duttenhoefer
- Resident, Department of Oral and Craniomaxillofacial Surgery, University Medical Center Freiburg, Freiburg, Germany
| | - Samuel Xavier
- Professor, Department of Oral and Craniomaxillofacial Surgery, University Medical Center Freiburg, Freiburg, Germany; and Department of Oral and Maxillofacial Surgery, University of São Paulo Faculty of Dentistry, Ribeirão Preto, São Paulo, Brazil
| | - Katja Nelson
- Professor, Department of Oral and Craniomaxillofacial Surgery, University Medical Center Freiburg, Freiburg, Germany
| | - Sebastian Sauerbier
- Associate Professor, Department of Oral and Craniomaxillofacial Surgery, University Medical Center Freiburg, Freiburg, Germany
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Rickert D, Vissink A, Slot WJ, Sauerbier S, Meijer HJA, Raghoebar GM. Maxillary sinus floor elevation surgery with BioOss® mixed with a bone marrow concentrate or autogenous bone: test of principle on implant survival and clinical performance. Int J Oral Maxillofac Surg 2013; 43:243-7. [PMID: 24183511 DOI: 10.1016/j.ijom.2013.09.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 07/01/2013] [Accepted: 09/10/2013] [Indexed: 01/30/2023]
Abstract
The purpose of this study was to assess implant survival and 1-year clinical performance of implants placed in the posterior maxilla that had been subjected to maxillary sinus floor elevation surgery with bovine bone mineral (BioOss®) mixed with autogenous bone marrow concentrate or autogenous bone. In a randomized, controlled, split-mouth design study, a bilateral sinus floor augmentation procedure was performed in 12 edentulous patients. At random, one side was treated with BioOss® seeded with an iliac crest bone marrow concentrate enriched in mesenchymal stem cells (test side) and the other with BioOss® mixed with autogenous bone (control side). Three to four months after augmentation, 66 implants were placed. Implant survival, plaque, gingival, and bleeding indices, probing depth, and peri-implant radiographic bone levels were assessed at baseline and 12 months after functional loading. During osseointegration, three implants failed on the test side (two patients) and no implants failed on the control side, resulting in 3-month survival rates of 91% and 100%, respectively. No implants were lost after functional loading and no differences in soft tissue parameters or peri-implant bone loss were observed between the control and test sides. After 1 year in function, no clinically relevant differences were observed regarding soft tissue parameters or peri-implant bone loss.
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Affiliation(s)
- D Rickert
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - A Vissink
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, The Netherlands.
| | - W J Slot
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, The Netherlands; Department of Prosthodontics, Academic Center for Oral Health, University Medical Center Groningen, Groningen, The Netherlands
| | - S Sauerbier
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg, Freiburg, Germany
| | - H J A Meijer
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, The Netherlands; Department of Prosthodontics, Academic Center for Oral Health, University Medical Center Groningen, Groningen, The Netherlands
| | - G M Raghoebar
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, The Netherlands
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Stricker A, Fleiner J, Dard M, Voss P, Sauerbier S, Bosshardt DD. Evaluation of a new experimental model to study bone healing after ridge expansion with simultaneous implant placement - a pilot study in minipigs. Clin Oral Implants Res 2013; 25:1265-1272. [DOI: 10.1111/clr.12265] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Andres Stricker
- Department of Oral and Maxillofacial Surgery; University Hospital of Freiburg; Freiburg Germany
| | - Jonathan Fleiner
- Oral Imaging Center; Faculty of Medicine; Katholieke Universiteit Leuven; Leuven Belgium
| | - Michel Dard
- Department of Periodontology and Implant Dentistry; New York University; New York NY USA
| | - Pit Voss
- Department of Oral and Maxillofacial Surgery; University Hospital of Freiburg; Freiburg Germany
| | - Sebastian Sauerbier
- Department of Oral and Maxillofacial Surgery; University Hospital of Freiburg; Freiburg Germany
| | - Dieter D. Bosshardt
- Department of Oral Surgery and Stomatology; School of Dental Medicine; University of Bern; Bern Switzerland
- Department of Periodontology; School of Dental Medicine; University of Bern; Bern Switzerland
- Robert K. Schenk Laboratory of Oral Histology; School of Dental Medicine; University of Bern; Bern Switzerland
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Duttenhoefer F, Souren C, Menne D, Emmerich D, Schön R, Sauerbier S. Long-term survival of dental implants placed in the grafted maxillary sinus: systematic review and meta-analysis of treatment modalities. PLoS One 2013; 8:e75357. [PMID: 24058679 PMCID: PMC3776785 DOI: 10.1371/journal.pone.0075357] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 08/12/2013] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND A prevalent modality to increase the amount of available bone prior to implantation is grafting of the maxillary sinus. Multiple factors such as the surgical technique, moment of implant placement as well as grafting materials and membranes are known to affect implant survival. However, the role of different factor combinations and associated reciprocal effects remain unclear. Conventional statistical methods do not consider inconsistency of study designs and do not take covariables into account. Hence, a systematic research and meta-analysis was conducted to investigate the influence of various treatment modalities on implant survival in the grafted maxillary sinus. MATERIALS AND METHODS A meta-analysis was conducted according to the PRISMA guidelines. Articles published from 1980 through January 2013 were electronically and manually searched in MEDLINE (Ovid), the Cochrane Register of Controlled Trials, the Database of Abstracts of Effects, and the Cochrane Database of Systematic Reviews. Clinical reports on single intervention sinus augmentation with root-form implants, a minimum of 10 patients and 6 months of loading were eligible for inclusion if implant survival was stated or calculable. Results were calculated by non-parametric univariate Kaplan-Meier analysis and Bayesian multivariate interval-censored Cox regression. RESULTS A total of 122 publications on 16268 endosseous implants placed in grafted maxillary sinus were included. The treatment parameters surgical approach, grafting material and implant type showed no selective preference. However, application of membranes showed a significantly reduced hazard-ratio, independent of other co-factors. CONCLUSIONS The use of membranes is the most significant factor to achieve long-term implant survival in sinus augmentation procedures. More data exceeding 3 years follow-up are needed to address prospective confounding and improve clinical evidence.
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Affiliation(s)
- Fabian Duttenhoefer
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg, Freiburg, Germany
- * E-mail:
| | - Cyriel Souren
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg, Freiburg, Germany
| | | | - Dominik Emmerich
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg, Freiburg, Germany
| | - Ralf Schön
- Department of Oral and Craniomaxillofacial Surgery, Malteser Krankenhaus St. Josefshospital, Krefeld-Uerdingen, Germany
| | - Sebastian Sauerbier
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg, Freiburg, Germany
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Wildburger A, Payer M, Jakse N, Strunk D, Etchard-Liechtenstein N, Sauerbier S. Impact of autogenous concentrated bone marrow aspirate on bone regeneration after sinus floor augmentation with a bovine bone substitute--a split-mouth pilot study. Clin Oral Implants Res 2013; 25:1175-81. [PMID: 23875876 DOI: 10.1111/clr.12228] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2013] [Indexed: 12/22/2022]
Abstract
PURPOSE Mesenchymal stem cells (MSC) with biomaterials have osteoinductive potential. The aim of this study was to evaluate early bone formation in xenogenic sinus grafts in a direct comparison with and without MSCs after 3 and 6 months. Literature on bone formation in pure xenogenic graft materials after 3 months in a human model is still lacking. MATERIALS AND METHODS In a split-mouth design, seven patients with a bilateral highly atrophic posterior maxilla were included. The test side was grafted with MSCs from concentrated bone marrow aspirate admixed to the bone graft material. On the control side, pure bovine bone material was applied. Biopsies were taken navigated after 3 and 6 months. RESULTS After 3 months, new bone formation in the control group was 11.8% (SD 6.2%) and in the test group 7.4% (SD 4.1%). After 6 months, the control group showed 13.9% (SD 8.5%) of new bone and the test group 13.5% NB (SD 5.4%). The fraction of bovine bone material after 3 months was 42.6% (SD 3.5%) in the test group and 34.9% (SD 11.8%) in the control group. After 6 months, the biomaterial content was comparable at both sides (test 36.2%, SD 7.8%; control 39.5%, SD 9.3%). CONCLUSIONS There was no significant difference in new bone formation between the test and control group with n = 7. The results may be dominated by the high mineral content of the biomaterial but could nevertheless be valuable for meta-analysis in the future.
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Affiliation(s)
- Angelika Wildburger
- Department of Oral Surgery and Radiology, Medical University of Graz, Graz, Austria
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15
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Sauerbier S, Duttenhoefer F, Sachlos E, Haberstroh J, Scheifele C, Wrbas KT, Voss PJ, Veigel E, Smedek J, Ganter P, Tuna T, Gutwald R, Palmowski M. Evaluation of bone substitute materials: comparison of flat-panel based volume CT to conventional multidetector CT. J Craniomaxillofac Surg 2013; 41:e128-36. [PMID: 23332471 DOI: 10.1016/j.jcms.2012.11.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 11/20/2012] [Accepted: 11/20/2012] [Indexed: 11/25/2022] Open
Abstract
Over the last decade tissue engineering has emerged as a key factor in bone regeneration within the field of cranio-maxillofacial surgery. Despite this in vivo analysis of tissue-engineered-constructs to monitor bone rehabilitation are difficult to conduct. Novel high-resolving flat-panel based volume CTs (fp-VCT) are increasingly used for imaging bone structures. This study compares the potential value of novel fp-VCT with conventional multidetector CT (MDCT) based on a sheep sinus floor elevation model. Calcium-hydroxyapatite reinforced collagen scaffolds were populated with autologous osteoblasts and implanted into sheep maxillary sinus. After 8, 16 and 24 weeks MDCT and fp-VCT scans were performed to investigate the volume of the augmented area; densities of cancellous and compact bone were assessed as comparative values. fp-VCT imaging resulted in higher spatial resolution, which was advantageous when separating closely related anatomical structures (i.e. trabecular and compact bone, biomaterials). Fp-VCT facilitated imaging of alterations occurring in test specimens over time. fp-VCTs therefore displayed high volume coverage, dynamic imaging potential and superior performance when investigating superfine bone structures and bone remodelling of biomaterials. Thus, fp-VCTs may be a suitable instrument for intraoperative imaging and future in vivo tissue-engineering studies.
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Affiliation(s)
- Sebastian Sauerbier
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany
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Reuter T, Hoffmann P, Sauerbier S, Klein C, Hoffmann M. Simulation of the Temperature Distribution in Protein Solder and Cartilage - Bone - Tissue by Laser Soldering. BIOMED ENG-BIOMED TE 2013; 58 Suppl 1:/j/bmte.2013.58.issue-s1-N/bmt-2013-4358/bmt-2013-4358.xml. [DOI: 10.1515/bmt-2013-4358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Sauerbier S, Gutwald R, Wiedmann-Al-Ahmad M, Wolkewitz M, Haberstroh J, Obermeyer J, Kuenz A, Betz H, Wolter F, Duttenhoefer F, Schmelzeisen R, Nagursky H, Proksch S, Al-Ahmad A. Effect of Gabapentin-Lactam and Gamma-Aminobutyric Acid/Lactam Analogs on Proliferation and Phenotype of Ovine Mesenchymal Stem Cells. Int J Oral Maxillofac Implants 2013; 28:e230-8. [DOI: 10.11607/jomi.te02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Voss PJ, Joshi Oshero J, Kovalova-Müller A, Veigel Merino EA, Sauerbier S, Al-Jamali J, Lemound J, Metzger MC, Schmelzeisen R. Surgical treatment of bisphosphonate-associated osteonecrosis of the jaw: Technical report and follow up of 21 patients. J Craniomaxillofac Surg 2012; 40:719-25. [DOI: 10.1016/j.jcms.2012.01.005] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 01/10/2012] [Accepted: 01/11/2012] [Indexed: 01/09/2023] Open
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Proksch S, Steinberg T, Schulz S, Sauerbier S, Hellwig E, Tomakidi P. Environmental Biomechanics Substantiated by Defined Pillar Micropatterns Govern Behavior of Human Mesenchymal Stem Cells. Cell Transplant 2012; 21:2455-69. [DOI: 10.3727/096368912x637037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
While evidence on the impact of the biomechanical environment elasticity on human mesenchymal stem cell (hMSC) behavior is growing, the aspect of micropatterning is still poorly understood. Thus, the present study aimed at investigating the influence of defined environmental micropatterning on hMSC behavior. Following characterization, hMSCs were grown on defined pillar micropatterns of 5, 7, 9, and 11 μm. With respect to cell behavior, primary hMSC adhesion was detected by indirect immunofluorescence (iIF) for paxillin, vinculin, integrin αV, and actin, while proliferation was visualized by histone H3. Morphogenesis was monitored by scanning electron microscopy and the expression of stem cell-specific biomarkers by real-time PCR. Favoritism of primary adhesion of hMSCs on pillar tops occurred at smaller pillar micropatterns, concomitant with cell flattening. While vinculin, integrin αV, and paxillin appeared initially more cytoplasmic, high pillar micropatterns favored a progressive redistribution with polarization to cell tension sites and at cell borders. Accomplishment of morphogenesis at day 3 revealed establishment of fully rotund cell somata at 5 μm, while hMSCs appeared progressively elongated at rising micropatterns. The hMSC proliferation capacity was influenced by pillar micropatterns and gene expression analysis of stem cell- and differentiation-associated biomarkers disclosed clear modulation by distinct pillar micropatterns. In response to environmental biomechanics, our results show that hMSC behavior is governed by pillar micropatterning. In turn, these findings may form the basis to prospectively direct lineage specificity of hMSCs in a customized fashion.
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Affiliation(s)
- S. Proksch
- Department of Operative Dentistry and Periodontology, Dental School and Hospital, University Freiburg Medical Center, Freiburg, Germany
| | - T. Steinberg
- Department of Oral Biotechnology, Dental School and Hospital, University Freiburg Medical Center, Freiburg, Germany
| | - S. Schulz
- Department of Oral Biotechnology, Dental School and Hospital, University Freiburg Medical Center, Freiburg, Germany
| | - S. Sauerbier
- Department of Oral and Maxillofacial Surgery, Dental School and Hospital, University Freiburg Medical Center, Freiburg, Germany
| | - E. Hellwig
- Department of Operative Dentistry and Periodontology, Dental School and Hospital, University Freiburg Medical Center, Freiburg, Germany
| | - P. Tomakidi
- Department of Oral Biotechnology, Dental School and Hospital, University Freiburg Medical Center, Freiburg, Germany
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Hoffmann P, Reuter T, Sauerbier S, Hoffmann M, Klein CC. Histological findings in articular cartilage grafts after laser exposition for tissue soldering. BIOMED ENG-BIOMED TE 2012. [DOI: 10.1515/bmt-2012-4071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Sauerbier S, Rickert D, Gutwald R, Nagursky H, Oshima T, Xavier SP, Christmann J, Kurz P, Menne D, Vissink A, Raghoebar G, Schmelzeisen R, Wagner W, Koch FP. Bone marrow concentrate and bovine bone mineral for sinus floor augmentation: a controlled, randomized, single-blinded clinical and histological trial--per-protocol analysis. Tissue Eng Part A 2011; 17:2187-97. [PMID: 21529247 DOI: 10.1089/ten.tea.2010.0516] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The purpose of this work was to evaluate the potential of substituting autogenous bone (AB) by bone marrow aspirate concentrate (BMAC). Both AB and BMAC were tested in combination with a bovine bone mineral (BBM) for their ability of new bone formation (NBF) in a multicentric, randomized, controlled, clinical and histological noninferiority trial. MATERIALS AND METHODS Forty-five severely atrophied maxillary sinus from 26 patients were evaluated in a partial cross-over design. As test arm, 34 sinus of 25 patients were augmented with BBM and BMAC containing mesenchymal stem cells. Eleven control sinus from 11 patients were augmented with a mixture of 70% BBM and 30% AB. Biopsies were obtained after a 3-4-month healing period at time of implant placement and histomorphometrically analyzed for NBF. RESULTS NBF was 14.3%±1.8% for the control and nonsignificantly lower (12.6%±1.7%) for the test (90% confidence interval: -4.6 to 1.2). Values for BBM (31.3%±2.7%) were significantly higher for the test compared with control (19.3%±2.5%) (p<0.0001). Nonmineralized tissue was lower by 3.3% in the test compared with control (57.6%; p=0.137). CONCLUSIONS NBF after 3-4 months is equivalent in sinus, augmented with BMAC and BBM or a mixture of AB and BBM. This technique could be an alternative for using autografts to stimulate bone formation.
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Affiliation(s)
- Sebastian Sauerbier
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg, Albert-Ludwigs University, Freiburg, Germany.
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Trautvetter W, Kaps C, Schmelzeisen R, Sauerbier S, Sittinger M. Tissue-engineered polymer-based periosteal bone grafts for maxillary sinus augmentation: five-year clinical results. J Oral Maxillofac Surg 2011; 69:2753-62. [PMID: 21680073 DOI: 10.1016/j.joms.2011.02.096] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 02/17/2011] [Accepted: 02/18/2011] [Indexed: 02/06/2023]
Abstract
PURPOSE Augmentation of the maxillary sinus with allogenic or alloplastic materials, as well as autologous bone grafts, has inherent disadvantages. Therefore, the aim of our study was to evaluate the long-term clinical repair effect of autologous periosteal bone grafts on atrophic maxillary bone. PATIENTS AND METHODS In the present retrospective cohort study, augmentation of the edentulous atrophic posterior maxilla was performed using autologous tissue-engineered periosteal bone grafts based on bioresorbable polymer scaffolds and, in a 1-step procedure, simultaneous insertion of dental implants. The clinical evaluation of 10 patients was performed by radiologic assessment of bone formation, with a follow-up of 5 years. Bone formation was further documented by measuring the bone height and by histologic examination. RESULTS Excellent clinical and radiologic results were achieved as early as 4 months after transplantation of the periosteal bone grafts. The bone height remained significantly (P < .05) greater (median 14.2 mm) than the preoperative atrophic bone (median 6.9 mm) during the 5-year observation period. Histologically, the bone biopsy specimens of 2 patients obtained after 6 months showed trabecular bone with osteocytes and active osteoblasts. No signs of bone resorption, formation of connective tissue, or necrosis were seen. CONCLUSION Our results suggest that the transplantation of autologous periosteal bone grafts and implantation of dental implants in a 1-step procedure is a reliable procedure that leads to bone formation in the edentulous posterior maxilla, remaining stable in the long term for a period of at least 5 years.
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Affiliation(s)
- Wolfram Trautvetter
- Laboratory for Tissue Engineering, Department of Rheumatology, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Karygianni L, Wiedmann-Al-Ahmad M, Finkenzeller G, Sauerbier S, Wolkewitz M, Hellwig E, Al-Ahmad A. Enterococcus faecalis affects the proliferation and differentiation of ovine osteoblast-like cells. Clin Oral Investig 2011; 16:879-87. [DOI: 10.1007/s00784-011-0563-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 04/26/2011] [Indexed: 01/12/2023]
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Veigel E, Moore RJ, Zarrinkalam MR, Schulze D, Sauerbier S, Schmelzeisen R, Voss PJ. Osteopenia in the maxillofacial area: a study in sheep. Osteoporos Int 2011; 22:1115-21. [PMID: 20503036 DOI: 10.1007/s00198-010-1289-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Accepted: 04/09/2010] [Indexed: 10/19/2022]
Abstract
UNLABELLED Osteoporosis is a major public health problem worldwide. Its significance in the fields of traumatology and implantology of the maxillofacial area requires investigation. A large animal model was used to assess bone loss in the lumbar spine and mandible. INTRODUCTION Osteoporosis is a prevalent disease characterized by low bone mass and microarchitectural deterioration of bone tissue. Osteoporosis-related fractures represent a major public health burden. The presence and relevance of osteoporosis in the maxillofacial area remain controversial. Research in humans is limited by difficulties in finding large homogenous study groups and, due to ethical considerations, numerous animal models have been used in osteoporosis research. The aim of this study was to assess a sheep model of generalized osteopenia for changes in the maxillofacial area. METHODS Bone loss was induced in ten Merino sheep by ovariectomy, intramuscular administration of glucocorticoids, and a calcium-reduced diet. Five untreated animals served as controls. Bone mineral density (BMD) was assessed by dual-energy X-ray absorptiometry at the lumbar spine at baseline and after 1, 3, 6, 9, and 12 months. Lumbar and mandibular bone biopsies were obtained and analyzed with microcomputed tomography. RESULTS Lumbar BMD decreased progressively in the intervention group and was most significantly low after 6 months (p < 0.001). Lumbar trabecular bone showed a significant decrease in bone volume (BV)/tissue volume (TV; p < 0.05) in the inducted group. Significant changes were found in both analyzed mandibular regions for BV/TV (p < 0.05). Regional variations were found for other parameters in the mandible. The cortical width was substantially reduced in the intervention group (p < 0.001). CONCLUSIONS Microstructural changes occurring in sheep as a result of induction seem to have a generalized nature. This sheep model meets the criteria for further investigation in the maxillofacial area.
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Affiliation(s)
- E Veigel
- Albert-Ludwigs-Universität, Hugstetterstrasse 55, 79106 Freiburg, Germany.
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Zecha PJ, Schortinghuis J, van der Wal JE, Nagursky H, van den Broek KC, Sauerbier S, Vissink A, Raghoebar GM. Applicability of equine hydroxyapatite collagen (eHAC) bone blocks for lateral augmentation of the alveolar crest. A histological and histomorphometric analysis in rats. Int J Oral Maxillofac Surg 2011; 40:533-42. [PMID: 21349689 DOI: 10.1016/j.ijom.2011.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 10/26/2010] [Accepted: 01/12/2011] [Indexed: 11/19/2022]
Abstract
This study assessed the mechanical characteristics, biocompatibility and osteoconductive properties of an equine hydroxyapatite collagen (eHAC) bone block when applied as a bone substitute for lateral augmentation of rat mandible. 96 rats underwent lateral augmentation of the mandible, using two substitute bone blocks (eHAC or Bio-Oss spongiosa) or autologous bone grafts. Signs of inflammation, amount of bone formation and ingrowth of bone into the bone blocks were assessed at 1 and 3 months. eHAC blocks were mechanically rigid and could be fixed firmly and easily. Bio-Oss spongiosa blocks were brittle and fixation was difficult. eHAC and Bio-Oss spongiosa blocks were biocompatible and induced few or no signs of inflammation. Inflammation prevalence between the groups was not statistically different. Bone formation and bone growth into the blocks was significantly higher in eHAC than Bio-Oss spongiosa blocks, but lower than in autologous bone grafts (after 1 and 3 months). Regression analysis showed that the autologous bone graft predicted new bone formation at both time points. The eHAC block was only a predictor at 1 month; a trend was found at 3 months. The application of biodegradable membranes was not related to more bone ingrowth.
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Affiliation(s)
- P J Zecha
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, The Netherlands.
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Sauerbier S, Stubbe K, Maglione M, Haberstroh J, Kuschnierz J, Oshima T, Xavier SP, Brunnberg L, Schmelzeisen R, Gutwald R. Mesenchymal stem cells and bovine bone mineral in sinus lift procedures--an experimental study in sheep. Tissue Eng Part C Methods 2011; 16:1033-9. [PMID: 20050809 DOI: 10.1089/ten.tec.2009.0734] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION New reconstructive and less invasive methods have been searched to optimize bone formation and osseointegration of dental implants in maxillary sinus augmentation. PURPOSE The aim of the presented ovine split-mouth study was to compare bovine bone mineral (BBM) alone and in combination with mesenchymal stem cells (MSCs) regarding their potential in sinus augmentation. MATERIAL AND METHODS Bilateral sinus floor augmentations were performed in six adult sheep. BBM and MSCs were placed into the test side and only BBM in the contra-lateral control side of each sheep. Animals were sacrificed after 8 and 16 weeks. Augmentation sites were analyzed by computed tomography, histology, and histomorphometry. RESULTS The initial volumes of both sides were similar and did not change significantly with time. A tight connection between the particles of BBM and the new bone was observed histologically. Bone formation was significantly (p = 0.027) faster by 49% in the test sides. CONCLUSION The combination of BBM and MSCs accelerated new bone formation in this model of maxillary sinus augmentation. This could allow early placement of implants.
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Affiliation(s)
- Sebastian Sauerbier
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs-University, Freiburg, Germany.
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Gutwald R, Schön R, Metzger M, Kreutzer K, Rahn B, Schmelzeisen R, Sauerbier S. Miniplate osteosynthesis with four different systems in sheep. Int J Oral Maxillofac Surg 2010; 40:94-102. [PMID: 21084173 DOI: 10.1016/j.ijom.2010.09.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Revised: 06/30/2008] [Accepted: 09/17/2010] [Indexed: 11/18/2022]
Abstract
The aim of this study was to compare a combination of a locking system with self-tapping (ST-L) or self-drilling-tapping (SDT-L) screws with a combination of conventional miniplates with self-tapping (ST) and self-forming (SF) screws. A standardized osteotomy and osteosynthesis with one of the above mentioned systems was performed in 24 sheep. Callus formation was measured with the help of CT scans assisted by a navigation system. Specimens of each osteotomy gap were taken and examined histologically. The best results were observed when self-tapping screws and the Mini-Locking-System (ST-L) were applied. The slowest healing was seen in animals treated with miniplates and SF screws. After 8 weeks an increase in bone formation could be observed in the ST, SF, SDT-L systems. The results after 8 weeks were comparable with those achieved by the ST-L system after 4 weeks. The improved stability of the osteosynthesis with the ST-L system resulted in early ossification of the osteotomy gap and the smallest amount of callus formation.
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Affiliation(s)
- R Gutwald
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg, Freiburg, Germany.
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Rickert D, Sauerbier S, Nagursky H, Menne D, Vissink A, Raghoebar GM. Maxillary sinus floor elevation with bovine bone mineral combined with either autogenous bone or autogenous stem cells: a prospective randomized clinical trial. Clin Oral Implants Res 2010; 22:251-8. [PMID: 20831758 DOI: 10.1111/j.1600-0501.2010.01981.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM To assess whether differences occur in bone formation after maxillary sinus floor elevation surgery with bovine bone mineral (BioOss(®)) mixed with autogenous bone or autogenous stem cells. The primary endpoint was the percentage of new bone three months after the elevation procedure. MATERIAL AND METHODS In a randomized, controlled split-mouth design, in 12 consecutive patients (age 60.8 ± 5.9 years, range 48-69 years) needing reconstruction of their atrophic maxilla, a bilateral sinus floor augmentation procedure was performed. Randomly, on one side the augmentation procedure was performed with bovine bone mineral (BioOss(®)) seeded with mononuclear stem cells harvested from the posterior iliac crest (test group) while BioOss(®) mixed with autogenous bone (harvested from the retromolar area) was applied on the contra-lateral side (control group). On 14.8 ± 0.7 weeks after the sinus floor elevation, biopsies from the reconstructed areas were taken at the spots where subsequently the endosseous implants were placed. The biopsies were histomorphometrically analyzed. RESULTS Significantly more bone formation was observed in the test group (17.7 ± 7.3%) when compared with the control group (12.0%± 6.6; P=0.026). In both the test and control group, all implants could be placed with primary stability. In one patient, not all biopsies contained BioOss(®). This patient was excluded from analysis. CONCLUSION Mesenchymal stem cells seeded on BioOss(®) particles can induce the formation of a sufficient volume of new bone to enable the reliable placement of implants within a time frame comparable with that of applying either solely autogenous bone or a mixture of autogenous bone and BioOss(®). This technique could be an alternative to using autografts.
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Affiliation(s)
- D Rickert
- Department of Oral and Maxillofacial Surgery, University Medical Center, University of Groningen, Groningen, The Netherlands
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Schmelzeisen R, Gutwald R, Oshima T, Nagursky H, Vogeler M, Sauerbier S. Making bone II: maxillary sinus augmentation with mononuclear cells--case report with a new clinical method. Br J Oral Maxillofac Surg 2010; 49:480-2. [PMID: 20678831 DOI: 10.1016/j.bjoms.2010.06.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 06/25/2010] [Indexed: 02/07/2023]
Abstract
We report a simplified method of using bone marrow aspirate concentrate (BMAC™) to regenerate hard tissue. The results suggest that BMAC™ combined with a suitable biomaterial can form sufficient bone within 3 months for further implants to be inserted, and at the same time minimise morbidity at the donor site.
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Affiliation(s)
- Rainer Schmelzeisen
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany
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Sauerbier S, Stricker A, Kuschnierz J, Bühler F, Oshima T, Xavier SP, Schmelzeisen R, Gutwald R. In VivoComparison of Hard Tissue Regeneration with Human Mesenchymal Stem Cells Processed with Either the FICOLL Method or the BMAC Method. Tissue Eng Part C Methods 2010; 16:215-23. [DOI: 10.1089/ten.tec.2009.0269] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sebastian Sauerbier
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg, Freiburg, Germany
| | - Andres Stricker
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg, Freiburg, Germany
| | - Jens Kuschnierz
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg, Freiburg, Germany
| | - Felicia Bühler
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg, Freiburg, Germany
| | - Toshiyuki Oshima
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg, Freiburg, Germany
- Faculty of Health Sciences, Institute for International Cooperation, Okayama, Japan
| | - Samuel Porfirio Xavier
- Department of Oral Maxillofacial Surgery and Periodontology, Faculty of Dentistry of University of Sao Paulo, Ribeirao Preto, Brazil
| | - Rainer Schmelzeisen
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg, Freiburg, Germany
| | - Ralf Gutwald
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg, Freiburg, Germany
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Sauerbier S, Palmowski M, Vogeler M, Nagursky H, Al-Ahmad A, Fisch D, Hennig J, Schmelzeisen R, Gutwald R, Fasol U. Onset and Maintenance of Angiogenesis in Biomaterials: In Vivo Assessment by Dynamic Contrast-Enhanced MRI. Tissue Eng Part C Methods 2009; 15:455-62. [DOI: 10.1089/ten.tec.2008.0626] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sebastian Sauerbier
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg, Freiburg, Germany
| | - Moritz Palmowski
- Department of Diagnostic Radiology and Institute of Experimental Molecular Imaging, RWTH-Aachen University, Aachen, Germany
| | - Michael Vogeler
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg, Freiburg, Germany
| | - Heiner Nagursky
- Hard Tissue Research Laboratory, Department for Oral- and Maxillofacial Surgery, University Hospital Freiburg, Freiburg, Germany
| | - Ali Al-Ahmad
- Cell Laboratory, Department of Operative Dentistry, University Hospital Freiburg, Freiburg, Germany
| | - Dagmar Fisch
- Department of Diagnostic Radiology, Medical Physics, University Hospital Freiburg, Freiburg, Germany
| | - Jürgen Hennig
- Department of Diagnostic Radiology, Medical Physics, University Hospital Freiburg, Freiburg, Germany
| | - Rainer Schmelzeisen
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg, Freiburg, Germany
| | - Ralf Gutwald
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg, Freiburg, Germany
| | - Ulrike Fasol
- Department of Diagnostic Radiology, Medical Physics, University Hospital Freiburg, Freiburg, Germany
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Gutwald R, Haberstroh J, Kuschnierz J, Kister C, Lysek DA, Maglione M, Xavier SP, Oshima T, Schmelzeisen R, Sauerbier S. Mesenchymal stem cells and inorganic bovine bone mineral in sinus augmentation: comparison with augmentation by autologous bone in adult sheep. Br J Oral Maxillofac Surg 2009; 48:285-90. [PMID: 19665265 DOI: 10.1016/j.bjoms.2009.06.226] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2009] [Indexed: 02/06/2023]
Abstract
Our aim was to compare the osteogenic potential of mononuclear cells harvested from the iliac crest combined with bovine bone mineral (BBM) (experimental group) with that of autogenous cancellous bone alone (control group). We studied bilateral augmentations of the sinus floor in 6 adult sheep. BBM and mononuclear cells (MNC) were mixed and placed into one side and autogenous bone in the other side. Animals were killed after 8 and 16 weeks. Sites of augmentation were analysed radiographically and histologically. The mean (SD) augmentation volume was 3.0 (1.0) cm(3) and 2.7 (0.3) cm(3) after 8 and 16 weeks in the test group, and 2.8 (0.3) cm(3) (8 weeks) and 2.8 (1.2) cm(3) (16 weeks) in the control group, respectively. After 8 weeks, histomorphometric analysis showed 24 (3)% BBM, and 19 (11)% of newly formed bone in the test group. The control group had 20 (13%) of newly formed bone. Specimens after 16 weeks showed 29 (12%) of newly formed bone and 19 (3%) BBM in the test group. The amount of newly formed bone in the control group was 16 (6%). The results show that mononuclear cells, including mesenchymal stem cells, in combination with BBM as the biomaterial, have the potential to form bone.
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Affiliation(s)
- Ralf Gutwald
- Universitätsklinik für Zahn-, Mund- und Kieferheilkunde, Abteilung Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Hugstetter Str. 55, D-79106 Freiburg, Germany
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Schmelzeisen R, Sauerbier S. Br J Oral Maxillofac Surg 2009; 47:426-427. [DOI: 10.1016/j.bjoms.2008.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Wongchuensoontorn C, Liebehenschel N, Wagner K, Fakler O, Gutwald R, Schmelzeisen R, Sauerbier S. Pathological Fractures in Patients Caused by Bisphosphonate-Related Osteonecrosis of the Jaws: Report of 3 Cases. J Oral Maxillofac Surg 2009; 67:1311-6. [DOI: 10.1016/j.joms.2008.12.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Revised: 08/25/2008] [Accepted: 12/05/2008] [Indexed: 11/16/2022]
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Schmelzeisen R, Sauerbier S, Metzger M, Gutwald R. Application of stem cells and preformed implants in craniomaxillary reconstructions. Int J Oral Maxillofac Surg 2009. [DOI: 10.1016/j.ijom.2009.03.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wongchuensoontorn C, Liebehenschel N, Schwarz U, Schmelzeisen R, Gutwald R, Ellis E, Sauerbier S. Application of a new chair-side method for the harvest of mesenchymal stem cells in a patient with nonunion of a fracture of the atrophic mandible--a case report. J Craniomaxillofac Surg 2009; 37:155-61. [PMID: 19155179 DOI: 10.1016/j.jcms.2008.11.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 10/21/2008] [Accepted: 11/05/2008] [Indexed: 02/06/2023] Open
Abstract
PURPOSE This case report describes a new clinical method for chair-side processing of a cell mixture which contains mesenchymal stem cells (MSCs) which was applied for the first time in the treatment of a nonunion of an atrophic fractured mandible. METHODS Bone marrow was aspirated and a corticocancellous bone graft was harvested from the iliac crest of a 56-year-old woman with medical comorbidities and a fracture of the atrophic mandible. The fracture was stabilized with a reconstruction bone plate, and mononuclear cells including MSCs were concentrated by centrifugation and applied in combination with a particulate bone transplant. A sample of the grafted cells was characterized by flow cytometric analysis and by their ability to differentiate into various cell types. RESULTS The fracture healed uneventfully. No complications occurred during the 4-month follow-up. CONCLUSION Adding MSCs is a feasible alternative to enhance bone healing. This chair-side method requires little training and no cell laboratory support.
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Sauerbier S, Schön R, Otten JE, Schmelzeisen R, Gutwald R. The development of plate osteosynthesis for the treatment of fractures of the mandibular body – A literature review. J Craniomaxillofac Surg 2008; 36:251-9. [DOI: 10.1016/j.jcms.2007.08.011] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Accepted: 08/31/2007] [Indexed: 11/26/2022] Open
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Abstract
OBJECTIVES The study series aims at testing the feasibility of the clinical application of tissue-engineered oral mucosa. The preliminary results were gathered over a period varying from 6 months to 12 years depending on the surgical method. METHODS Tissue-engineered oral mucosa was used to cover defects in various surgical procedures like vestibuloplasty (n=42), freeing of the tongue (n=10), prelaminating the radial flap (n=5) and reconstruction of the urethra (n=16). In all interventions small samples of oral mucosa were harvested, cut into small pieces, resuspended in culture medium and seeded into a culture flask. Cultured keratinocytes were transferred onto membranes which then were used to cover mucosal defects in the oral cavity. RESULTS To gain a graft of 15 cm(2) size a mucosa biopsy of 4-8 mm(2) and 40 ml autologous patients serum is needed. Tissue-engineered oral mucosa was applied successfully in all four surgical methods. Six months after transplantation a regular epithelial layering with a histological delimitation of the stratum, epithelial crest and a strong basal membrane appeared. According to the reception site the tissue engineered oral mucosa differentiated in several ways. CONCLUSION Tissue-engineered oral mucosa fulfils the requirements for clinical routine. With view to healing time and outcome it does not appear to be superior to regular harvested oral mucosa transplants. Because of a smaller harvesting defect and primary wound closure at the actual operation site the patients' convenience is increased. Thus this method reduces morbidity and advances the quality of life.
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Affiliation(s)
- Sebastian Sauerbier
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg, Freiburg, Germany
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