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CAD/CAM - international magazine of digital dentistry

I 09 special _ science & practice I CAD/CAM 2_2013 sequently, to the detriment of traditional bone grafting (with all its inherent problems), this novel method of combining stem cells with mineralised materialsusesaviablegraftwithcellsfromthepa- tient himself/herself without the need for surgical bone harvesting. Until recently, no studies had compared the differentmethodsavailableforusingbonemarrow stemcellsforbonereconstruction.Inthefollowing paragraphs, I shall summarise a study conducted by our research team, which entailed the creation ofcriticalbonydefectsinrabbitsandsubsequently applying each of the four main stem cell methods used globally in order to compare their effective- ness in terms of bone healing:1 _fresh bone marrow (without any kind of process- ing); _a bone marrow stem cell concentrate; _a bone marrow stem cell culture; and _a fat stem cell culture (Figs. 6 & 7). In a fifth group of animals, no cell therapy method (control group) was used. The best bone regeneration results were found in the groups in which a bone marrow stem cell concentrate and a bone marrow stem cell culture were used, and the control group showed the worst results. Con- sequently, it was suggested that stem cells from bone marrow would be more suitable than those from fat tissue for bone reconstruction and that a simple stem cell concentrate method (which takes a few hours) would achieve similar results to those obtained using complex cell culture proce- dures (which take on average three to four weeks; Figs. 8a & b). Similar studies performed in humans have corroborated the finding that bone marrow stem cells improve the repair of bony defects caused by trauma, dental extractions or tumours. The histological images below illustrate the potential of bone-sparing materials combined with stem cells for bone reconstruction (Fig. 9). It is clear that the level of mineralised tissue is significantly higherinthoseareaswherestemcellswereapplied (Figs. 10a & b). Evidently, although bone marrow stem cell techniques for bone reconstruction are very close to routine clinical use, much caution must be exercised before indicating such a procedure. This procedure requires an appropriately trained surgi- cal and laboratory team, as well as the availability of the necessary resources (Figs. 11a–h, taken dur- ing laboratory manipulation of marrow stem cells at São Leopoldo Mandic dental school in Brazil)._ 1 André Antonio Pelegrine, Antonio Carlos Aloise, Allan Zimmermann et al., Repair of critical-size bone defects using bone marrow stromal cells: A histomorphometric study in rabbit calvaria. Part I: Use of fresh bone mar- roworbonemarrowmononuclearfraction,Clinical Oral Implants Research,00(2013):1–6. 2 André Antonio Pelegrine, Antonio Carlos Aloise & Carlos Eduardo Sorgi da Costa, Células Tronco em Implanto- dontia(SãoPaulo:Napoleão,2013). Fig. 11g_The pellet containing the bone marrow mononuclear cells after the second centrifuge spin. Fig. 11h_A bovine bone graft combined with a bone marrow stem cell concentrate. All images courtesy of Células Tronco em Implantodontia.2 Dr André Antonio Pelegrine is a specialist dental surgeon in periodontology and implant dentistry (CFO) with an MSc in Implant Dentistry (UNISA), and a PhD in clinical medicine (University of Campinas).He completed postdoctoral research in transplant surgery (Federal University of São Paulo).He is an associate lecturer in implant dentistry at São Leopoldo Mandic dental school and coordinator of the perio-prosthodontic-implant dentistry team at the University of Campinas in Brazil.He can be contacted at pelegrineandre@gmail.com. CAD/CAM_about the author Fig. 11hFig. 11g