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20 Implant Tribune Faster, easier, safer: experience Constic – the new self-etching, self-adhesive flowable composite from DMG. Constic combines etching gel, bonding agent and flowable in one single product. You thus save treatment steps – and thereby benefit from increased safety during application. Whether for small Class I restorations, linings or fissure sealing: start relying on Constic - the 3-in-1 flowable now! www.dmg-dental.com Constic: Do more with less. The new 3-in-1 flowable: etching, bonding, filling in one step. NEW! AZM_Constic_GB_E_2013_8.indd 1 16.08.13 12:50 January 2014United Kingdom Edition References 1 André Antonio Pelegrine, Antonio Carlos Aloise, Allan Zimmermann et al., Repair of critical-size bone defects using bone marrow stromal cells: A histomor- phometric study in rabbit calvaria. Part I: Use of fresh bone marrow or bone mar- row mononuclear fraction, Clinical Oral Implants Research, 00 (2013): 1–6. 2 André Antonio Pelegrine, Antonio Carlos Aloise & Carlos Eduardo Sorgi da Costa, Células Tronco em Implantodontia (São Paulo: Napoleão, 2013). Until recently, no stud- ies had compared the differ- ent methods available for us- ing bone marrow stem cells for bone reconstruction. In the following paragraphs, I shall summarise a study conducted by our research team, which entailed the creation of criti- cal bony defects in rabbits and subsequently applying each of the four main stem cell meth- ods used globally in order to compare their effectiveness in terms of bone healing:1 • fresh bone marrow (without any kind of processing) • a bone marrow stem cell concentrate • a bone marrow stem cell culture • a fat stem cell culture (Figs 6&7). In a fifth group of animals, no cell therapy method (con- trol group) was used. The best bone regeneration results were found in the groups in which a bone marrow stem cell concen- trate and a bone marrow stem cell culture were used, and the control group showed the worst results. Consequently, 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 con- centrate method (which takes a few hours) would achieve simi- lar results to those obtained us- ing 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 recon- struction (Fig 9). It is clear that the level of mineralised tissue is significantly higher in those areas where stem cells were applied (Figs 10a&b). Evidently, although bone marrow stem cell techniques for bone reconstruction are very close to routine clinical use, much caution must be ex- ercised before indicating such a procedure. This procedure re- quires an appropriately trained surgical and laboratory team, as well as the availability of the necessary resources (Figs 11a– h, taken during laboratory ma- nipulation of marrow stem cells at São Leopoldo Mandic dental school in Brazil). DT All images courtesy of Célu- las Tronco em Implantodontia.2 About the author Dr André Antonio Pelegrine is a spe- cialist dental surgeon in periodontol- ogy and implant dentistry (CFO) with an MSc in Implant Dentistry (UNISA), and a PhD in clinical medicine (Uni- versity 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 coordina- tor of the perio-prosthodontic-implant dentistry team at the University of Campinas in Brazil. He can be con- tacted at pelegrineandre@gmail.com. page 19DTß Fig. 11f_Second centrifuge spin. 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. AZM_Constic_GB_E_2013_8.indd 116.08.1312:50