Stem Cells in Sinus Augmentation?

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Dr. S. asks:

I read in the Journal of Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology that a sinus augmentation can successfully be done using beta-tricalcium phosphate, hydroxyl apatite and human mesenchymal stem cells, or MSC’s [2008;106(2):203]. The stem cells were isolated from the patient’s iliac crest and cultured. The authors conclude that: “Clinical findings suggest that sinus grafting with HA/TCP in combination with MSCs provide a viable therapeutic alternative for implant placement.”

I’m wondering if this technology is currently for general use by oral surgeons in a hospital setting? Exactly who does the culturing and preparation of the stem cells for use in the graft? Any other thoughts on the viability of using mesenchymal stem cells?

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7 Responses to “ Stem Cells in Sinus Augmentation? ”

  • ziv mazor September 2nd, 2008

    Using stem cells for sinus augmentation is not a new technique.The first reports were from Germany where they cultured human cells taken from the jaw two to three weeks before the surgery,cultured and delivered on a collagen carrier.The big question is does it make any sense spending so much resources in doing a sinus augmentation- a closed compartment where almost any biological material will work( look at Piatelli’s articles and ours a s well).I think stem cells will be needed for extreme ridge aug cases or vertical aug cases but not for sinuses.

  • Dennis Smiler September 3rd, 2008

    Articles supporting use of autogenous stem cells can be found in recent publications of Implant Dentistry. The procedure to harvest bone marrow aspirate is simple with little or no morbidity. We see no reason to culture the stem cells when the dentists can have stem cells, cytokines and growth factors as an in-office procedure. The results we report via histomorphometric analysis are better than that with autogenous bone. Dr. Soltan and I have published 4-5 articles that should be read for a better background of the material. We find efficacy in this technique for most all bone graft surgery, not only the sinus lift. Dennis Smiler

  • Mainoralsurgeryman September 3rd, 2008

    Dennis I know your out there “teaching” general dentists how to do hip apsirates and selling your kits associated with it. But I would still caution a General Dentist that a aspiration from the hip when one only takes a day long course can be a prescription for disaster.

    I appreciate you contributions to the field of dentistry, but if you teach the wrong cowboy and he or she perforates the bowel with your needle, the General Dentist will have a line up of Oral Surgeons to testify that the procedure of the hip aspirate was beyond their scope of care.

    Even through in your mind it is just a simple “needle puncture”. Sometimes even the simplest things can go wrong.

    I do commend you on your research.

  • piezo1 September 3rd, 2008

    Stem cells for a sinus lifting? It’ s not a good deal; you can predictably graft a sinus with almost anything you want: CaS, BioOss, DFDBA, Beta-TCP or even nothing (as Dr. Lundgren teaches us).

  • R. Hughes September 4th, 2008

    I have to agree with main OS man. Let the OMS do what they are trained to do and let the GP’s do what they are correctly trained to do. I place alot of implants in my practice and do an excellent job, but I would refer a hip procedure to an OMS or have an orthopaedic surgeon perform the harvesting. There is plenty of action to go around.

  • R. Hughes September 4th, 2008

    I agree with Dr. Mazor.

  • Dr. Morales Schwarz September 8th, 2008

    Even though the use of stem cells for sinus augmentations could be usefull in very large sinuses of elderly and/or osteoporotic patients. routine indication of such a technique is not justified neither from a patient centered nor from an evidence based point of view. I have performed three of those procedures and the results are very similar as those obtained with far easier,less traumatic and cheaper procedures such as using a biomaterial mixed or not with PRP.

    Esposito M, Grusovin MG, Kwan S, Worthington HV, Coulthard P. Interventions for replacing missing teeth: bone augmentation techniques for dental implant treatment. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD003607. DOI: 10.1002/14651858.CD003607.pub3
    http://www.cochrane.org/reviews/en/ab003607.html

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