Document Type : Case Report
Authors
1
Oral and Maxillofacial Surgery department, Faculty of Dentistry, Minia University, Minia, Egypt
2
Professor of Oral and Maxillofacial Surgery Faculty of Dentistry, Minia University
3
Head of Oral Biology Department, Faculty of Dentistry, Minia University, Minia, Egypt
4
Professor of Clinical and Chemical Pathology
5
Demonstrator at Oral medicine and periodontology department, Faculty of Dentistry, Alsalam University
Abstract
Alveolar ridge deficiencies, particularly of the posterior mandible, are extremely difficult to rehabilitate with implant and other functional restoration. Vertical bone augmentation in this area is typically indicated to ensure an adequate anchorage of the implant and long-term stability. While traditional bone grafting techniques, i.e., the use of xenografts and platelet-rich fibrin (PRF), have also provided promising outcomes, the use of mesenchymal stem cells (MSCs) may contribute to bone healing by stimulating cellular activity and promoting osteogenesis [1,2].MSCs derived from Wharton’s Jelly, due to their inbuilt high rate of proliferation and ability to undergo differentiation towards the osteogenic lineage, provide a novel dimension to the engineering of bone tissue[3]. This study will compare the efficacy of the application of xenograft and PRF with Wharton’s Jelly-derived MSCs for vertical bone augmentation of the posterior mandible against the efficacy of the application of xenograft and PRF,which will offer greater predictability and long-term outcomes in implant-supported rehabilitation of compromised mandibular ridges[4].
Methods: Five female patients aged between 45 and 55 years were chosen and divided randomly into two groups in a split-mouth design. Group 1 is vertical bone augmentation using xenograft and PRF, while Group 2 is a combination of xenograft, PRF, and MSCs derived from Wharton’s Jelly on the other side. Inclusion criteria were patients who have a minimum of 5 mm depth of alveolar ridge defect and 2.8 mm width in the posterior mandible and overall good health and compliance during follow-ups. Exclusion criteria were systemic diseases such as uncontrolled diabetes, heart ailments, and autoimmune disease, among others. The preoperative evaluation was done with panoramic radiographs and cone-beam computed tomography (CBCT) to evaluate the atrophied ridge in 3D. MSCs were harvested from the umbilical cord of Wharton’s Jelly through an enzymatic and explant technique and identified by immunophenotyping (CD 105, CD 271, CD 90). PRF was obtained by obtaining blood samples of the patient from the antecubital vein and then preparing sticky bone with autologous thrombin serum. Operative techniques were standardized, periosteal full-thickness flaps were raised and cortical perforations were made to allow graft integration. for postoperative care, patients administered antibiotics, analgesics and mouth rinses.The follow-up visits were scheduled at 3 and 6 months for radiographic and clinical
assessment. Bone regeneration was evaluated after 6 month using CBCT imaging. This prospective clinical study was conducted at the Department of Oral and Maxillofacial Surgery, Minia University, Egypt. Statistical comparison was carried out using SPSS software comparing bone levels between groups.
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