Pattern of bone resorption after extraction
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- Roxanne Park
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4 Teeth loss
5 Pattern of bone resorption after extraction 50% in 1st year 2/ 3 in first 3 months Reich KM, Huber CD, Lippnig WR, Um C, Watzek G, Tangl S. (2011, 17). Atrophy of Residual Alveolar Ridge following tooth loss in an historical population, Oral Diseases, 17,
6 Le, B., Rohrer, M. D., & Prassad, H. S. (2010, 02). Screw Tent-Pole Grafting Technique for Reconstruction of Large Vertical Alveolar Ridge Defects Using Human Mineralized Allograft for Implant Site Preparation. Journal of Oral and Maxillofacial Surgery, 68(2), Vertical Alveolar deficiency 3 dimensional Defect (3D bone reconstruction) The larger the defect the greater is the tension Soft tissue tension increase resorption of graft Wound Dehiescence (infection, loss of graft)
7 Management of vertical alveolar ridge deficiency Donor site morbidity Higher rate of bone resorption Wound Dehiscence Zhang, Z. (2011, 12). Bone regeneration by stem cell and tissue engineering in oral and maxillofacial region. Front. Med. Frontiers of Medicine, 5(4),
8 Stem Cell Based Alveolar Regeneration Expanded MSCs
9 Stem Cell Based Alveolar Regeneration Cells Cells Scaffold Scaffold Growth Factor Growth Factor Mechanical Environment Nie e Nie, H., Lee, C. H., Tan, J., Lu, C., Mendelson, A., Chen, M.,... Mao, J. J. (2012, 03). Musculoskeletal tissue engineering by endogenous stem/progenitor cells. Cell Tissue Res Cell and Tissue Research, 347(3), t al.,
10 Stem Cell Based Alveolar Regeneration
11 Cells Rapid expansion Stable with extended passaging Multipotency Ease of isolation Egusa, H., Sonoyama, W., Nishimura, M., Atsuta, I., & Akiyama, K. (2012, 10). Stem cells in dentistry Part II: Clinical applications. Journal of Prosthodontic Research, 56(4),
12 Cells - Proliferation & differentiation - Migration & chemotaxix -Provide cell attachment - Maintain phenotye Tissue -Biocompatible -Biodegradable - Mechanical strength before degradation -Angiogenesis & vasculogenesis - Hydrophillic Surgeon -cost effective - easily handled -available in relevant quantities Bose, S., Roy, M., & Bandyopadhyay, A. (2012, 10). Recent advances in bone tissue engineering scaffolds. Trends in Biotechnology, 30(10),
13 Dohan, D. M., Choukroun, J., Diss, A., Dohan, S. L., Dohan, A. J., Mouhyi, J., & Gogly, B. (2006, 03). Platelet-rich fibrin (PRF): A secondgeneration platelet concentrate. Part II: Platelet-related biologic features. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 101(3). Fibrin Scaffold in Bone tissue Engineering FG PRP PRF BM-MSCs in treatment of articular cartilage defects. BM- MSCs in treatment of alveolar bone defects in rats.
14 PRF in Bone Tissue Engineering Stimulation of cellular adhesion and Proliferation of human gingival fibroblast, dermal prekeratinocyte, preadipocyte and maxillofacial osteoblast and also osteoblastic differentiation Dose dependant stimulation of Proliferation & differentiation of BM-MSCs Stimulate cellular adhesion and proleferation of rat osteoblasts, human osteoblasts, human periodontal ligament fibroblasts, and human pulp fibroblasts. - Ehrenfest, D. M., Diss, A., Odin, G., Doglioli, P., Hippolyte, M., & Charrier, J. (2009, 09). In vitro effects of Choukroun's PRF (platelet-rich fibrin) on human gingival fibroblasts, dermal prekeratinocytes, preadipocytes, and maxillofacial osteoblasts in primary cultures. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 108(3), Ehrenfest, D. M., Doglioli, P., Peppo, G. M., Corso, M. D., & Charrier, J. (2010, 03). Choukroun's platelet-rich fibrin (PRF) stimulates in vitro proliferation and differentiation of human oral bone mesenchymal stem cell in a dose-dependent way. Archives of Oral Biology, 55(3), Wu, C., Lee, S., Tsai, C., Lu, K., Zhao, J., & Chang, Y. (2012, 05). Platelet-rich fibrin increases cell attachment, proliferation and collagenrelated protein expression of human osteoblasts. Australian Dental Journal, 57(2),
15
16 Aim Of The Study (PRF+ MSCs) (PRF+ MSCs +Bi- Phasic Ca- Ph) Pattern of Bone Formation
17 Materials & Methods
18 3 vertical alveolar ridge defects 10 dogs months Kg Weight
19 Stage I Defect induction Gingival harvesting A- In-Vivo Stage II Augmentation Procedures Animal Scarify B- In-Vitro Stem Cell Isolation, Characterization and expansion
20 A- In- Vivo Stage I (Defect Induction )
21 Stage I (Defect Induction )
22 Stage I (Defect Induction )
23 Stage I (Defect Induction ) 4 Weeks
24 Stage I Gingival Harvesting
25 Tissue Engineering Laboratory
26 Stage II Augmentation Procedures Group I (PRF + MSCs) Group II (PRF + MSCs + Bi-phasic Ca- Ph block) Group III (PRF + Bi- phasic Ca- Ph block)
27 PRF Scaffold Preparation
28 Augmentation Procedures
29 Mesh Fixation
30 Group I (PRF+ MSCs)
31 Group II (PRF+ Bi- Phasic Ca- Ph + MSCs) Group III (PRF+ Bi- Phasic Ca- Ph)
32 Group II (PRF+ Bi- Phasic Ca- Ph + MSCs) Group III (PRF+ Bi- Phasic Ca- Ph)
33
34 Results
35 MSCs in Culture In-vitro Cell Surface Marker Expression Osteogenic Multi-lineage Differentiation Chondrogenic
36 MSCs in Culture Day 0 Day 7 Day 14
37 Cell Surface Marker Expression
38 Multi-lineage Differentiation Osteoblastic Differentiation Chondrogenic Differentiation
39 Histology H & E In-vivo Histochemical (Masson Trichrome) Mature Bone Histomorphometry Bone Matrix
40 Histological Results H & E Bone Interface Bone formation in center Bone Trabeculae Reversal Lines Osteocytes Osteoclasts
41 Group I Bone interface Bone formation in center
42 Group I Bone Trabeculae Reversal Lines Osteocytes Osteoclasts
43 Group II Bone interface Bone formation in center
44 Group II Bone Trabeculae Reversal Lines Osteocytes Osteoclasts
45 Group III Bone interface Bone formation in center
46 Group III Bone Trabeculae Reversal Lines Osteocytes Osteoclasts
47 Histomorphometric Results Area percent of Mature Bone
48 Mean area percent of Mature Bone Gp 1 Gp2 Gp3
49 Histochemical Results Group I
50 Group II
51 Group III
52 Histomorphometric Results Area percent of Bone Matrix
53 Percent Mean area percent of Bone Matrix Gp 1 Gp2 Gp3
54 Conclusion
55 PRF membranes loaded with MSCs could induce early bone formation and maturation in vertical alveolar defects. PRF couldn't support osteogensis process in vertical alveolar ridge defects till complete bone formation and restoration of the whole bone volume. The combined use of Bi-phasic calcium phosphate block together with PRF loaded with MSCs is superior to single use of PRF loaded with MSCs in treatment of vertical alveolar ridge defects. The combined use of Bi-phasic calcium phosphate block together with MSCs loaded PRF yields promising results in treatment of vertical alveolar ridge defects
56 Recommendation Larger sample size with longer period of follow up. Radiographic assessment.
57 Thank You
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