Buccal Fat Pad–Derived Stem Cells in Three-Dimensional Rehabilitation of Large Alveolar Defects: A Report of Two Cases
This case report seeks to describe efficient clinical application of adipose-derived stem cells (AdSCs) originated from buccal fat pad (BFP) in combination with conventional guided bone regeneration as protected healing space for reconstruction of large alveolar defects after extraction of multiple impacted teeth. The first case was a 19-year-old woman with several impacted teeth in the maxillary and mandibular regions, which could not be forced to erupt and were recommended for surgical extraction by the orthodontist. After this procedure, a large bone defect was created, and this space was filled by AdSC loaded natural bovine bone mineral (NBBM), which was protected with lateral ramus cortical plates, microscrews, and collagen membrane. After 6 months of post-guided bone regeneration, the patient received 6 and 7 implant placements, respectively, in the maxilla and mandible. At 10 months postoperatively, radiographic evaluation revealed thorough survival of implants. The second case was a 22-year-old man with the same complaint and large bony defects created after his teeth were extracted. After 6 months of post-guided bone regeneration, he received 4 dental implants in his maxilla and 7 implants in the mandible. At 48 months postoperatively, radiographs showed complete survival of implants. This approach represented a considerable amount of 3-dimensional bone formation in both cases, which enabled us to use dental implant therapy for rehabilitation of the whole dentition. The application of AdSCs isolated from BFP in combination with NBBM can be considered an efficient treatment for bone regeneration in large alveolar bone defects.
Preoperative radiographs of patient 1 showing multiple impacted teeth; note the impacted teeth in the mandible and maxilla. (a) Panoramic view. Cone-beam computerized tomography evaluations of (b) maxilla at coronal plane and (c) sagittal plane.
Preoperative radiographs of patient 2 showing multiple impacted teeth. (a) Panoramic view. Cone-beam computerized tomography evaluations at coronal plane and sagittal plane of (b) maxilla and (c) mandible.
Figure 3. Intraoperative image of patient 1. (a) Fixation of lateral ramus cortical bone via microscrew and plates, defect site was filled by (b) stem cell loaded scaffold and (c) collagen membrane placement in order to preserve the healing space and sutured. Figure 4. Intraoperative image of patient 2. (a) Fixation of lateral ramus cortical bone via microscrew and plates. Defect site was filled by (b) stem cell loaded scaffold and (c) collagen membrane placement in order to preserve the healing space and covering the graft. Figure 5. Intraoperative image of patient 2. (a) Clinical view of regenerated bone after flap repositioning, (b) Dental implant placements at 7 months postoperatively.
Flow cytometry analysis of harvested and cultured buccal fat pad stem cells; 95% of cells were positive for mesenchymal markers (CD73 [SH3] and CD105 [SH2]) and cell adhesion molecules (CD 44 and CD 90). Hematopoietic markers (CD34 and CD45) were expressed at very low percentages of the cells.
Figure 7. Alizarin red staining (×40); mineralized nodule-like structures represent osteogenic differentiation of stem cells. Figure 8. Scanning electron microscope view of buccal fat pad derived stem cells' attachment to natural bovine bone mineral scaffold. Figure 9. Postoperative radiographs of patient 1 showed the considerable amount of new bone formation in the (a) maxilla and (b) and mandible 6 months postoperatively.
Figure 10. Panoramic radiographs of dental implant placement: (a) patient 1 after 10 months and (b) patient 2 at 48 months postoperatively. Figure 11. Postoperative radiographs of patient 2 showing the significant amount of bone regeneration in the (a) maxilla and (b) mandible 6 months postoperatively. Figure 12. The trabecular pattern was mostly lamellar organization, containing osteocytes within lacunae and (a) a fibrous bone marrow (hematoxylin and eosin [H&E], ×40), osteocytes (white arrows), osteoblastic rim (black arrow), and residual body (Asterix) are shown in the histogram B (H&E, ×40).
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