Marco N. Helder

This prospective cohort study aimed to assess long-term safety, dental implant survival, and clinical and radiological outcomes after maxillary sinus floor elevation (MSFE; lateral window technique) using freshly isolated autologous stromal vascular fraction (SVF) combined with calcium phosphate ceramics. All 10 patients previously participating in a phase I trial were included in a 10-year follow-up. They received either β-tricalcium phosphate (β-TCP; n = 5) or biphasic calcium phosphate (BCP; n = 5) with SVF-supplementation on one side (study). Bilaterally treated patients (6 of 10; 3 β-TCP, 3 BCP) received only calcium phosphate on the opposite side (control). Clinical and radiological assessments were performed on 44 dental implants at 1-month pre-MSFE, and 0.5- to 10-year post-MSFE. Implants were placed 6 months post-MSFE. No adverse events or pathology was reported during a 10-year follow-up. Forty-three dental implants (98%) remained functional. Control and study sides showed similar peri-implant soft-tissue quality, sulcus bleeding index, probing depth, plaque index, keratinized mucosa width, as well as marginal bone loss (0-6 mm), graft height loss (0-6 mm), and graft volume reduction. Peri-implantitis was observed around 6 implants (control: 4; study: 2) in 3 patients. This study is the first to demonstrate the 10-year safety of SVF-supplementation in MSFE for jawbone reconstruction. SVF-supplementation showed enhanced bone regeneration in the short term (previous study) and led to no abnormalities clinically and radiologically in the long term.

This study aimed to analyze the efficacy of stem cell-based tissue engineering for the treatment of alveolar cleft (AC) and cleft palate (CP) defects in animal models. Systematic review and meta-analysis. Preclinical studies on alveolar cleft repair in maxillofacial practice. Electronic search was performed using PubMed, Embase, and Cochrane databases. Pre-clinical studies, where stem cell-based tissue engineering was used in the reconstruction of AC and CP in animal models were included. Quality of the selected articles was evaluated using SYRCLE (SYstematic Review Centre for Laboratory animal Experimentation). Review of alveolar cleft bone augmentation interventions in preclinical models. Outcome parameters registered were new bone formation (NBF) and/or bone mineral density (BMD). Thirteen large and twelve small animal studies on AC (21) and CP (4) reconstructions were included. Studies had an unclear-to-high risk of bias. Bone marrow mesenchymal stem cells were the most widely used cell source. Meta-analyses for AC indicated non-significant benefits in favor of: (1) scaffold + cells over scaffold-only (NBF P = .13); and (2) scaffold + cells over empty control (NBF P = .66; BMD P = .31). Interestingly, dog studies using regenerative grafts showed similar to superior bone formation compared to autografts. Meta analysis for the CP group was not possible. AC and CP reconstructions are enhanced by addition of osteogenic cells to biomaterials. Directions and estimates of treatment effect are useful to predict therapeutic efficacy and guide future clinical trials of bone tissue engineering.

Objectives. Ameloblastoma is a slow-growing epithelial odontogenic neoplasm of the jaws with a high recurrence rate. The main treatment strategies for this lesion are radical or conservative surgical approaches. The aim of the present study was to analyze clinical presentations, histological types, and treatment strategies of recurrent ameloblastoma and to define its disease-free survival (DFS) rate. Materials and Methods. Twenty-four cases of recurrent ameloblastomas, treated between January 2009 and July 2021, were enrolled in this study. Medical files from each patient, including gender, age, size of the lesion, localization, patient complaints, clinical manifestation, radiographic appearance, histological type, surgical management, and treatment results were reviewed and analyzed retrospectively. Result. Out of 69 operated primary ameloblastomas, the rate of recurrence was 35%. Out of 24 recurrent cases, 21 developed after conservative treatment and 3 after radical treatment. In most cases, recurrences were found in the mandible (n = 20). A unilocular pattern was predominant in radiographic examination (44%). Estimated 3-year DFS was 84.5 ± 4.8%, and the 5-year and 10-year DFS were 73.0 ± 6.3% and 43.9 ± 8.343.9 ± 8.3%, respectively. Conclusion. Results obtained in the present retrospective study proved the necessity of long-term follow-up after both conservative and radical treatment approaches. The DFS median in our study was 8 years (95% CI 6 years–10 years). For recurrent cases, radical resection with histologically free margins after exact MRI determination of the ameloblastoma border within the soft tissues should be considered as the method of choice to avoid secondary recurrence.