Use of corticocancellous allogeneic bone blocks impregnated with bone marrow aspirate: a clinical, tomographic, and histomorphometric study.

The aim of this study was to evaluate the efficacy of allogeneic block grafts impregnated with autologous bone marrow in horizontal ridge augmentation therapy. Ten patients with severe ridge volume deficiency in the anterior maxilla were treated with horizontal ridge augmentation. The patients were randomized into two groups: Five patients, using two allogeneic block grafts, were in the control group, and five patients, using two allogeneic block grafts impregnated with autologous bone marrow, were in the test group. Hematologists collected 4 mL of bone marrow from the iliac crest of the patients in the test group immediately prior to the surgeries. The blocks were fixed using titanium screws to obtain rigid fixation and to standardize the reference points for measurement purposes. CT scans were obtained both preoperatively and six months postoperatively to allow evaluation of horizontal bone gain. After a healing period of six months, the sites were reopened and the screws were removed. Before implant placement, bone cores were harvested and prepared for histologic and histomorphometric evaluation. Tomographic and histomorphometric measurements were recorded. The test group demonstrated better tomographic results (P < 0.05) in augmenting alveolar thickness, with a mean value of 4.60 ± 1.43 mm (118.23 ± 56.93%), while the control group had bone gain of 2.15 ± 0.47 mm (49.91 ± 20.24%). Despite the different results in alveolar thickness gained between groups, all sites received dental implants. The histomorphometric analysis also showed better results (P < 0.05) in the amount of vital mineralized bone in the test group as compared to the control group. The findings of this study suggest that an autologous bone marrow aspirate can increase the regenerative potential of corticocancellous allogeneic bone grafts.

Clinical and histomorphometric evaluation of extraction sockets treated with an autologous bone marrow graft.

PURPOSE: The aim of this study was to evaluate the potential of an autologous bone marrow graft in preserving the alveolar ridges following tooth extraction. MATERIALS: Thirteen patients requiring extractions of 30 upper anterior teeth were enrolled in this study. They were randomized into two groups: seven patients with 15 teeth to be extracted in the test group and six patients with 15 teeth to be extracted in the control group. Hematologists collected 5 ml of bone marrow from the iliac crest of the patients in the test group immediately before the extractions. Following tooth extraction and elevation of a buccal full-thickness flap, titanium screws were positioned throughout the buccal to the lingual plate and were used as reference points for measurement purposes. The sockets were grafted with an autologous bone marrow in the test sites and nothing was grafted in the control sites. After 6 months, the sites were re-opened and bone loss measurements for thickness and height were taken. Additionally, before implant placement, bone cores were harvested and prepared for histologic and histomorphometric evaluation. RESULTS: The test group showed better results (P<0.05) in preserving alveolar ridges for thickness, with 1.14+/-0.87 mm (median 1) of bone loss, compared with the control group, which had 2.46+/-0.4 mm (median 2.5) of bone loss. The height of bone loss on the buccal plate was also greater in the control group than in the test group (P<0.05), 1.17+/-0.26 mm (median 1) and 0.62+0.51 (median 0.5), respectively. In five locations in the control group, expansion or bone grafting complementary procedures were required to install implants while these procedures were not required for any of the locations in the test group. The histomorphometric analysis showed similar amounts of mineralized bone in both the control and the test groups, 42.87+/-11.33% (median 43.75%) and 45.47+/-7.21% (median 45%), respectively. CONCLUSION: These findings suggest that the autologous bone marrow graft can contribute to alveolar bone repair after tooth extraction.