Theoretical model for bone graft success.

Theoretical assumptions must correlate with clinical efficacy and good surgical outcomes to be of value to clinicians and patients. This article examines several common assumptions regarding the use of bone marrow aspirate to enhance bone grafting procedures. Contrary to these assumptions, evidence-based research suggests the following: (1) No more than 4 mL of bone marrow should be aspirated from a single donor site.

Antral membrane elevation using a post graft: a crestal approach.

The crestal approach to elevating the antral membrane by a resorbable StemVie post is a modification of the sinus lift technique. This technique can add 4-10 mm of bone height for severely atrophic ridges in areas that are difficult to access through a lateral window. The procedure is minimally invasive, simple, and predictable, and has less postoperative morbidity due to smaller flap design and minimal osteotomy.

Monocytes: super cells for bone regeneration.

Monocytes are progenitor cells that lead the inflammatory cascade reaction responsible for guiding revascularization and regeneration of tissue at injury sites. They do this by secreting inductive cytokines responsible for endothelial cell migration. When released into the peripheral blood, monocytes enter tissues and become macrophages.

The crestal approach: antral membrane elevation via a post graft.

The crestal approach to elevating the antral membrane by a resorbable StemVie Post is a modification of the sinus lift technique. This technique can add 4 to 10 mm bone height for severely atrophic ridges in areas that are difficult to access through a lateral window. The procedure is minimally invasive, simple, predictable, and has less postoperative morbidity because of smaller flap design and minimal osteotomy.

Bone grafting by means of a tunnel dissection: predictable results using stem cells and matrix.

Bone marrow aspirate has been shown to add stem cells, growth factors, and cytokines to bone graft matrices used in bone augmentation sites. The combination of bone marrow aspirate and resorbable scaffold material has a significant osteogenic capability that exceeds that of autogenous bone grafts. This article describes a subperiosteal tunneling technique for applying such grafts to defective sites.

Growth factors and gene expression of stem cells: bone marrow compared with peripheral blood.

Purpose: To evaluate and compare the presence of cytokines and growth factors in both bone marrow (BM) and peripheral blood.

Material: Samples of autogenous BM aspirate and peripheral blood (PB) from 7 patients ranging in age from 49 to 80 years were analyzed with real-time polymerase chain reaction technology to identify and compare selected gene expression for specific cytokines and growth factors. The genes selected for analysis included those involved in osteogenesis, hematogenesis, angiogenesis, extracellular matrix molecules, and cell-adhesion molecules.

The inverted periosteal flap: a source of stem cells enhancing bone regeneration.

The periosteum is a necessary component for bone growth, healing, and remodeling. It provides vascularity, osteoblasts, and osteoclasts. It is a regenerative source for stem cells similar to those obtained from bone marrow aspiration.

Bone marrow: orchestrated cells, cytokines, and growth factors for bone regeneration.

Bone regeneration requires an orchestrated interaction between various cells and other biological components. The synthesis of bone matrix with the release of cellular cytokines and growth factors facilitates and regulates cell growth. This leads to the maturation of bone that can support functional implants.

Toward the identification of mesenchymal stem cells in bone marrow and peripheral blood for bone regeneration.

Background: The advent of monoclonal antibody stem cell marker technology has made it possible to identify a variety of human stem cells and their progeny. Specific markers exist for cells related to bone healing and bone regeneration. These include but are not limited to hematopoietic, mesenchymal, endothelial, angiogenic, and vasculargenic precursor cells.

Bone block allograft impregnated with bone marrow aspirate.

Purpose: To evaluate the influence of bone marrow aspirate when added to bone block allograft to repair osseous defects.

Background: Bone-marrow aspirate has been combined with xenograft and allograft particulate material and has produced a significant quantity of new bone growth. However, the use of allograft bone blocks has advantages in some clinical situations.

A histomorphogenic analysis of bone grafts augmented with adult stem cells.

Purpose: To evaluate the influence of bone marrow aspirate added to xenograft or alloplast graft matrix scaffold to produce bone.

Materials: A maximum of 4 cc bone marrow was aspirated from the anterior iliac crest of 5 patients to saturate the matrix scaffold prior to bone graft. Seven graft sites evaluated included sinus lift augmentation, particulate onlay graft of the maxilla via a tunneling procedure, and particulate onlay graft of the maxilla stabilized with titanium mesh.

Bone marrow aspiration: technique, grafts, and reports.

This article describes a technique for obtaining adult stem cells from bone marrow aspirate. Case reports show how this procedure might replace the gold standard for bone grafts with the platinum standard of obtaining stem cells. The bone marrow aspirate and transplantation of adult stem cells within the resorbable) matrix and under the influence of soluble regulators have the potential for introducing the platinum standard for bone grafts.

The bone-grafting decision tree: a systematic methodology for achieving new bone.

Successful bone grafting requires that the clinician select the optimal bone grafting material and surgical technique from among a number of alternatives. This article reviews the biology of bone growth and repair, and presents a decision-making protocol in which the clinician first evaluates the bone quality at the surgical site to determine which graft material should be used. Bone quantity is then evaluated to determine the optimal surgical technique.

A new "platinum" standard for bone grafting: autogenous stem cells.

Autogenous bone has long been considered the gold standard of all bone grafting materials. However, complications have been associated with autogenous bone-harvesting procedures. This article suggests that an alternative approach, grafting with autogenous bone marrow aspirate, may become a new platinum standard.

Antral membrane balloon elevation.

Many edentulous posterior maxilla are found to be encumbered by alveolar resorption and increased pneumatization of the sinus. These factors limit the quantity and quality of bone necessary for successful implant placement in these areas. One solution is to use shorter implants, but this often results in an unfavorable crown-root ratio.

Trephine bone core sinus elevation graft.

The sinus cavity often limits the amount of available bone for the placement of implants in the posterior maxilla. The sinus lift operation and graft is a technique that can add grafted bone in excess of 10 to 16 mm through a lateral wall quadrilateral osteotomy. However, when moderate alveolar atrophy is present, an osteotome technique can provide an average bone height in crease of 3.