Clinical Study Using Bone Marrow Mononuclear Cells Combined

A. Shahrouz^*
*Correspondence: A. Shahrouz, Department of Materials Science and Engineering, Tel Aviv University, Israel, Email:

Introduction

The most frequent congenital bone abnormality is alveolar cleft. The most often used technique for treating alveolar clefts is an autologous iliac crest bone graft (ICBG), yet this condition is linked to door-site morbidities. This work repaired an alveolar bone deficiency for the first time using beta-tricalcium phosphate (-TCP) granules and bone marrow mononuclear cells (BMMNCs). After a 12-month follow-up, the efficacy of this method was compared to autologous ICBG. Utilizing three-dimensional computed tomography and computer-aided engineering technology, the bone production volume was quantitatively assessed. In the healing of alveolar clefts, BMMNCs/-TCP granule grafting was radio graphically similar to ICBG. Even though there was a significant amount of resorption up to 6 months after surgery, there were no discernible differences between the groups in the Chelsea score or bone formation volume [1,2].

Description

The most frequent congenital bone abnormality is alveolar cleft. Prior to canine eruption, secondary alveolar bone grafting is thought to be the norm for cleft lip and palate patients. Repairing the alveolar bone cleft aids in reestablishing the continuity of the dental arch, stabilising the maxilla, facilitating subsequent orthodontic treatment, and supporting soft tissue structures. Iliac crest bone grafting (ICBG) is the "gold standard" for treating alveolar clefts, and it is used to treat these lesions However ICBG is linked to problems such nerve damage, infection, pelvic instability, and excruciating postoperative pain at the donor site. Additionally, several papers have very variable success rates for repairing alveolar clefts using ICBG.

In order to circumvent the aforementioned drawbacks, novel approaches to bone regeneration have been sought after, including bone morphogenetic proteins (BMPs) osteo-conductive polymers, and cytokines. Autologous bone grafting is a possible alternative to stem cell therapy. The usefulness of using cultivated mesenchymal stem cells (MSCs) in conjunction with biomaterials to mend bone defects has been shown in numerous animal models. However, obtaining regulatory approval for clinical application of cultured grafts is exceedingly challenging due to the complex production process, high manufacturing costs, and contamination risk involved in their preparation. Ex vivo culture-expanded MSCs have been used in very few clinical investigations that have been published to date. MSCs can be found in abundance in bone marrow. Numerous regenerating cells can be found in bone marrow mononuclear cells (BMMNCs), which can be created during surgery. BMMNCs have previously been utilized to treat bone non-union and spine fusion, but seldom to cure craniofacial bone deformities. For the first time, BMMNCs and beta-tricalcium phosphate (-TCP) granules were used in this investigation to treat alveolar bone deficiencies in cleft lip patients. The effectiveness of BMMNCs/-TCP and conventional ICBG were examined in the study. During a 12-month follow-up period, bone development was quantitatively assessed using three-dimensional (3D) computed tomography (CT) scans and computer-aided engineering (CAE). A natural source of cells and cytokines for bone healing is bone marrow.

Fresh bone marrow aspirate has been employed often to treat bone abnormalities since the 1980s. Connolly et al. published the centrifugation procedure for BMMNC preparation in 198925. In an ovine lumbar spine fusion model26, Gupta et al. showed that TCP coupled BMMNCs had a similar fusion rate and denser bone growth compared with autograft. According to Muschler et al., when compared to DBM coupled with bone marrow, BMMNCs delivered a mean 5.6-fold increase in progenitor cells, increasing the spinal fusion volume and union scores. This is the first clinical investigation on the BMMNC treatment of alveolar clefts that we are aware of. Treatment of a small bone defect is only one part of the repair of the alveolar gap. In the sequential management of cleft lip and palate repair is crucial. Although iliac crest bone grafting is the most often used surgery, its door-site morbidities are a significant drawback. Iligac bone marrow aspiration is a less invasive process than iliac bone harvest. In this study, we compared the BMMNCs/-TCP granule protocol's effectiveness to ICBG, the accepted practise for repairing alveolar clefts. With the BMMNCs/-TCP scaffold, we saw satisfactory outcomes in the majority of patients without any issues [3-5].

Conflict of Interest

The authors declare that there is no conflict of interest associated with this manuscript.

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