PMC4714459_01
Clinical, radiographic, and histological observations in Case 1. a The implant is placed into the cavity created by the SFE procedure. b The cavity is filled with MSC-CM/beta-TCP. c The second surgery. A bone biopsy was taken from the newly formed bone 6 months after the SFE procedure. d-f CT images before and after the SFE procedure. d Before the SFE procedure. e Three months after the SFE procedure. f Six months after the SFE procedure. g, h, i Histologic findings of the specimen from the augmented area (H-E stain). g Out line of the specimen (x12.5). h Nasal side of the specimen (H; x100). i Oral side of the specimen (x100). Newly formed bone was seen throughout the specimen. Arrow indicates the arrangement of osteoblasts along with the newly formed bone. The residual beta-TCP granules were seen at the nasal side of specimen. The dotted arrow indicates beta-TCP resorption by osteoclasts. (TCP: beta-TCP, NB: Newly formed bone)
13005_2016_101_Fig2_HTML.jpg
PMC4714459_01_13005_2016_101_Fig2_HTML.jpg
Fig2
Once the lateral maxillary window was opened and the maxillary sinus membrane was elevated, two Branemark MkIII Groovy 11.5-mm long implants were placed into the prepared cavity (Fig. 2a). About 0.5 g beta-TCP was used to fill the cavity (Fig. 2b). Osseointegration of the implants was good, and a bone biopsy was taken from the augmented area (Fig. 2c). In CT images, the particles of implanted beta-TCP were clear 1 month after the first surgery, but became gradually indistinct after 6 months (Fig. 2d-f). Interestingly, infiltration of inflammatory cells was not severe, and newly formed bone was seen throughout the specimen (Fig. 2g, h).
Histological observation in the reference case. CT images and histology of an SFE case with beta-TCP alone are shown. a, b CT images after the SFE procedure. a Three months after the SFE procedure. b Six months after the SFE procedure. c Outline of the specimen. Newly formed bone is scarce, and beta-TCP remains much from nasal part to the middle area of the specimen (H-E, x12.5). d Nasal side of the specimen (x100). e Oral side of the specimen (x100). Replacement of new bone is insufficient. The arrow indicates infiltration of inflammatory cells. Arrow indicates the arrangement of osteoblasts along with the newly formed bone. The dotted arrow indicates that osteoclasts, but the number of osteoclasts was less. Infiltration of the inflammatory cells was seen in the oral part of the specimen. (TCP: beta-TCP, NB: Newly formed bone, AB: Alveolar bone)
13005_2016_101_Fig3_HTML.jpg
PMC4714459_01_13005_2016_101_Fig3_HTML.jpg
Fig3
As a reference control, histology from a patient who had undergone SFE with beta-TCP only (i.e., without MSC-CM) 6 months before is shown in Fig. 3.
PMC4714459_02
Clinical, radiographic, and histological observations in Case 2. a The extraction socket remains at the distal part of the right mandibular first premolar. b The socket was filled with MSC-CM/ACS. c The implant placement 8 months after MSC/ACS implantation. The socket is completely regenerated with newly formed bone. A bone biopsy was done where the implant was placed. d-f CT images before and after the SP procedure. d Before the SP procedure. e Three months after the SP procedure. f Six months after the SP procedure. g, h Histologic findings of the specimen from the augmented area (H-E stain) (G; x12.5 and H; x40). Newly formed and mature bone was seen throughout the specimen. No inflammatory cells were seen in this specimen. (NB: Newly formed bone)
13005_2016_101_Fig4_HTML.jpg
PMC4714459_02_13005_2016_101_Fig4_HTML.jpg
Fig4
MSC-CM/ACS was implanted into the bony defect, and the flap was closed (Fig. 4a, b). CT images showed gradual bone formation in the implanted area (Fig. 4d-f). Prior to implant placement, a bone biopsy was done from where the NobelActive 11.5-mm-long implant would be placed (Fig. 4c). H-E staining of the specimen showed dense trabecular bone with little infiltration of inflammatory cells (Fig. 4g, h).