Karpyuk V.B., Perova M.D., Porkhanov V.A., Reshetov I.V., Gilevich I.V., Sevostyanov I.A. The use of the stromal-vascular fraction of adipose tissue in regenerative surgery of the alveolar ridge. Golova i sheya. Rossijskij zhurnal Head and neck Russian Journal. 2019;7(4):18–26 (in Russian).
In modern dentistry and maxillofacial surgery, regenerative technologies for bone restoration using both minimally manipulated cells and stromal/stem cell lines from various tissue sources, including adipose tissue, are being actively tested.
Objective: to assess the possibilities of using the stromal-vascular fraction of adipose tissue (SVF-AT) to improve the methods of reconstructive surgery of the alveolar ridge.
Material and methods. The study included 141 patients with secondary adentia and concomitant regression transformation of the alveolar ridge of the jaws, among them were 61 (43.3%) men and 80 (56.7%) women. The age of the patients ranged from 45 to 78 years, with median of 57 (52–63) years. Open sinus lift (OSL), horizontal, vertical, and three-dimensional augmentation of the alveolar ridge of the maxilla (ARM) and the alveolar part of the mandible (APM) in the test group (TG, 68 patients; 55, 26 and 31 of the OSL, ARM and APM, respectively) were performed using bone autografts and bone replacement materials in combination with autologous SVF-AT. In the control group (CG, 73 patients; 52, 28, and 37 OSL, ARM, and APM, respectively), operations were performed using similar methods and materials, but without the cellular component. In TG were installed 302, and in the CG – 318 dental implants (DI). The average period from osteoplasty to implantation was 176±28 and 215±35 days in TG and CG, respectively (p=0.385). The observation continued until the completion of all stages of prosthetics, and included the long-term evaluation of the reconstructed alveolar ridge parameters and the DI state. Clinical, radiological and morphological research methods were used. Statistical analysis was performed using the IBM SPSS Statistics 23 software. Results and discussion. The total complication rate with complete or partial loss of the graft was 0.9 and 13.7% in TG and CG, respectively (p<0.001). As a result of the operation, a sufficient volume of bone was obtained for dental implantation in both groups. The height of the accessible bone in the TG was 20.3% higher than the CG level (p<0.001). and width in TG was 7.6% more than in CG (p<0.001). n a histomorphometric study, it was found that SVF-AT, when added to the granules of osteoplastic material based on deproteinized bovine bone, significantly increases bone remodeling in vivo: the area of vital mineralized tissue was 40.14±3.36% and 24.23±2.63%; osteoconductor residual granules 13.31±1.59 and 24.98±1.97% in TG and CG, respectively (p≤0.001). SVF-AT in the composition of osteoplastic material creates the conditions for its more active neovascularization after implantation in the defect zone: the density of microvessels on sections of the subantral osteoregenerate was 63.1±8.1 and 36.7±7.8 units per 1 mm2 in TG and CG, respectively (p=0.033). The low level of peri-implant marginal bone loss during the functioning of completed orthopedic constructions indicates the functional advantages of the supporting bone restored using SVF-AT: in all control periods, bone loss was significantly less in TG compared with CG (p<0.001). The five-year survival of DI in TG was 99.7%, in the CG – 96.5% (p=0.006).
Conclusion. The use of autologous SVF-AT as a source of regenerative cells and stimuli in combination with osteoconductive biomaterials improves the clinical, radiological, and histomorphological results of osteosubstitution during reconstruction of the atrophied alveolar ridge. The implementation of the presented regenerative approach can significantly increase the effectiveness of treatment and the quality of rehabilitation of the most complex category of patients with secondary adentia and severe deficiency of the supporting bone.
Key words: stromal-vascular fraction of adipose tissue, regeneration of jaw bone tissue, reconstruction of the alveolar ridge, dental implantation in atrophy.
The authors declare no conflict of interest.
Source of financing: not specified.
For citation: Karpyuk V.B., Perova M.D., Porkhanov V.A., Reshetov I.V., Gilevich I.V., Sevostyanov I.A. The use of the stromal-vascular fraction of adipose tissue in regenerative surgery of the alveolar ridge. Golova i sheya. Rossijskij zhurnal Head and neck Russian Journal. 2019;7(4):18–26 (in Russian).
The authors are responsible for the originality of the data presented and the possibility of pub-lishing illustrative material – tables, figures, photographs of patients.