Adipose-derived stem cells in alveolar cleft management: looking for a better scaffold

Abstract

Background: Although various sources of bone graft material have been suggested in the literature for alveolar cleft reconstruction including autogenous, allogenic, xenogenic, and alloplastic grafts, autogenous bone graft from either the iliac crest or the tibial plateau remains the gold standard against which other sources are evaluated. However, the procedure is invasive and associated with a potential risk of early complications such as bleeding, pain, infection, fracture or late complications such as chronic pain, scarring, paresthesia, and gait abnormalities. Moreover, its failure rate is about 15%. In an effort to improve outcome and decrease donor site morbidity, we tried to find a better scaffold for adipose-derived stem cells (ACSs) as an alternative to autologous bone graft for alveolar cleft reconstruction.Aim of the study: To study the efficacy of demineralized bone matrix (DBM) versus autologous bone graft as a scaffold for adipose-derived stem cells (ASCs) and to compare both techniques to the standard autologous iliac crest bone graft (ICBG).Methods: 54 patients underwent alveolar cleft reconstruction at the age of mixed dentition over a 3-year period. Their mean age was 11 and their mean postoperative follow-up was 12.4 months. Of these, 18 constituted the ICBG group (standard group), 20 constituted the ACSs with ICBG scaffold (ASCs/ICBG) group, whereas the remaining 16 patients made up ACSs with DBM (ASCs/DBM) group. Results were assessed by rating the radiographs obtained 6 months postoperatively according to Bergland scale. Results: Alveolar cleft repairs using cancellous bone only (ICBG group) were 72.2 percent successful, alveolar cleft repairs using cancellous bone enhanced with ASCs (ASCs/ICBG group) were 90 percent successful, and alveolar cleft repairs using DBM enhanced with ASCs (ASCs/DBM group) were 62.5 percent successful. However, there was no statistical difference between the groups. A significantly shorter operative time (average time saving was 103 minutes/case) and higher infection rate (18.8 percent) were observed in ASCs/DBM group as compared to the other two groups.Conclusion: Although not being significantly better than DBM, ICBG appears to be a good scaffold for ASCs that improves results of alveolar cleft reconstruction.

Keywords

• alveolar cleft reconstruction
• stem cells
• demineralized bone matrix