الفهرس 
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Abstract
With the widespread use of cellular therapy in medical practice, attention has been directed to the application of autologous bone marrow in the field of reconstruction. The use of bone marrow concentrate has become an increasingly popular alternative and adjunct in the treatment of bony defects, cartilaginous lesions, and tendinous injuries.
The available literature regarding the use of BMC in different tissue repair is highly heterogeneous with regards to indications, concentrations and overall functional outcomes. Hence, this study attempts to examine the evidence behind the use of BMC as an alternative to autologous bone graft in the repair of bony defects.
This study included two parts:
1- A clinical study
2- An experimental study
The clinical study was conducted on 14 residual surgical non- continuity defects resulting from enucleation of benign odontogenic/non- odontogenic cyst or tumour with low recurrence rate.
Patients were divided into two groups:
• group A (study group): included seven residual surgical non- continuity defects where grafting of the defects was done using a composite of bone marrow aspirate concentrate (BMAC) and an alloplastic scaffold.
• group B (control group): included seven residual surgical non- continuity defects where grafting of the residual surgical defects was done using autologous bone graft.
Radiographic evaluation was done using Cone beam C.T. scan at the following intervals:
Immediate postoperatively.
6 and 12 months postoperatively.
Each scan was assessed to determine the following parameters:
Volumetric calculation of the bone graft material
Volumetric calculation of the residual surgical defect size
Average radio-density of the residual surgical defect
The experimental part of the study was conducted on 14 standardized surgically created defects in seven white New Zealand rabbits with weights ranging from three to four kilograms. Each rabbit was submitted to two standardized surgical defects at the parietal bone.
Animals were divided into two groups:
• group A (study group): included seven standardized surgical defects where grafting of the defects was done using a composite of bone marrow concentrate (BMC) and an alloplastic scaffold.
• group B (control group): included seven standardized surgical defects where grafting of the defects was done using autologous bone graft.
All animals were sacrificed two months postoperatively by intra-venous administration of anesthetic overdose of sodium thiopental. Histo- morphometric assessment was done to calculate the percentage of newly formed bone with regard to the defect size.
The results of the clinical part of this study showed that, among the control group, residual surgical defect volume decreased significantly at six
months and one year post-operative when compared to immediate post- operative volume. Also, among the study group, residual surgical defect volume decreased significantly at six months and one year post-operative when compared to immediate post-operative volume.
However, there was no statistically significant difference between control and study groups regarding percentage of reduction in residual surgical defect volume along follow-up period.
Assessment of change in graft volume in this study showed that, among the control group, graft volume decreased significantly at six months and one year post-operative when compared to immediate post-operative volume. Also, among the study group, graft volume decreased significantly at six months and one year post-operative when compared to immediate post- operative volume.
However, there was no statistically significant difference between control and study groups regarding percentage of reduction in graft volume along follow-up period.
Regarding defect radiodensity, there was no statistical significant change in radiodensity along follow-up period among control group. Also, there was no statistical significant change in radiodensity along follow-up period among study group. In addition, there was no statistically significant difference between control and study groups regarding percentage of change in defect radiodensity along follow-up period.
The results of the experimental part of this study showed that, the mean area fraction (MAF) of newly formed osteoid was higher in the study group than that of control group. However, comparing these results revealed that
there was no statistically significant difference between control and study groups.
Conclusions
1. The use of the composite of bone marrow concentrate and Nano- hydroxyapatite granules might be a reliable alternative to autogenous bone graft in the reconstruction of residual surgical defects.
2. Radiographically, bone marrow concentrate might have increased the rate of resorption of Nano-hydroxyapatite granules.
3. Histologically, the composite of bone marrow concentrate and Nano- hydroxyapatite granules is a comparable alternative to autogenous bone graft regarding percentage of newly formed bone.
Recommendations
1. Future studies are recommended to establish the optimum timing for application of bone marrow concentrate.
2. Further researches are recommended to identify the ideal scaffold for bone marrow concentrate.
3. Controlled clinical trials are recommended, addressing the characterization of the cells and the quantification of the new bone formation.
4. Future studies are recommended to compare between currently available methods for concentration of bone marrow.