Stem Cells Assisted Cancellous Bone Graft Versus Stem Cells with Demineralized Bone Matrix for Alveolar Cleft Reconstruction

Background: Although different bone graft materials have been suggested in the literatures for alveolar cleft reconstruction including autogenous, allogenic, xenogenic, and alloplastic grafts, Autogenous bone graft either from the iliac crest or the tibial plateau remains the gold standard against which other graft materials are evaluated. However, the procedure is invasive and associated with a potential risk of early complications such as bleeding, pain, infection, fracture and/or late complications such as chronic pain, scarring, paresthesia and gait abnormalities. Moreover, its failure rate is about 15%. Objectives: To assess the efficacy of using adipose derived stem cells (ASCs) in alveolar cleft reconstruction; whether added to the cancellous bone or used with demineralized bone matrix scaffold; in comparison to the conventional iliac crest bone grafting (ICBG). Patients and Methods: 24 patients underwent alveolar cleft reconstruction at the age of mixed dentition over a 3years period; three of them had two grafted sites (bilateral cleft cases) giving an overall total of 27 grafted sites assessed during this study. Their mean age was 11.9 years and their mean postoperative follow-up was 11.7 months. Of these, 9 constituted the ICBG group (standard group), 10 constituted the ACSs with ICBG scaffold (ASCs/ICBG) group, whereas the remaining 8 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 77.8 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 50 percent successful, but there were no significant statistical difference between the groups. ASCs/DBM group shows significantly shorter operative time, and higher cleft site infection rates. Conclusion: Using ASCs whether with DBM or ICBG is not significantly better than the conventional method, while using DBM significantly reduced operative time, but associated with higher risk of infection.