Introduction: Iliac crest cortical bone is an effective technique for correction of cleft alveolar defects but patients have significant hip discomfort post-harvest. Previously in our laboratory, critical-sized rabbit femoral defects were histologically healed with bone marrow stem cells seeded on collagen. To investigate the efficacy of a similar technique in alveolar cleft defects, volumetric bone healing of clefts treated with bone-marrow stem cells and collagen was compared those clefts treated with traditional iliac bone. Methods: Patients with unilateral alveolar cleft defects were prepared orthodontically and randomly divided into 2 equal treatment groups: 1) iliac crest bone graft or 2) bone marrow aspirate seeded on collagen (n=18). Preoperative and follow-up (mean=8 months) evaluations, intraoral photographs, NewTom orthognathic xrays (panorex, periapical films and 3-D CT scans) were performed. Wound and bone healing, tooth eruption and volumetric closure of the alveolar defect were recorded. Results: Patients ages ranged from 6 to 11 years (mean=7.9 years). Preoperative volume defects ranged from 5.1ccs to 10.3ccs and was 6.8ccs in Group 1 (iliac bone) and 7.1cc in Group 2 (stem cells). Postoperatively, 2 group 1 patients had bone exposure and 0 group 2 patients had exposure. In follow-up, alveolar defects were filled with new bone as follows-Group 1 (iliac bone) >90%=5 patients, 50-90%=2 patients, <50%=2 patients and Group 2 (stem cells): >90%=6 patients, 50-90%=3 patients, <50%=0 patients. Tooth eruption was as follow: Group 1=5 of 9 patients and Group 2=4 of 9 patients. Group 2 patients had less hip pain by survey and select Group 2 patients (3/9) had outpatient procedures. Conclusions: From these data we concluded that bone marrow derived stems cells seeded appropriately on a collagen matrix will heal alveolar cleft defects. To decrease the donor site morbidity further, an ongoing study involves processed lipoaspirate (PLA) (stem) cells (from liposuction) and BMP-2 on a similar collagen matrix in alveolar cleft defects.
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