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In-Site Monocyte Implantation in Bone Grafting for Maxillary Atrophy Reconstruction

A Preliminary Observational Proof of Concept Study

Del Deo, Vito, MD*; Fico, Antonio, DDS; Marini, Corrado, MD; Senese, Salvatore, MD§; Gasparini, Giulio, MD

doi: 10.1097/ID.0000000000000813
Basic and Clinical Research

Purpose: The main objective of this study, involving 11 patients, is to share our experience on an integrated treatment modality, namely, the use of cellular therapy simultaneously with surgical reconstruction. Published works show that the implantation of monocytes in ischemic tissue enhances healing by providing neo-angiogenesis, a key mechanism in tissue regenerative processes.

Materials and Methods: Our approach included the utilization of autologous monocytes and endothelial precursor cells in the bone graft itself to improve the success rate of the integration of the bone graft and its long-term viability/survival by promoting angiogenesis. We compared the standard regenerative procedures, namely sinus lift grafting performed with xenogeneic particle bone graft and posterior mandible grafting performed with on-lay or in-lay autologous cortical/medullary bone-block graft harvested from the iliac crest, with and without the use of cellular implementation. We evaluated results by both radiological and histological assessment.

Results: Autologous cortical/medullary bone-block graft had a different response to implementation with monocytes, showing a better osteointegration than expected conversely to the xenogeneic particle bone graft.

Conclusions: Monocytes seem to improve autologous bone-block graft according to the “Therapeutic Angiogenesis” concept. Implementation with monocytes does not always improve xenogeneic particle bone graft.

*Chief of Integrated Service of Maxillofacial Surgery, Casa di Cura San Michele Hospital, Maddaloni (CE), Italy.

Attending Oral Surgeon of Integrated Service of Maxillofacial Surgery, Casa di Cura San Michele Hospital, Maddaloni (CE), Italy; Private Practice, Afragola (NA), Italy.

Full Professor, Intensive Trauma Care Department, New York Medical College, Valhalla, NY.

§Attending Vascular Surgeon, Vascular Surgery Department, Casa di Cura San Michele Hospital, Maddaloni (CE), Italy.

U.O.C. of Maxillo Facial Surgery. Fondazione Policlinico Gemelli, I.R.C.C.S., Catholic University of the Sacred Heart, Rome, Italy.

Reprint requests and correspondence to: Antonio Fico, DDS, 16, Via Montella, Maddaloni 81024 (CE), Italy, Phone: +39 0823 208 563; +39 392 91 60 864, Fax: +39 081 851 06 08, E-mail:

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