Tissue engineering/Stem cell technology

Tissue engineering/Stem cell technology

The History of Bone Reconstruction
Replacing a large amount of bone has been a challenge for reconstructions where large amounts of bone is missing. Missing teeth for a long time, wearing dentures and having cysts and tumors in the mouth can cause extensive amount of missing bone. Hip bone and rib bone was commonly used for reconstructions in the mouth. Hip and rib grafts require taking your own hip or rib bone and moving it to the mouth where the bone is needed. These procedures require hospital stay and long recovery time. The development of tissue engineering has allowed reconstruction to be completed with lower risk in the office with shorter recovery time.

What is tissue engineering? 
Tissue engineering is a recipe for bone creating. Formation of bone requires a scaffold, a signal and stem cells. Science and technology allowed us to build bone using these components. The scaffold is the structure that supports the new bone to fill in. The signal is sent by growth factors or synthetic proteins that recruit stem cells (PRP, Rh-BMP-2, Gem21). Stem cells are mother cells that have the potential to become different tissues in your body such as bone. Combining the components will allow formation of new bone. BMP, PRP, Gem 21 and BMAC are different modalities used for tissue engineering.

Dr. Song and Dr. Um are experts in tissue engineering to create a good platform for implant placement.

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What is PRP?
PRP or Platelet rich plasma is a stem cell technology that uses your own blood to promote your body’s ability to heal itself.

How does platelets help heal?
Platelets help coordinate repair through release of growth factors and regeneration of tissue such as bone and gum. PRP is a concentration of platelets and growth factors derived from your own blood. It acts as a biologic glue that holds graft together and enhances healing of the surgical site by releasing growth factors. Growth factors such as platelet derived growth factor (PDGF), transforming growth factor beta (TGF-b) and vascular endothelial growth factors (VEGF) send signals to recruit stem cells. Stem cells are mother cells that have the potential to become different type of cells such as bone (osteoblasts) and gum (endothelial cell).
 
When can you use PRP?
It is a safe way to enhance healing in a minimally invasive way. In non-healing defects and large defects PRP has shown to enhance healing. In large defect PRP is used in adjunct with BMP and bone graft to reconstruct the area in preparation for an implant. It is also used when a large defect is present after a cyst or tumor removal. 

What is the process?
The blood draw is completed at the same time as the bone graft appointment in the office. The blood is transferred to a centrifuge and in 15 minutes that platelets and growth factors are concentrated.

Is PRP Safe?
PRP is safe because it is your own blood. There is no risk for foreign body reaction since this is your own blood. The risks involved are equivalent to blood draw or an IV placement.

What are some contraindications to PRP?
If you have platelet dysfunction, anemia, malignancy (hematologic or bone marrow involvement) and bleeding disorders, PRP may not be right for you. Ask your Surgeon or physician.

Why is it a great adjunct to a bone graft?
PRP helps contain the bone graft like a glue and enhances the healing process by recruiting stem cells and allowing it to turn into bone. Dr. Song and Dr. Um are experts in bone grafting techniques using PRP. Please ask them if PRP is the right choice for you. 

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What is BMP?
Bone morphogenic protein (BMP) is a protein plays an important role in bone formation. It is a signal for the body to recruit stem cells. Stem cells are mother cells that have the potential to become different type of cells such as bone. A synthetic BMP (rh-BMP 2) has been used in orthopedics and now it is implemented in dental reconstruction. The synthetic BMP is used as an adjunct to bone grafting procedures such as sinus lifts and ridge augmentation.

When can you use rh-BMP2?
Rh-BMP 2 enhances healing of a bone graft and is commonly used with PRP (platelet rich plasma) and cadaveric or bovine (cow) bone for sinus lifts and other grafting procedures prior to implant placement. Placing an implant is like building a house. It needs a good base which is the supporting bone. Tissue engineering with stem cell technology such as BMP, PRP and Gem 21 can aid in creating good supporting bone.

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BMAC (Bone marrow aspirate concentrate)

What is BMAC?
BMAC or bone marrow aspiration and aspirate concentrate technology is to obtain your own stem cells. Stem cells are mother cells that have the potential to become bone and gum tissue.

When do you use BMAC?
For larger defects due to a lesion inIf you have a large defect due to a pathology removal or an accident in your jaw, BMAC can be used along with BMP and PRP to generate bone.
Where do you get BMAC from?
Your hip bone or iliac crest contains bone marrow that is a rich source of stem cells and growth factors.

How do you get BMAC?
BMAC is obtained in a hospital setting. After general anesthesia is achieved, a needle is inserted and bone marrow is aspirated from the hip. The concentrate is centrifuged in a sterile container and
Is BMAC safe?
 
BMAC is minimally invasive and a great way to get large amount of stem cells that can generate bone. Most patients are able to walk the same day. Please ask your Dr. Song and Dr. Um whether BMP is the right choice for you.
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