Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Stem Cells. Jul 26, 2015; 7(6): 976-991
Published online Jul 26, 2015. doi: 10.4252/wjsc.v7.i6.976
Mesenchymal stem cells in maxillary sinus augmentation: A systematic review with meta-analysis
Francesco G Mangano, Marco Colombo, Giovanni Veronesi, Alberto Caprioglio, Carlo Mangano
Francesco G Mangano, Marco Colombo, Alberto Caprioglio, Carlo Mangano, Department of Surgical and Morphological Science, Dental School, University of Varese, 21100 Varese, Italy
Giovanni Veronesi, Department of Clinical and Experimental Medicine, University of Varese, 21100 Varese, Italy
Author contributions: Mangano FG, Colombo M, Veronesi G, Caprioglio A and Mangano C equally contributed to this paper.
Conflict-of-interest statement: The authors declare that they have no financial relationship with any commercial firm that may pose a conflict of interests regarding the publication of this study. No grants, equipment, or other sources of support were provided.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at Francesco Mangano (francescomangano1@mclink.net). Participants gave informed consent for data sharing even though are anonymized and the risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Francesco G Mangano, DDS, Department of Surgical and Morphological Science, Dental School, University of Varese, Piazza Trento 4, 21100 Varese, Italy. francescomangano1@mclink.net
Telephone: +39-344-85524 Fax: +39-344-530251
Received: November 25, 2014
Peer-review started: November 26, 2014
First decision: December 27, 2014
Revised: March 27, 2015
Accepted: May 5, 2015
Article in press: May 6, 2015
Published online: July 26, 2015
Processing time: 248 Days and 17 Hours
Abstract

AIM: To investigate the effectiveness of mesenchymal stem cells (MSCs) in maxillary sinus augmentation (MSA), with various scaffold materials.

METHODS: MEDLINE, EMBASE and SCOPUS were searched using keywords such as sinus graft, MSA, maxillary sinus lift, sinus floor elevation, MSC and cell-based, in different combinations. The searches included full text articles written in English, published over a 10-year period (2004-2014). Inclusion criteria were clinical/radiographic and histologic/ histomorphometric studies in humans and animals, on the use of MSCs in MSA. Meta-analysis was performed only for experimental studies (randomized controlled trials and controlled trials) involving MSA, with an outcome measurement of histologic evaluation with histomorphometric analysis reported. Mean and standard deviation values of newly formed bone from each study were used, and weighted mean values were assessed to account for the difference in the number of subjects among the different studies. To compare the results between the test and the control groups, the differences of regenerated bone in mean and 95% confidence intervals were calculated.

RESULTS: Thirty-nine studies (18 animal studies and 21 human studies) published over a 10-year period (between 2004 and 2014) were considered to be eligible for inclusion in the present literature review. These studies demonstrated considerable variation with respect to study type, study design, follow-up, and results. Meta-analysis was performed on 9 studies (7 animal studies and 2 human studies). The weighted mean difference estimate from a random-effect model was 9.5% (95%CI: 3.6%-15.4%), suggesting a positive effect of stem cells on bone regeneration. Heterogeneity was measured by the I2 index. The formal test confirmed the presence of substantial heterogeneity (I2 = 83%, P < 0.0001). In attempt to explain the substantial heterogeneity observed, we considered a meta-regression model with publication year, support type (animal vs humans) and follow-up length (8 or 12 wk) as covariates. After adding publication year, support type and follow-up length to the meta-regression model, heterogeneity was no longer significant (I2 = 33%, P = 0.25).

CONCLUSION: Several studies have demonstrated the potential for cell-based approaches in MSA; further clinical trials are needed to confirm these results.

Keywords: Mesenchymal stem cells; Maxillary sinus; Sinus floor augmentation; Scaffolds; Bone regeneration

Core tip: Cell-based approaches, utilizing adult mesenchymal stem cells, may overcome the limitations of conventional bone augmentation procedures. The present review of the current literature aims to systematically review the available evidence on the characteristics and clinical effectiveness of cell-based maxillary sinus augmentation, compared to current evidence-based methods.