search
Back to results

Bone Tissue Engineering Using Autologous Bone Repair Cell (BRC) Therapy for Sinus Floor Bone Augmentation

Primary Purpose

Tooth Loss

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Sinus lift augmentation and dental implant
Aastrom BRCs
Sponsored by
University of Michigan
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Tooth Loss focused on measuring sinus lift, tooth extraction, dental implant

Eligibility Criteria

20 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Age range: 20-70 yrs
  • Gender: Male and female
  • Systemically healthy: Physical status according to the American Society of Anesthesiologists (ASA) I or II
  • Requiring sinus augmentation to allow dental implant placement
  • Missing teeth: Maxillary second premolar, maxillary first molar and/or maxillary second molar
  • Remaining alveolar bone height: 2 to 6 mm
  • Must be able and willing to follow study procedures and instructions
  • Must have read, understood and signed an informed consent form

Exclusion Criteria:

  • Allergies or hypersensitivities to study related medications: dexamethasone, chlorhexidine, ibuprofen. For patients allergic to amoxicillin a comparable substitute antibiotic will be used
  • Hematologic disorders/ blood dyscrasias
  • Active infectious disease
  • Liver or kidney dysfunction/failure- Patients will have blood drawn for serum laboratory tests, including creatinine, blood urea nitrogen, AST, ALT, and bilirubin. All of these must be within normal limits for a patient to be included in the study
  • Laboratory values that will define normal renal and hepatic function, as well as criteria for exclusion of metabolic bone disease are consistent with those established by the University of Michigan Health System (UMHS). Normal clinical values will be used to help assure the health of all subjects in this trial. Potential subjects whose laboratory values fall outside the UMHS normal ranges and are considered clinically significant will be required to have medical clearance from their primary care provider prior to participation. Potential subjects presenting with clinically insignificant laboratory abnormalities will not require medical clearance and will be considered for inclusion in the study
  • Endocrine disorders/dysfunctions (i.e. Type I and II diabetes)
  • Cancer - The explicit definition of cancer used to exclude patients is consistent with that described by the National Cancer Institute (NCI), National Institutes of Health. According to NCI, cancer is any disease in which abnormal cells divide without control and invade nearby tissues (invasive disease). These include carcinomas, sarcomas, leukemias, and lymphomas. Any patient with a history of these invasive diseases will be excluded from the study.
  • Patients who currently use bisphosphonates or have a history of bisphosphonate use will be excluded from the trial
  • HIV+
  • Metabolic Bone Diseases- Patients with metabolic bone diseases such as Paget's disease, hypercalcemia, moderate to severe vitamin D3 abnormalities or any other metabolic bone disease including osteoporosis and osteoporotic fractures will be excluded
  • Pregnant women- Female patients who are of childbearing potential are excluded except those who are using hormonal or barrier methods of birth control (oral or parenteral contraceptives, diaphragm plus spermicide, or condoms). Pregnancy status will be determined with a urine test and patients who are pregnant will be excluded
  • Patients with acute sinusitis, or presenting any sinus pathology that would contraindicate sinus augmentation
  • Patients with congenital or metabolic bone disorders
  • Current smokers (have smoked within 6 mos. of study onset)
  • Subjects with congenital, or co-morbid conditions that would affect the study outcome or interpretation of study results will be excluded
  • Individuals who have a BMI outside normal limits that deems them overweight (BMI >25) will be excluded due to potential difficulties in locating appropriate surgical entry of the iliac crest during the bone marrow aspiration procedure
  • Long term (>2 weeks) use of antibiotics in the past 3 months
  • Periodontally unstable subjects
  • Subjects having any extractions in the possible treatment area in the past 3 months
  • Subjects that are edentulous

Sites / Locations

  • Michigan Center for Oral Health Research

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Experimental

Arm Label

sinus lift plus dental implant

sinus lift plus BRCs and dental implant

Arm Description

Transalveolar sinus augmentation will be performed. After 4 months dental implants will be delivered only if primary stability can be achieved. Intervention (Procedure/Surgery): Sinus lift augmentation and dental implant transalveolar sinus augmentation will be performed. After 4 months, dental implants will be delivered only if primary stability can be achieved. Biological/Vaccine: N/A; only sinus augmentation and dental implant

transalveolar sinus augmentation will be performed. A unit dose of BRC (10 ml) will be mixed with a commercially available β-TCP (Cerasorb), which will be used as a carrier to deliver the cells. Intervention (Procedure/Surgery): Sinus lift augmentation and dental implant transalveolar sinus augmentation will be performed. After 4 months, dental implants will be delivered only if primary stability can be achieved. Biological/Vaccine: Aastrom BRCs, sinus augmentation, BRC application, dental implant

Outcomes

Primary Outcome Measures

Bone Mineral Density of Bone Core
Bone mineral density of bone core was measured by histological and µCT analyses
Bone Volume Fraction of Bone Core
Bone volume fraction of bone core histological and µCT analyses

Secondary Outcome Measures

Change in Linear Radiographic Bone Height
Change in linear radiographic bone heights were measured before and after bone graft reconstruction
Change in Sinus Bone Volume
CBCT was used to evaluated 3-D changes in the bone volume within the treated areas of the sinus cavity
Final Bone Volume: Initial Graft Volume Ratio
Bone volume fraction of bone core histological and µCT analyses

Full Information

First Posted
September 18, 2009
Last Updated
November 18, 2015
Sponsor
University of Michigan
search

1. Study Identification

Unique Protocol Identification Number
NCT00980278
Brief Title
Bone Tissue Engineering Using Autologous Bone Repair Cell (BRC) Therapy for Sinus Floor Bone Augmentation
Official Title
Cell Therapy Using Autologous Bone Marrow Cells Expanded Ex Vivo and Delivered Using Tricalcium Phosphate
Study Type
Interventional

2. Study Status

Record Verification Date
November 2015
Overall Recruitment Status
Completed
Study Start Date
March 2010 (undefined)
Primary Completion Date
July 2013 (Actual)
Study Completion Date
July 2013 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Michigan

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this research is to determine if one's own bone marrow tissue can help regenerate (grow) bone in the area of the jaw where an implant will be placed. The name of the process is called Bone Repair Cell (BRC) Therapy. A sample of bone marrow tissue will be collected and sent to a laboratory where it will be processed to form more cells. These new cells will then be transplanted in the regenerative site or sinus floor augmentation site. The researchers are testing to see if these cells (BRC) will help form bone indicating. The research will also determine if the implant will be more stable in the area with new bone growth.
Detailed Description
The overall aim is to promote bone regeneration, using Aastrom's proprietary Adult Stem Cell Therapy (AST) developed collaboratively with the University of Michigan, to enable placement of dental implants in patients who lack adequate alveolar bone. This project addresses specifically the placement of dental implants following bone regenerative sinus floor augmentation. This novel therapy mitigates the risks of other therapies, providing additional benefits of adequate cell numbers for high quality bone regeneration, and has the potential to become the new standard of care. In Aastrom's patented manufacturing technology, iliac bone marrow aspirates are expanded ex-vivo to enrich for adult multipotent cells (Bone Repair Cells- BRC) capable of regenerating bone and blood vessels. BRC will then be mixed with bone matrix graft extender, beta-tricalcium phosphate (β-TCP), before their implantation into the regenerative site.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Tooth Loss
Keywords
sinus lift, tooth extraction, dental implant

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
26 (Actual)

8. Arms, Groups, and Interventions

Arm Title
sinus lift plus dental implant
Arm Type
Active Comparator
Arm Description
Transalveolar sinus augmentation will be performed. After 4 months dental implants will be delivered only if primary stability can be achieved. Intervention (Procedure/Surgery): Sinus lift augmentation and dental implant transalveolar sinus augmentation will be performed. After 4 months, dental implants will be delivered only if primary stability can be achieved. Biological/Vaccine: N/A; only sinus augmentation and dental implant
Arm Title
sinus lift plus BRCs and dental implant
Arm Type
Experimental
Arm Description
transalveolar sinus augmentation will be performed. A unit dose of BRC (10 ml) will be mixed with a commercially available β-TCP (Cerasorb), which will be used as a carrier to deliver the cells. Intervention (Procedure/Surgery): Sinus lift augmentation and dental implant transalveolar sinus augmentation will be performed. After 4 months, dental implants will be delivered only if primary stability can be achieved. Biological/Vaccine: Aastrom BRCs, sinus augmentation, BRC application, dental implant
Intervention Type
Procedure
Intervention Name(s)
Sinus lift augmentation and dental implant
Intervention Description
transalveolar sinus augmentation will be performed. After 4 months, dental implants will be delivered only if primary stability can be achieved.
Intervention Type
Biological
Intervention Name(s)
Aastrom BRCs
Intervention Description
sinus augmentation, BRC application, dental implant
Primary Outcome Measure Information:
Title
Bone Mineral Density of Bone Core
Description
Bone mineral density of bone core was measured by histological and µCT analyses
Time Frame
4 months
Title
Bone Volume Fraction of Bone Core
Description
Bone volume fraction of bone core histological and µCT analyses
Time Frame
4 months
Secondary Outcome Measure Information:
Title
Change in Linear Radiographic Bone Height
Description
Change in linear radiographic bone heights were measured before and after bone graft reconstruction
Time Frame
Screening and 1 week post-op from baseline
Title
Change in Sinus Bone Volume
Description
CBCT was used to evaluated 3-D changes in the bone volume within the treated areas of the sinus cavity
Time Frame
Pre-baseline and within 2 weeks of 4 Month visit
Title
Final Bone Volume: Initial Graft Volume Ratio
Description
Bone volume fraction of bone core histological and µCT analyses
Time Frame
4 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
20 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age range: 20-70 yrs Gender: Male and female Systemically healthy: Physical status according to the American Society of Anesthesiologists (ASA) I or II Requiring sinus augmentation to allow dental implant placement Missing teeth: Maxillary second premolar, maxillary first molar and/or maxillary second molar Remaining alveolar bone height: 2 to 6 mm Must be able and willing to follow study procedures and instructions Must have read, understood and signed an informed consent form Exclusion Criteria: Allergies or hypersensitivities to study related medications: dexamethasone, chlorhexidine, ibuprofen. For patients allergic to amoxicillin a comparable substitute antibiotic will be used Hematologic disorders/ blood dyscrasias Active infectious disease Liver or kidney dysfunction/failure- Patients will have blood drawn for serum laboratory tests, including creatinine, blood urea nitrogen, AST, ALT, and bilirubin. All of these must be within normal limits for a patient to be included in the study Laboratory values that will define normal renal and hepatic function, as well as criteria for exclusion of metabolic bone disease are consistent with those established by the University of Michigan Health System (UMHS). Normal clinical values will be used to help assure the health of all subjects in this trial. Potential subjects whose laboratory values fall outside the UMHS normal ranges and are considered clinically significant will be required to have medical clearance from their primary care provider prior to participation. Potential subjects presenting with clinically insignificant laboratory abnormalities will not require medical clearance and will be considered for inclusion in the study Endocrine disorders/dysfunctions (i.e. Type I and II diabetes) Cancer - The explicit definition of cancer used to exclude patients is consistent with that described by the National Cancer Institute (NCI), National Institutes of Health. According to NCI, cancer is any disease in which abnormal cells divide without control and invade nearby tissues (invasive disease). These include carcinomas, sarcomas, leukemias, and lymphomas. Any patient with a history of these invasive diseases will be excluded from the study. Patients who currently use bisphosphonates or have a history of bisphosphonate use will be excluded from the trial HIV+ Metabolic Bone Diseases- Patients with metabolic bone diseases such as Paget's disease, hypercalcemia, moderate to severe vitamin D3 abnormalities or any other metabolic bone disease including osteoporosis and osteoporotic fractures will be excluded Pregnant women- Female patients who are of childbearing potential are excluded except those who are using hormonal or barrier methods of birth control (oral or parenteral contraceptives, diaphragm plus spermicide, or condoms). Pregnancy status will be determined with a urine test and patients who are pregnant will be excluded Patients with acute sinusitis, or presenting any sinus pathology that would contraindicate sinus augmentation Patients with congenital or metabolic bone disorders Current smokers (have smoked within 6 mos. of study onset) Subjects with congenital, or co-morbid conditions that would affect the study outcome or interpretation of study results will be excluded Individuals who have a BMI outside normal limits that deems them overweight (BMI >25) will be excluded due to potential difficulties in locating appropriate surgical entry of the iliac crest during the bone marrow aspiration procedure Long term (>2 weeks) use of antibiotics in the past 3 months Periodontally unstable subjects Subjects having any extractions in the possible treatment area in the past 3 months Subjects that are edentulous
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
William Giannobile, DDS, DMedSc
Organizational Affiliation
University of Michigan
Official's Role
Principal Investigator
Facility Information:
Facility Name
Michigan Center for Oral Health Research
City
Ann Arbor
State/Province
Michigan
ZIP/Postal Code
48106
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
7246093
Citation
Albrektsson T, Branemark PI, Hansson HA, Lindstrom J. Osseointegrated titanium implants. Requirements for ensuring a long-lasting, direct bone-to-implant anchorage in man. Acta Orthop Scand. 1981;52(2):155-70. doi: 10.3109/17453678108991776.
Results Reference
background
PubMed Identifier
5251474
Citation
Amler MH. The time sequence of tissue regeneration in human extraction wounds. Oral Surg Oral Med Oral Pathol. 1969 Mar;27(3):309-18. doi: 10.1016/0030-4220(69)90357-0. No abstract available.
Results Reference
background
PubMed Identifier
10725391
Citation
Colter DC, Class R, DiGirolamo CM, Prockop DJ. Rapid expansion of recycling stem cells in cultures of plastic-adherent cells from human bone marrow. Proc Natl Acad Sci U S A. 2000 Mar 28;97(7):3213-8. doi: 10.1073/pnas.97.7.3213.
Results Reference
background
PubMed Identifier
10759420
Citation
Krebsbach PH, Kuznetsov SA, Bianco P, Robey PG. Bone marrow stromal cells: characterization and clinical application. Crit Rev Oral Biol Med. 1999;10(2):165-81. doi: 10.1177/10454411990100020401.
Results Reference
background
PubMed Identifier
11425250
Citation
Kaigler D, Mooney D. Tissue engineering's impact on dentistry. J Dent Educ. 2001 May;65(5):456-62.
Results Reference
background
PubMed Identifier
16763200
Citation
Mankani MH, Kuznetsov SA, Wolfe RM, Marshall GW, Robey PG. In vivo bone formation by human bone marrow stromal cells: reconstruction of the mouse calvarium and mandible. Stem Cells. 2006 Sep;24(9):2140-9. doi: 10.1634/stemcells.2005-0567. Epub 2006 Jun 8.
Results Reference
background
PubMed Identifier
15998216
Citation
Marei MK, Nouh SR, Saad MM, Ismail NS. Preservation and regeneration of alveolar bone by tissue-engineered implants. Tissue Eng. 2005 May-Jun;11(5-6):751-67. doi: 10.1089/ten.2005.11.751.
Results Reference
background
PubMed Identifier
16332231
Citation
Nevins M, Giannobile WV, McGuire MK, Kao RT, Mellonig JT, Hinrichs JE, McAllister BS, Murphy KS, McClain PK, Nevins ML, Paquette DW, Han TJ, Reddy MS, Lavin PT, Genco RJ, Lynch SE. Platelet-derived growth factor stimulates bone fill and rate of attachment level gain: results of a large multicenter randomized controlled trial. J Periodontol. 2005 Dec;76(12):2205-15. doi: 10.1902/jop.2005.76.12.2205.
Results Reference
background
PubMed Identifier
5284182
Citation
Atwood DA, Coy WA. Clinical, cephalometric, and densitometric study of reduction of residual ridges. J Prosthet Dent. 1971 Sep;26(3):280-95. doi: 10.1016/0022-3913(71)90070-9. No abstract available.
Results Reference
background
PubMed Identifier
6950085
Citation
Evian CI, Rosenberg ES, Coslet JG, Corn H. The osteogenic activity of bone removed from healing extraction sockets in humans. J Periodontol. 1982 Feb;53(2):81-5. doi: 10.1902/jop.1982.53.2.81.
Results Reference
background
PubMed Identifier
350596
Citation
Friedenstein AJ, Ivanov-Smolenski AA, Chajlakjan RK, Gorskaya UF, Kuralesova AI, Latzinik NW, Gerasimow UW. Origin of bone marrow stromal mechanocytes in radiochimeras and heterotopic transplants. Exp Hematol. 1978 May;6(5):440-4.
Results Reference
background
PubMed Identifier
25652112
Citation
Kaigler D, Avila-Ortiz G, Travan S, Taut AD, Padial-Molina M, Rudek I, Wang F, Lanis A, Giannobile WV. Bone Engineering of Maxillary Sinus Bone Deficiencies Using Enriched CD90+ Stem Cell Therapy: A Randomized Clinical Trial. J Bone Miner Res. 2015 Jul;30(7):1206-16. doi: 10.1002/jbmr.2464.
Results Reference
result
Links:
URL
http://www.umengage.org
Description
University of Michigan Clinical Research Database homepage

Learn more about this trial

Bone Tissue Engineering Using Autologous Bone Repair Cell (BRC) Therapy for Sinus Floor Bone Augmentation

We'll reach out to this number within 24 hrs