Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Stem Cells. Feb 26, 2019; 11(2): 124-146
Published online Feb 26, 2019. doi: 10.4252/wjsc.v11.i2.124
Improved guided bone regeneration by combined application of unmodified, fresh autologous adipose derived regenerative cells and plasma rich in growth factors: A first-in-human case report and literature review
Önder Solakoglu, Werner Götz, Maren C Kiessling, Christopher Alt, Christoph Schmitz, Eckhard U Alt
Önder Solakoglu, External Visiting Lecturer, Dental Department of the University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
Önder Solakoglu, Clinic for Periodontology and Implantology, Hamburg 22453, Germany
Werner Götz, Department of Orthodontics, Center of Dento-Maxillo-Facial Medicine, University of Bonn, Bonn 53111, Germany
Maren C Kiessling, Christoph Schmitz, Institute of Anatomy, Faculty of Medicine, LMU Munich, Munich 80336, Germany
Christopher Alt, Eckhard U Alt, InGeneron GmbH, Munich 80331, Germany
Eckhard U Alt, InGeneron, Inc., Houston, TX 77054, United States
Eckhard U Alt, Isar Klinikum Munich, 80331 Munich, Germany
Author contributions: Solakoglu Ö, Götz W, Alt C, and Alt EU designed the report; Solakoglu Ö and Götz W collected the patient’s clinical data; Solakoglu Ö, Götz W, Kiessling MC, Alt C, Schmitz C, and Alt EU analyzed the data and wrote the paper.
Informed consent statement: Consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors have no conflicts of interest to report.
Open-Access: This article is an open-access article that 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:
Corresponding author: Önder Solakoglu, DDS, MSc, PhD, Adjunct Professor, Clinic for Periodontology and Implantology, Groß Borsteler Str. 9, Hamburg 22453, Germany.
Telephone: +49-40-515050 Fax: +49-40-53997289
Received: October 9, 2018
Peer-review started: October 9, 2018
First decision: November 14, 2018
Revised: December 7, 2018
Accepted: January 10, 2019
Article in press: January 11, 2019
Published online: February 26, 2019

Novel strategies are needed for improving guided bone regeneration (GBR) in oral surgery prior to implant placement, particularly in maxillary sinus augmentation (GBR-MSA) and in lateral alveolar ridge augmentation (LRA). This study tested the hypothesis that the combination of freshly isolated, unmodified autologous adipose-derived regenerative cells (UA-ADRCs), fraction 2 of plasma rich in growth factors (PRGF-2) and an osteoinductive scaffold (OIS) (UA-ADRC/PRGF-2/OIS) is superior to the combination of PRGF-2 and the same OIS alone (PRGF-2/OIS) in GBR-MSA/LRA.


A 79-year-old patient was treated with a bilateral external sinus lift procedure as well as a bilateral lateral alveolar ridge augmentation. GBR-MSA/LRA was performed with UA-ADRC/PRGF-2/OIS on the right side, and with PRGF-2/OIS on the left side. Biopsies were collected at 6 wk and 34 wk after GBR-MSA/LRA. At the latter time point implants were placed. Radiographs (32 mo follow-up time) demonstrated excellent bone healing. No radiological or histological signs of inflammation were observed. Detailed histologic, histomorphometric, and immunohistochemical analysis of the biopsies evidenced that UA-ADRC/PRGF-2/OIS resulted in better and faster bone regeneration than PRGF-2/OIS.


GBR-MSA with UA-ADRCs, PRGF-2, and an OIS shows effectiveness without adverse effects.

Keywords: Case report, Cell-based therapy, Guided bone regeneration, Maxillary sinus augmentation, Lateral alveolar ridge augmentation, Unmodified autologous adipose-derived regenerative cells, Stem cells

Core tip: Novel strategies are needed in oral surgery for improving guided bone regeneration in maxillary sinus augmentation prior to implant placement. We demonstrate that the combination of freshly isolated, unmodified autologous adipose-derived regenerative cells, fraction 2 of plasma rich in growth factors and an osteoinductive scaffold is superior to the combination of fraction 2 of plasma rich in growth factors and the same osteoinductive scaffold alone. This novel procedure may contribute to a decreased healing period and increased bone quality in rehabilitation of the edentulous posterior maxilla as well as in other regenerative techniques in pre-implant bone augmentation procedures.