The Cell-Multilayered Periosteal Sheet —A Promising Osteogenic and Osteoinductive Grafting Material - New Trends in Tissue Engineering and Regenerative Medicine - page 30

cortical bone particles was faster in bone grafting with CAPCs than in conventional bone
grafting.
Figure 6. CT images of the maxillary sinus constructed from DICOM data before surgery and at 3 months (3M) and 1
year (1Y) after CAPC(+) bone graft or conventional CAPC(-) bone grafting. Color mapping of the images according to
bone density as determined by Hounsfield units (HU) for CT data was applied. In the graft material at 3M, many areas
are depicted in light blue (D1) and blue (D2), which is indicative of autogenous cortical bone particles (A and B).
4.4. Conclusions
In this clinical research into CAPC use in bone augmentation, we investigated the effects of
CAPCs on bone regeneration in patients. Augmentation that is difficult to achieve by conven‐
tional autogenous bone grafting, such as that for building bone in both the directions of height
and width in the alveolar ridge or for performing a sinus lift of ≥15 mm in patients with a less
than 2-mm-thick maxillary sinus floor, are feasible through the application of CAPCs,
regardless of age and sex of the patients. The results of histological and 3D-CT analyses suggest
that grafted CAPCs effectively recruited osteoblasts and osteoclasts, thereby simultaneously
promoting bone formation and remodeling.
The effects of CAPCs in regenerative bone therapy may be exerted via various biological
mechanisms, as illustrated in Figure 7. For instance, CAPCs may serve as the original cell
population that gives rise to osteoblasts for bone matrix formation and to constituent cells of
bone tissue such as vascular endothelial cells, as well as serving as a source of various growth
factors, thereby recruiting and activating osteoclasts.