# Examination of the Quality of Particulate and Filtered
## 4 Discussion
Since it is not possible to obtain oral grafting material without bacterial contamination, a pre-surgical antibiotic treatment seems to be recommendable [27; 28; 34; 38; 53; 54]. The cytotoxic or cytostatic effect of Clindamycin on primary human osteoblasts observed by [PERSON] and coworkers might be reduced by choosing an alternative antibiotic, e.g., Ciprofloxacin. Beyond this, using antibiotic-supplemented bone grafts or rinsing the bone chips with a solution of antibiotics must be considered carefully [27; 28; 55; 56]. [PERSON] and colleagues reported that high concentration of Gentamicin inhibited proliferation of osteoblast-like cells in vitro while Rifampicin was shown to be harmful on osteoblasts and bone tissue [57; 58]. Other studies investigating the effect of three antimicrobials showed also cytotoxicity on gingival MSCs [59]. In conclusion, high local antibiotic doses should be avoided and further investigations to define the best antibiotic, or combination of antibiotics, in in combination of utilizing stem cells for bone built-up in implantation are required. Taken together, stem cells isolated from the medical waste of various dental tissues can be differentiated into multiple cell types. They can also be used to generate cell lines and iPSCs for long-term in vitro research [12]. In clinical studies the stability of dental implantsusing pre-osteoblasts from autogenic MSCs or xenogeneic grafts showed promising results. [PERSON] and colleagues evaluated the effect of transplantation of precultured preosteoblasts for experimental sinus floor augmentation on primary dental implant stability in comparison with conventional augmentation procedures in rabbits and revealed an enhanced primary stability of implants with experimental maxillary sinus floor augmentation with precultured osteoblast precursor cells from autogenic stems cells [60]. [PERSON] et al. focused on volumetric stability of autologous and xenogeneic block grafts and primary stability of implants in maxillary grafted areas. They showed that xenogeneic block grafts are a suitable alternative to reconstruct horizontal defects in the alveolar ridge that had undergone extensive resorption [61]. Next to clinician's skills and surgery methods on the implant site preparation, which may also have an impact on the stability of implants, the use of different scaffold materials is steadily emerging and shows improving cell adhesion, growth and differentiation [62; 63; 64]. Thus, the question arises which bone chips are best for these investigations and consecutive treatments. With respect to the outgrowth time point of ectomesenchymal stem cells, cortical-cancellous bone chips are superior compared to those of cortical sources. Yet, cortical bone chips showed a comparable osteogenic differentiation potential and are known to be more stable against resorption under clinical conditions. Pre-operative antibiotic treatment of patients reduced the microbial contamination of the collected bone chip material without influencing its viability and increased the outgrowth success. Taken together, particulate and filtered mandibular bone chips are a useful grafting material in dental implantology. Conceptualization, E.T. and P.B. ; methodology, P.B. ; formal analysis, C.O. ; investigation, P.B., C.K. and A.P. ; resources, M.W. ; writing--original draft preparation, P.B. ; writing--review and editing, E.T. ; visualization, P.B. ; supervision, E.T. ; project administration, E.T. ; funding acquisition, E.T. All authors have read and agreed to the published version of the manuscript. This research was funded by AdiPaD, BMBF-AiF, FKZ: 1720X06; Gerateprogramm, Fachhochschulen 2008 and 2009; HybridKEM, FKZ: 13 FH569 IX6. The study was conducted according to the guidelines of the Declaration of Helsinki. The study protocol was accepted by the Ethics Committee of the University of Bonn (reference number 209/04). All patients gave their informed consent before taking part in the study. Written informed consent had been obtained from the patient(s) to publish this paper.