Ability of bone graft substitutes to support the osteoprogenitor cells: An in-vitro study

AIM: To compare seven commercially available bone graft substitutes(BGS) in terms of these properties and without using any additional biological growth factors.METHODS: Porcine osteoprogenitor cells were loaded on seven commercially available BGS and allowed to proliferate for one week followed by osteogenic induction. Staining for live/dead cells as well as scanning electron microscopy(SEM) was carried out to determine viability and cellular binding. Further outcome measures included alkaline phosphatase(ALP) assays with normalisation for DNA content to quantify osteogenic potential. Negative and positive control experiments were carried out in parallel to validate the results.RESULTS: Live/dead and SEM imaging showed higher viability and attachment with β-tricalcium phosphate(β-TCP) than with other BGS(P < 0.05). The average ALP activity in nmol/mL(normalised value for DNA content in nmol/μg DNA) per sample was 657.58(132.03) for β-TCP, 36.22(unable to normalise) for calcium sulphate, 19.93(11.39) for the Hydroxyapatite/Tricalcium Phosphate composite, 14.79(18.53) for polygraft, 13.98(8.15) for the highly porous β-Tricalcium Phosphate, 5.56(10.0) for polymers, and 3.82(3.8) for Hydroxyapatite.CONCLUSION: Under the above experimental conditions, β-TCP was able to maintain better the viability of osteoprogenitor cells and allow proliferation and differentiation(P < 0.05).

Bone graft substitutes for spine fusion: A brief review

Bone graft substitutes are widely used in the field of orthopedics and are extensively used to promote vertebral fusion. Fusion is the most common technique in spine surgery and is used to treat morbidities and relieve discomfort. Allograft and autograft bone substitutes are currently the most commonly used bone grafts to promote fusion. These approaches pose limitations and present complications to the patient. Numerous alternative bone graft substitutes are on the market or have been developed and proposed for application. These options have attempted to promote spine fusion by enhancing osteogenic properties. In this review, we reviewed biology of spine fusion and the current advances in biomedical materials and biological strategies for application in surgical spine fusion. Our findings illustrate that, while many bone graft substitutes perform well as bone graft extenders, only osteoinductive proteins(recombinant bone morphogenetic proteins-2 and osteogenic protein-1) provide evidence for use as both bone enhancers and bone substitutes for specific types of spinal fusion. Tissue engineered hydrogels, synthetic polymer composites and viral based gene therapy also holds the potential to be used for spine fusion in future, though warrants further investigation to be used in clinical practice.

A Study on the Meat and Bone Meal or Poultry By-product Meal as Protein Substitutes of Fishmeal in Concentrated Diets for Paralichthys olivaceus

A study was conducted to evaluate the effects of meat and bone meal （MBM） and poultry by-product meal （PBM） as the replacement of fishmeal in the diets on the growth performance, survival and apparent digestibility coefficient （ADC） of Japanese flounder （Paralichthys olivaceus）. The experimental diets included 0%, 20%, 40%, 60% and 80% MBM or PBM replacement of total fishmeal respectively. All diets were iso-nitrogenous and isocaloric. The results showed that there are no significant differences （P 〉0.05） in growth performance among the treatments fed with 0% -60% MBM replacement of fishmeal, while the percent weight gain （WG, % ）, body length gain （BLG, % ） and ADC significantly decrease when fishmeal is replaced by 80% MBM. The result showed also that there are no significant differences （P 〉0.05） in growth performance and ADC among all treatments fed with the diets with 0% -80% replacements of fishmeal with PBM.

Creep-Recovery and Relaxation Behavior of High Density Polyethylene/Hydroxyapatite Nano Particles for Bone Substitutes: Effects of Gamma Radiation

The following article has been retracted due to the fact that it cannot be accepted by the author as a journal publication. The Editorial Board takes a very strong respect to the author’s situation on this matter. This paper published in Journal of Biosciences and Medicines Vol.2 No.2, April 2014, has been removed from this site.

A Study on the Meat and Bone Meal and Poultry By-product Meal as Protein Substitutes of Fish Meal in Practical Diets for Litopenaeus vannamei Juveniles

A study was conducted to evaluate the effects of meat and bone meal (MBM) and poultry by-product meal (PBM) as the replacement of fish meal in the diets on the growth performance, survival and apparent digestibility coefficients (ADC) of Litopenaeus vannamei. The basal diets were formulated with 22% fish meal and other ingredients which provided about 40% protein and 9% lipid in the diet. The experimental diets included MBM or PBM to replace 0, 20%, 40%, 60% and 80% of total fish meal respectively. All diets were iso-nitrogenous and isocaloric in gross terms. The results showed that there were no significant differences (P>0.05) in growth performance and ADC among the treatments fed with the diets in which 0-60% fish meal had been replaced with MBM, while the percent weight gain (WG, %), body length gain (BLG, %) and ADC significantly decreased when the MBM was up to 80% of the fish meal. There were no significant differences (P>0.05) in growth performance and ADC among all the treatments fed with the diets in which 0-80% fish meal had been replaced with PBM.

Engineering of Carbonate Apatite Bone Substitute Based on Composition-Transformation of Gypsum and Calcium Hydroxide

Even though a lot of research has been carried out concerning the preparation of carbonate apatite (CHA), they were related to CHA in the form of powder. In the present study, macroporous CHA bone substitutes were prepared through composition-transformation of gypsum and Ca-hydroxide. Here, we investigated the effect of added Ca-hydroxide to gypsum, carbonation periods, and hydrothermal temperatures for phosphatization to understand the basic principle of composition-transformation of gypsum added Ca-hydroxide to fabricate CHA bone substitutes. The specimens were characterized in terms of chemical and physical properties, such as extent of transformation of macroporous gypsum added Ca-hydroxide into CHA body, type and content of carbonate, and crystal morphology. It was observed that the transformation was faster with higher hydrothermal temperature. However, higher hydrothermal temperature caused de-carbonation phenomena which resulted in the lack of carbonate ions of the product. Moreover, the higher the percentage of Ca-hydroxide added to gypsum, caused the complete transformation of gypsum into CHA to be slower. These findings have been applied to the standard fabrication procedure of carbonate apatite, which in turn will allow scaling up process, and will be provided for biomedical purposes for the Indonesian community.

Demineralized Bone Matrix Fibers plus Allograft Bone for Multilevel Posterolateral Spine Fusion: A Game Changer?

Introduction: While autograft bone is the gold standard for multilevel posterolateral lumbar fusion, bone substitutes and graft extenders such as allograft bone, ceramics and demineralized bone matrix (DBM) have been used to avoid the morbidity and insufficient quantity associated with harvesting autologous bone. The primary objective of this retrospective study was to determine whether, in patients with increased risk of operative nonunion related to multilevel fusion, adding DBM fibers to mineralized bone allograft resulted in better fusion than using allograft alone. The secondary objectives were to evaluate how adding DBM fibers affects functional disability, low back pain, intraoperative blood loss and the nonunion rate. Methods: This retrospective study involved a chart review of consecutive patients who underwent multilevel lumbar spinal fusion and were operated on by a single surgeon. The patients were divided into two groups: 14 patients received mineralized bone allograft (control group) and 14 patients received a combination of mineralized bone allograft and DBM (experimental group). Patients were reviewed at a mean of 16.4 ± 2.2 months after surgery at which point CT scans were analyzed to determine whether fusion had occurred;Oswestry disability index (ODI) and pain were also evaluated. Results: A mean of 5 levels [min 2, max 13] were fused in these patients. Posterolateral fusion as defined by the Lenke classification was not significantly different between groups. The experimental DBM group had a significantly better composite fusion score than the control group (P Discussion: Adding DBM fibers to allograft bone during multilevel posterolateral spinal fusion was safe and produced better composite fusion than using allograft only as an autograft extender.

Minimally Invasive Subpericranial Model: Can It Be Used to Study Bone Substitutes?

Objective: To evaluate the feasibility and effectiveness of a new approach for craniofacial augmentation by a minimally-invasive subpericranial injection. Three commercially available semi-liquid bioceramic bone-grafting materials were examined for this application in a rat model. Material and Methods: Twenty-four adult male rats were randomly assigned to undergo onlay calvarial grafting by subpericranial injection of three semi-liquid bone void fillers: Norian SRS(calcium phosphate), ChronOs InjectTM (porous beta-tricalcium phosphate), or BonePlastharvested after 24 hours to serve as controls. The rest were studied after 16 weeks. The volume fraction of the following parameters was morphometrically measured: new bone, blood vessels, residual bone filler and inflammation. Results: In all study groups (including controls), histological examination demonstrated that bone fillers were successfully delivered to the desired subpericranial space by the percutaneous injection method. New bone formation was evidenced adjacent to the cranial bone in all the study groups. The Norian filler material survived in a significantly higher volume fraction (38.4% ± 6.5%) than the ChronOs filler (18.8% ± 1.6%;P 0.0001) and the BonePlast filler (17.8% ± 1.5%;P 0.0001). New bone was formed in all groups, particularly adjacent to the interface of graft material with native bone but only to minimal extent. Conclusion: This new approach for craniomaxillofacial augmentation was successfully demonstrated in a rat model. The Norian filler (calcium phosphate) demonstrated superior space preservation abilities. This model may be further applied to test new injectable bone substitutes in the craniomaxillofacial area.

Current Concepts in Bone Graft Substitutes

Purpose: Bone grafting is still requested to fill bone defects in traumatology, or after tumor removal, but also in orthopedic surgery for spine, arthroplasty revisions, and osteotomies. Due to the limitations of autografts and allografts, and the progress of biomaterial research, a large number of nonhuman bony scaffolds have been developed including synthetic calcium phosphates and highly processed xenografts. The most important parameters for bone ingrowth are the macroporosity of the scaffold with the suitable biological autologous cells and factors, optimal osteoinductive, osteointegrative and osteoconductive properties can be achieved. Methods and Results: The important factors regulating these properties are discussed in this paper, which also reports preclinical and clinical results obtained with such bone graft substitutes. Conclusions: Among different bone graft substitutes available, the porosity, the accessibility of pores, the internal surface exposed to the biological components of bone repair, are present in highly processed bovine hydroxyapatites. Compared to autografts, allografts and synthetic substitutes, they associate an initial conductivity, and a long term stability suitable for some orthopedic indications.

Evaluation of 4 different bone graft substitutes and autogenous bone grafting in root-end resection osteotomies after retrograde root-filling with Intermediate Restorative Material(IRM):An experimental study in dogs

Purpose: To investigate the periapical tissue response after root end filling with intermediate restorative material (IRM) and filling of the root-end resection bone defects with autogenous bone or a bone graft substitute in comparison to empty controls. Materials and Methods: Vital roots of the second, third and fourth mandibular premolars in six healthy mongrel dogs were apectomized. The root canals were prepared and sealed with IRM following a standardized surgical procedure. The resection bone defects were either filled with autogenous bone (PB) or one of the bone graft substitutes;CERAMENTTM|BONE VOID FILLER, ChronOS?, TigranTM PTG, Easygraft? CLASSIC or left empty. After 120 days the animals were sacrificed and the specimens were analyzed radiologically and histologically. Kruskal-Wallis and Mann-Whitney tests were performed for statistical evaluation. Results: 34 sections were analyzed histologically. The evaluation revealed a variation in the outcome amongst the tested options, regarding reestablishment of the periapical bone healing and inflammatory infiltration in the sections. According to the tested variables, there was no statistical significant difference between the materials when comparing all groups as a whole. When comparing individual materials to each other there was statistical differences among some of the tested materials. Conclusion: The healing outcome after periapical surgery of a five-wall resection defect could not be increased by infill with autogenous bone or bone graft substitutes. The most important factor for the healing outcome in periapical surgery is the quality of the root-end sealing. The healing outcome after some of the tested bone substitutes, might be improved by longer healing time.

Co-delivery of rhBMP-2 and zoledronic acid using calcium sulfate/hydroxyapatite carrier as a bioactive bone substitute to enhance and accelerate spinal fusion

Recombinant human bone morphogenetic protein-2(rhBMP-2)has been FDA-approved for lumbar fusion,but supraphysiologic initial burst release due to suboptimal carrier and late excess bone resorption caused by osteoclast activation have limited its clinical usage.One strategy to mitigate the pro-osteoclast side effect of rhBMP-2 is to give systemic bisphosphonates,but it presents challenges with systemic side effects and low local bioavailability.The aim of this in vivo study was to analyze if posterolateral spinal fusion(PLF)could be improved by utilizing a calcium sulfate/hydroxyapatite(CaS/HA)carrier co-delivering rhBMP-2 and zoledronic acid(ZA).Six groups were allocated(CaS/HA,CaS/HA+BMP-2,CaS/HA+systemic ZA,CaS/HA+local ZA,CaS/HA+BMP-2+systemic ZA,and CaS/HA+BMP-2+local ZA).10-week-old male Wistar rats,were randomly assigned to undergo L4-L5 PLF with implantation of group-dependent scaffolds.At 3 and 6 weeks,the animals were euthanized for radiography,μCT,histological staining,or biomechanical testing to evaluate spinal fusion.The results demonstrated that the CaS/HA biomaterial alone or in combination with local or systemic ZA didn’t support PLF.However,the delivery of rhBMP-2 significantly promoted PLF.Combining systemic ZA with rhBMP-2 didn’t enhance spinal fusion.Notably,the co-delivery of rhBMP-2 and ZA using the CaS/HA carrier significantly enhanced and accelerated PLF,without inhibiting systemic bone turnover,and potentially reduced the dose of rhBMP-2.Together,the treatment regimen of CaS/HA biomaterial co-delivering rhBMP-2 and ZA could potentially be a safe and cost-effective off-the-shelf bioactive bone substitute to enhance spinal fusion.

Vancomycin-encapsulated hydrogel loaded microarc-oxidized 3D-printed porous Ti6Al4V implant for infected bone defects:Reconstruction,anti-infection,and osseointegration

Infected bone defect is a formidable clinical challenge.Conventional approaches to prevention and treatment for infected bone defects are unsatisfactory.The key elements of the treatment are bone defect reconstruction,antiinfection,and osteogenesis.Conventional treatment methods remain unsatisfactory owing to the absence of composite integrating materials with anti-infective,and osteogenic activities as well as proper mechanical strength at the same time.In this study,we fabricated a vancomycin-encapsulated hydrogel with bacteriaresponsive release properties combined with a shaved porous(submicron-micron)three-dimensional-printed Ti6Al4V implant.The implant surface,modified with submicron-sized pores through microarc oxidation(MAO),showed enhanced osteogenic activity and integrated well with the hydrogel drug release system,enabling sustained vancomycin release.In vitro experiments underscored the commendable antibacterial ability,biosafety,and osteoinductive potential.Effective antibacterial and osteogenic abilities of the implant were further demonstrated in vivo in infected rabbit bone defects.These results showed that the vancomycinencapsulated hydrogel-loaded microarc-oxidized 3D-printed porous Ti6Al4V can repair the infected bone defects with satisfactory anti-infection and osseointegration effects.

自体骨移植与骨替代物手术治疗胫骨平台骨折的Meta分析

目的:通过Meta分析系统评价自体骨移植和骨替代物治疗胫骨平台骨折的临床疗效。方法:计算机检索2005年1月至2022年8月PubMed、Web of Science、中国知网、万方等数据库已发表的关于自体骨移植和骨替代物治疗胫骨平台骨折的病例对照研究文献。根据纳排标准进行文献筛选及数据提取,对入选的随机对照研究(randomized controlled trial,RCT)采用Cochrane手册中的干预性Meta分析标准进行质量评价。采用RevMan 5.3软件对两种方法的关节凹陷、关节面二次塌陷率、失血量、手术时间和感染率进行Meta分析。结果:共纳入7项RCT研究,424例患者,其中骨替代物组296例,自体骨移植组128例。两组手术时间[MD=-16.79,95%CI(-25.72,-7.85),P=0.0002],出血量[MD=-70.49,95%CI(-79.34,-61.65),P<0.00001]比较,差异有统计学意义。而关节凹陷[MD=-0.17,95%CI(-0.91,0.58),P=0.66],关节面二次塌陷率[RR=-0.74,95%CI(0.35,1.57),P=0.43],感染率[RR=1.21,95%CI(0.31,4.70),P=0.78]比较,差异无统计学意义。结论:骨替代物与自体骨移植治疗胫骨平台骨折在关节凹陷、关节面二次塌陷率和感染率方面疗效相近。但骨替代物较自体骨移植,能减少失血量,缩短手术时间。

生物可降解镁基材料在颅颌面外科的应用及其研究进展

作为一种新型骨植入材料,生物可降解镁基材料在颅颌面外科显示出广阔的应用前景。与传统骨植入材料相比,镁具有良好的降解特性、生物相容性、力学特性和成骨特性,其降解产物镁离子具有抗凋亡、抗炎的作用,能够促进骨折和骨缺损部位的愈合。多项研究将生物可降解镁基材料应用于颅颌面部骨内固定、引导骨再生技术、骨替代材料、药物负载、种植体表面涂层等领域,其结果显示该类材料能够为骨愈合提供稳定的支持,并发挥出良好的促进成骨作用。此外,镁在口腔其他领域,如牙组织工程、促进软组织愈合等方面也表现出应用潜能,显示出生物可降解镁基材料具有重要的研究价值。

富血小板纤维蛋白联合Bio-Oss骨粉修复颌骨囊肿术后骨缺损的疗效

目的:观察使用富血小板纤维蛋白(platelet-rich fibrin,PRF)联合Bio-Oss骨粉修复颌骨囊肿术后骨缺损的临床疗效。方法:选取颌骨囊肿术后存在一定大小范围的骨缺损病人共36例作为研究对象,随机分为2组,各18例。对照组病人单纯使用Bio-Oss充填修复骨缺损;观察组病人使用PRF联合Bio-Oss充填颌骨囊肿造成的骨缺损空腔。所有病人术后分别于3、6、12个月进行定期随访观察,通过CBCT影像学检查测量骨密度值评估临床疗效。结果:观察组颌骨囊肿术后伤口愈合良好,对照组有1例术后7 d创口出现轻度糜烂红肿,未见充填材料排异反应。影像学检查显示观察组较对照组病人颌骨缺损空腔内的充填材料随着时间推移与新生骨及周围骨组织生长良好,能够达到临床满意的骨组织修复效果。观察组术后3、6、12个月骨缺损区骨密度均高于对照组,差异均有统计学意义(P<0.05~P<0.01)。结论:PRF联合Bio-Oss骨粉可有效提高颌骨囊肿术后骨缺损的成骨疗效。

浓缩生长因子联合骨替代材料在上颌窦侧壁开窗提升术中的临床应用

目的探讨浓缩生长因子联合骨替代材料在上颌窦侧壁开窗提升术中的临床疗效。方法收集2020年9月—2021年12月30例上颌后牙缺失伴垂直骨高度不足的病例,采用上颌窦侧壁开窗提升术联合浓缩生长因子与骨替代材料进行骨增量并即刻或延期植入种植体30颗,平均随访时间(12±2.5)个月,观察术后6~8个月获得的牙槽骨高度及垂直骨高度吸收的百分比。结果术后所有种植体均取得了良好的临床效果。种植体骨结合良好,术后6~8个月上颌窦提升获得的垂直骨高度为(8.81±0.76)mm,垂直高度吸收的百分比为6.3%±0.6%。结论浓缩生长因子联合骨替代材料在上颌窦侧壁开窗提升术中获得良好的短期疗效,但长期效果需要进一步随访观察。

硫化铜/氧化石墨烯/壳聚糖/纳米羟基磷灰石复合材料的抗菌及促成骨作用

目的探讨硫化铜(CuS)/氧化石墨烯(GO)/壳聚糖(CS)/纳米羟基磷灰石(nHA)复合材料(CGCHs)的抗菌和促成骨作用及其作用机制。方法采用水热法合成CuS/GO纳米颗粒,通过原位沉淀法合成CS/nHA支架和CGCHs支架,检测材料表征、光热转换性能和生物安全性,评估CGCHs组和近红外光(NIR)照射下CGCHs(CGCHs+NIR)组的细菌抑制效果及其对细菌生物膜相关基因表达的影响,观察CGCHs和CS/nHA不同材料组的促成骨分化和成骨、破骨相关基因表达。结果CGCHs是具有高度孔隙率的三维支架,在CuS/GO浓度为200μg/mL时CGCHs同时兼具良好的红外升温效果和生物安全性。琼脂糖平板涂菌和细菌死活染色结果均表明CGCHs+NIR组抗菌性能最佳,生物膜相关基因qPCR检测证实其具有抑制细菌生物膜相关基因表达的作用。茜素红染色结果表明CGCHs具有良好的体外促成骨性能,体外共培养3、7、14、21和28 d qPCR结果表明CGCHs对成骨早期和晚期相关基因表达均具有促进作用。与破骨细胞共培养结果可观察到CGCHs具有抑制破骨细胞形成的作用,细胞凋亡检测结果进一步验证这一结论,破骨分化相关基因qPCR检测结果表明,CGCHs主要通过抑制抗酒石酸酸性磷酸酶、组织蛋白酶K、CTR、P65和P38在共培养7、14 d的表达来抑制破骨细胞的分化。结论作为纳米复合材料,CGCHs生物安全性好,具有良好的红外光热协同抗菌作用,在促成骨分化的同时抑制破骨细胞分化,有望为感染性骨缺损治疗提供新的思路。

Efficacy of bone grafts in jaw cystic lesions:A systematic review

BACKGROUND Bone grafts have been applied for many years in orthopedic surgery to assist with bone repair for defects or bone discontinuity caused by trauma and tumors as well as periodontal defects.Jaw cysts are another common benign disease of the maxillofacial region which may lead to pathological bone fracture,loss of teeth,and infection.However,whether bone grafts are beneficial for bone regeneration in jaw cystic lesions and when bone grafts should be used remains unclear.AIM To study the efficacy of bone grafts compared to spontaneous healing in the treatment of jaw cystic lesions.METHODS A literature search was performed in Medline,Cochrane Library and Embase to identify related articles published in English in the last ten years.The following key words and Me SH terms were used:“jaw cyst”,“cystic lesion”,“odontogenic cyst”,“periapical cyst”,“dentigerous cyst”,“follicular cyst”,“keratocyst”,“treatment”,“surgery”,“bone graft”,“enucleation”,“cystectomy”,and“bone regeneration”.Case reports,clinical trials,clinical studies,observational studies and randomized controlled trials were included.Study quality was evaluated.RESULTS Ten studies(n=10)met the inclusion criteria.Five studies reported spontaneous bone healing after enucleation,three studies investigated the efficacy of various bone grafts,and two randomized comparative studies focused on the comparison between spontaneous healing and bone grafting.Over 90%of bone regeneration occurred within 6 mo after bone grafting.The bone regeneration rate after cystectomy showed great variation,ranging from 50%to 100%after 6 mo,but reaching over 90%after 12 mo.CONCLUSION While the long-term superiority of bone grafting compared with spontaneous healing after cystectomy is unclear,bone grafts accelerate the process of healing and significantly increase bone quality.

A Comparable Study of Combinational Regenerative Therapies Comprising Enamel Matrix Derivative plus Deproteinized Bovine Bone Mineral with or without Collagen Membrane in Periodontitis Patients with Intrabony Defects

Aim: The aim of the present study was to examine the effectiveness of collagen membrane (CM) in regenerative therapy with deproteinized bovine bone mineral (DBBM) and enamel matrix derivative (EMD) for periodontal intrabony defects. Methods: Eighteen periodontal intrabony defects of nine chronic periodontitis patients were evaluated. Two defects per patient with probing pocket depth (PPD) ≥ 6 mm were assigned to two different types of treatments: EMD + DBBM + CM or EMD + DBBM. Clinical parameters including Gingival Index (GI), PPD, clinical attachment level (CAL), gingival recession (GR), bleeding on probing (BOP), tooth mobility (MOB), and the filled bone volume/rate (FBV/FBR), which was measured by cone beam computed tomography, were compared at baseline and 12 months post-treatment. Differences between groups were determined by the chisquare test, McNemar’s test, and Wilcoxon signed-rank test. Results: Clinically, PPD, CAL, and FBR significantly improved in both groups (p Conclusion: Periodontal regenerative therapies comprising EMD and DBBM with and without CM resulted in positive clinical outcomes. The use of CM may result in better outcomes in MOB decrease;however, long-term prognosis must be further studied.