Review of Bone Substitutes

Craniomaxillofacial Trauma and Reconstruction 10/2009; 2(3):151-60. DOI: 10.1055/s-0029-1224777
Source: PubMed


Bone substitutes are being increasingly used in craniofacial surgery and craniomaxillofacial trauma. We will review the history of the biomaterials and describe the ideal characteristics of bone substitutes, with a specific emphasis on craniofacial reconstruction. Some of the most commonly used bone substitutes are discussed in more depth, such as calcium phosphate and hydroxyapatite ceramics and cements, bioactive glass, and polymer products. Areas of active research and future directions include tissue engineering, with an increasing emphasis on bioactivity of the implant.

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    • "This process could decelerate bone regeneration in the early stages of restoration, in comparison with autologous bone as graft [9]. However, TCP has a high rate of resorption in vivo [8] due to its porosity and small granule size [31], determinants of nutrients and oxygen diffusion, insertion, migration and differentiation of cells. Handschel et al. [32] reported that although at the early stages of bone healing autologous bone shows a higher total bone volume , over time bone substitutes approach this result, and after 9 months no statistical differences are found between bone grafts. "

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    • "It should be possibly traceable in vivo; to this aim radiolucency is ideal to allow optimal radiographic assessment. Also, the ideal bone substitute should be thermally nonconductive, sterilizable, and readily available at a reasonable cost [12]. "
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    ABSTRACT: Bone substitutes are being increasingly used in surgery as over two millions bone grafting procedures are performed worldwide per year. Autografts still represent the gold standard for bone substitution, though the morbidity and the inherent limited availability are the main limitations. Allografts, i.e. banked bone, are osteoconductive and weakly osteoinductive, though there are still concerns about the residual infective risks, costs and donor availability issues. As an alternative, xenograft substitutes are cheap, but their use provided contrasting results, so far. Ceramic-based synthetic bone substitutes are alternatively based on hydroxyapatite (HA) and tricalcium phosphates, and are widely used in the clinical practice. Indeed, despite being completely resorbable and weaker than cortical bone, they have exhaustively proved to be effective. Biomimetic HAs are the evolution of traditional HA and contains ions (carbonates, Si, Sr, Fl, Mg) that mimic natural HA (biomimetic HA). Injectable cements represent another evolution, enabling mininvasive techniques. Bone morphogenetic proteins (namely BMP2 and 7) are the only bone inducing growth factors approved for human use in spine surgery and for the treatment of tibial nonunion. Demineralized bone matrix and platelet rich plasma did not prove to be effective and their use as bone substitutes remains controversial. Experimental cell-based approaches are considered the best suitable emerging strategies in several regenerative medicine application, including bone regeneration. In some cases, cells have been used as bioactive vehicles delivering osteoinductive genes locally to achieve bone regeneration. In particular, mesenchymal stem cells have been widely exploited for this purpose, being multipotent cells capable of efficient osteogenic potential. Here we intend to review and update the alternative available techniques used for bone fusion, along with some hints on the advancements achieved through the experimental research in this field.
    Journal of Materials Science Materials in Medicine 05/2014; 25(10). DOI:10.1007/s10856-014-5240-2 · 2.59 Impact Factor
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    • "The authors will consider histological and morphometric assessment of graft remodeling when planning further studies on radiation-sterilized allogeneic bone grafts. Demineralized, irradiated bone, which does not tolerate axial loading, was used for sinus-lift and postextraction alveoli augmentation procedures at lowstress areas (Krasny et al. 2011; Kao and Scott 2007; Hardin 1994). Allogeneic irradiated frozen bone blocks, that possess similar properties as autologous ones, were used for reconstruction of alveolar processes . "
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    ABSTRACT: Bone grafting allows reconstruction of the atrophied or destroyed alveolar process. In orthopaedics and traumatology allogeneic grafting has been used to restore defects of osseous tissue for over 60 years. In order to improve safety of the graft recipient, sterilized allogeneic grafts have been use. The aim of the study was to assess the direct and long-term outcomes following augmentation of atrophied alveolar processes with the use of radiation-sterilized allogeneic bone grafts. Sixty-eight patients were surgically treated between 2004 and 2011: 29 underwent open sinus floor elevation, post-extraction alveoli augmentation was performed in 16 subjects and 23 underwent reconstruction of the atrophied alveolar process. Augmentation of bone defects used bone granulate in 63 patients and bone blocks stabilized with titanium screws in 5 patients. PRF membranes collected from the patient's blood were also used in all the procedures. In each of the cases optimal dimensions of the alveolar process were obtained allowing embedment of BIOMET 3I dental implant/-s. In all the patients the defects were successfully restored with implant-supported prostheses. Radiation-sterilized allogeneic bone grafts proved to be safe and effective for the patients and manageable for the surgeon constituting a good alternative to autogeneic material.
    Cell and Tissue Banking 12/2012; 14(3). DOI:10.1007/s10561-012-9348-7 · 1.25 Impact Factor
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