The Otto Aufranc Award: Demineralized Bone Matrix Around Porous Implants Promotes Rapid Gap Healing and Bone Ingrowth

Division of Orthopaedic Surgery, Faculty of Medicine, McGill University, Montreal, QC, Canada.
Clinical Orthopaedics and Related Research (Impact Factor: 2.77). 08/2011; 470(2):357-65. DOI: 10.1007/s11999-011-2011-y
Source: PubMed


Noncemented revision arthroplasty is often complicated by the presence of bone implant gaps that reduce initial stability and biologic fixation. Demineralized bone matrix has osteoinductive properties and therefore the potential to enhance gap healing and porous implant fixation.
We determined at what times and to what extent demineralized bone matrix promotes gap healing and bone ingrowth around a porous implant.
We inserted porous titanium implants into the proximal metaphyses of canine femora and humeri, with an initial 3-mm gap between host cancellous bone and implants. We left the gaps empty (control; n = 12) or filled them with either demineralized bone matrix (n = 6) or devitalized demineralized bone matrix (negative control; n = 6) and left them in situ for 4 or 12 weeks. We quantified volume healing of the gap with new bone using three-dimensional micro-CT scanning and quantified apposition and ingrowth using backscattered scanning electron microscopy.
The density of bone inside gaps filled with demineralized bone matrix reached 64% and 93% of surrounding bone density by 4 and 12 weeks, respectively. Compared with empty controls and negative controls at 4 and 12 weeks, gap healing using demineralized bone matrix was two to three times greater and bone ingrowth and apposition were up to 15 times greater.
Demineralized bone matrix promotes rapid bone ingrowth and gap healing around porous implants.
Demineralized bone matrix has potential for enhancing implant fixation in revision arthroplasty.

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    • "Histologic evidence of osteoblasts penetrating the surface of the DBM granules denoted the material’s ability to support osteoblastic cell adhesion (21). Results showed that the density of the newly formed bone inside surgically created gaps filled with DBM reached 93% of native bone density after 12 weeks (22). Moreover radiographic evidence of new bone formation after using injectable DBM during sinus elevation surgery was seen following a 6 months healing period (23). "
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    ABSTRACT: To evaluate the effectiveness of beta tricalcium phosphate (β-TCP) alone compared to β-TCP and Demineralized Bone Matrix (DBM) in regenerating localized horizontal maxillary alveolar ridge deficiencies prior to implant placement. The study included 20 patients with horizontal maxillary ridge deficiencies limited to one or more neighbouring teeth and initial ridge width of ≤ 5mmm. Patients were divided equally into two equal groups. Ridge augmentation was performed using Guided Bone Regeneration (GBR) principals. In group I GBR was performed using β-TCP only, while in group II both β-TCP and DBM were used. Following a 6 months healing period, bone cores from both groups were retrieved and implants were inserted. Specimens were examined histologically to calculate percentage of mineralized bone. Apical and crestal changes in ridge dimensions were calculated by digital subtraction using Cone Beam Computed Tomography (CBCT) immediately after graft placement and six months later. There was a statistically significant difference between the mean area percentage of mineralized bone between both groups where it was 40.1 % (range: 27.76-% 66.29 %) for group I and 68.96 % (range: 60.07 % - 87.33 %) for group II. Radiograpically, the mean ridge width in group I increased crestally to 4.66 mm (range:3.5-5mm) and apically to 6.12 mm (range: 4.1-6.7 mm). In group II the mean ridge width increased crestally to 5.2 mm (range 4.9-5.4mm) and apically to 6.9 mm (range 6.0-7.8 mm). Group II showed more bone gain with a mean of 1.37 mm crestally and 2.44 mm apically. This difference however was not statistically significant Conclusion: Within the limitations of this study the combination of DBM and β-TCP can be used effectively in cases exhibiting minimal alveolar ridge defects. Key words:Guided bone regeneration, equine bone, alloplast, bone graft.
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    • "After 6 weeks, biomechanical results were better than autologous bone grafts (Bigham et al. 2008). Also Lim et al. evaluated DBM in gaps left around an implant in canine femur and humorous, and found that density of bone inside gaps filled with DBM reached 93% of surrounding bone density by 12 weeks (Lim et al. 2011). In another survey, using type I mineralized collagen matrix combined with autologous bone marrow in fracture site, biomechanically, showed stability after 15 months (Faundez et al. 2006). "
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    ABSTRACT: Regaining adequate bone strength, in bone loss, is one of the main purposes for new bone regeneration in bone tissue engineering. Biomechanical hardness test can be one approach to assay bone consistency in new bone formation. In addition, following up the serum alkaline phosphatase (ALP) alterations may help us in order to evaluate bone formation activity. In the current research, two groups of five male white New Zealand rabbits were studied. Two defects, 8 mm in diameter each, were made in each rabbit calvarium, one defect was filled with either human pericardial collagen (HPM) or demineralized bone matrix (DBM), and the other one was left empty as control. Every 10 days post-surgery, the serum ALP level was assessed, for 60 days. After performing euthanasia on day 60, the specimens were sent for biomechanical hardness test. The results for the DBM containing group were better than the HPM containing group in both biomechanical and biochemical tests. However, they were not statistically significant (p > 0. 05). In the biomechanical test, all the experimental groups, in both DBM and HPM, had significantly more hardness than the control (p < 0. 05). DBM is a current and well-known graft used in bone regeneration. Since, there was no significant difference between HPM and DBM on one hand, and the superiority of the HPM experimental group in the biomechanical test to the control on the other hand, HPM might be considered as a suitable graft in bone repair leading to acceptable bone strength.
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