An evaluation of two configurations of tricalcium phosphate for treating craniotomies

Porous biphasic calcium phosphate ceramics coated with nano-hydroxyapatite and seeded with mesenchymal stem cells for reconstruction of radius segmental defects in rabbits

The osteoconduction of porous biphasic calcium phosphate (BCP) ceramics has been widely reported. In a previous study, we demonstrated that applying a nano-hydroxyapatite (nHA) coating enhances the osteoinductive potential of BCP ceramics, making these scaffolds more suitable for bone tissue engineering applications. The aim of the present study was to determine the effects of reconstructing radius defects in rabbits using nHA-coated BCP ceramics seeded with mesenchymal stem cells (MSCs) and to compare the bone regeneration induced by different scaffolds. Radius defects were created in 20 New Zealand rabbits, which were divided into four groups by treatment: porous BCP ceramics (Group A), nHA-coated porous BCP ceramics (Group B), porous BCP ceramics seeded with rabbit MSCs (Group C), and nHA-coated porous BCP ceramics seeded with rabbit MSCs (Group D). After in vitro incubation, the cell/scaffold complexes were implanted into the defects. Twelve weeks after implantation, the specimens were examined macroscopically and histologically. Both the nHA coating and seeding with MSCs enhanced the formation of new bone tissue in the BCP ceramics, though the osteoinductive potential of the scaffolds with MSCs was greater than that of the nHA-coated scaffolds. Notably, the combination of nHA coating and MSCs significantly improved the bone regeneration capability of the BCP ceramics. Thus, MSCs seeded into porous BCP ceramics coated with nHA may be an effective bone substitute to reconstruct bone defects in the clinic.

Critical size defects for bone regeneration experiments in rabbit calvariae: systematic review and quality evaluation using ARRIVE guidelines

OBJECTIVES

To perform a systematic review of studies that report the healing of critical size defects (CSDs) in rabbit calvaria and to determine the quality of the studies according to ARRIVE guidelines.

MATERIALS AND METHODS

An Internet search was made in duplicate between December 2011 and August 2013 using MEDLINE, PubMed and Google Scholar (without restrictions on date of publication) for rabbit studies reporting the healing of CSD in the calvaria. Animal Research Reporting in Vivo Experiment (ARRIVE) guidelines (a list of 20 aspects to score and to ensure comparison between different experimental studies in animals) were used to evaluate the quality of the selected works.

RESULTS

Twenty-five manuscripts were evaluated. Case-control studies predominated (92.59%). Animal age was not stated in 70.37% of the studies; weight was not reported in 29.62%; most animals weighed 3.5 kg (26.31%). A CSD dimension of 15 mm was common (51.61%), generally located centrally (51.85%), followed by bilateral locations (48.14%). Circular (66.66%), rectangular (14.81%), square (14.81%) and ovoid (1.48%) geometries were used. Histomorphometric data showed incomplete healing in all CSDs and higher percentages of healing in smaller defects (<10 mm). The longer the healing time allowed, the more bone healing took place, for both smaller and larger defects (>15 mm). Minimum quality grades were assigned to ARRIVE items study design (6), experimental animals (8), housing and husbandry (9), sample size (10), allocation (11), statistics (13), results-baseline data (14), numbers analyzed (15), adverse events (17) and funding (20).

CONCLUSIONS

Data on CSDs in rabbit calvariae lack homogeneity. Smaller defects can be considered critical depending on the time of sacrifice. When new diagnostic technologies are used in addition to histomorphometry, these should be applied with caution to facilitate future comparison with other research. The ARRIVE guidelines should be followed in any animal research protocol to improve the homogeneity, comparison and reproducibility between studies.

The rabbit as experimental model for research in implant dentistry and related tissue regeneration

The use of rabbits for experimental research has a long historical tradition. The aim of this review consists in outlining the use of the rabbit for research in implant dentistry and related tissue regeneration. Rabbits appear as a first-hand choice for fundamental implant design studies because of their size, easy handling, short life span, and economical aspects in purchasing and sustaining. In the following, the various anatomical sites in the rabbit will be summarized to provide an overview of current possibilities and limitations of this model for bone research in oral implantology.

Plasma rich in growth factors and bone formation: a radiological and histomorphometric study in New Zealand rabbits

A radiographic and histomorphometric study was conducted on the influence of autologous plasma rich in growth factors (PRGF) upon bone healing in surgically created defects in rabbits. Radiographically, bone regeneration was significantly greater with the use of PRGF after one month (p = 0.005), though no differences were recorded after the second month. In the histomorphometric analysis one month after surgery, the defects filled with autologous bone plus PRGF showed a greater percentage of neoformed bone (35.01 +/- 5.31) than the control defects (22.90 +/- 12.23), though the differences were not significant. Two months after surgery, the defects filled with autologous bone showed greater regeneration (46.04 +/- 10.36%) than the control defects (30.59 +/- 5.69%), though the differences were not significant. The application of PRGF in the bone defects produced in New Zealand rabbits exerted a limited effect on local bone formation.

Closing capacity of cranial bone defects using porous calcium phosphate cement implants in a rabbit animal model

Calcium phosphate (Ca-P) cement is a well established material for bone repair. The bone biological properties of Ca-P cement can even be further improved by creating porosity in the material. The current study aimed on the evaluation of the osteoconductive behavior of porous Ca-P cement. Therefore, circular defects (6, 9, and 15 mm in diameter) were created in the cranium of 3 months old rabbits and filled with porous Ca-P cement implants. The total porosity of implants was calculated to be 71, 74 and 74% respectively and the average pore diameter was 150 microm. In addition, empty control defects were prepared. After 12 weeks implantation time the animals were sacrificed and radiographic, histological, and histomorphometrical evaluation was performed. The Critical Size Defect (CSD) of this species at this location for an implantation time of 12 weeks was confirmed to be 15 mm. Bone was observed to be present over and through almost all porous Ca-P cement implants. Only, in one out of eight animals with a 15 mm implant complete bone bridging of the defect did not occur. The size of the defect was found not to affect the total percentage of bone formation in the cement; (17 +/- 7)%, (18 +/- 6)% and (17 +/- 3)% for respectively 6, 9, and 15 mm diameter implants. We concluded that porous Ca-P cement is an excellent osteoconductive material in non weight bearing situations and complete bridging of a critical sized skull defect occurs in this rabbit model after 12 weeks of implantation.

Validity of radiographic evaluations of bone formation in a rat calvaria osteotomy defect model

OBJECTIVE

The objective of this study was to evaluate the validity of radiographic evaluations of bone formation in a critical-size rat calvaria osteotomy defect model.

METHODS

Bilateral, critical-size ( [symbol in text] 6 mm) calvaria osteotomy defects in 30 adult Sprague-Dawley rats treated with a rat platelet-rich plasma preparation or control treatments were evaluated by radiographic and histometric measures following a 4- or 8-week healing interval. Standardized radiographic images of the rat calvaria gross specimens were used to assess bone formation within the defect sites by visual evaluation of the grey scale by three masked examiners. The most central portion of each defect site was subject to histometric analysis using a PC-based image analysis system. Kappa statistics and percentage agreement between the radiographic and histometric analysis were estimated.

RESULTS

Radiographic evaluations of bone formation are associated with significant weaknesses poorly representing actual healing events; kappa statistics (0.17) denoting slight agreement beyond chance. Perfect agreement between the histologic and radiographic analysis for defect sites showing complete and partial histologic bone fill was achieved 63% and 50% of the time, respectively. Agreement reached only 20% for sites with no/limited bone fill. When no/limited and partial bone fill occurred, the radiographic analysis tended to overestimate bone fill and underestimate bone fill when complete closure of the defect sites was observed in the histologic analysis.

CONCLUSION

Low accuracy was observed when radiographic evaluations were employed in identifying and characterizing bone fill in the rat calvaria osteotomy defects. Assessment of bone healing in animal models aiming at treatment recommendations for clinical application must not solely be based on radiographic analysis, but should be confirmed using histologic observations.

Effects of degradation and porosity on the load bearing properties of model hydroxyapatite bone scaffolds

Degradation of three types of model hydroxyapatite (HA) scaffolds was studied after in vitro degradation in a sodium acetate buffer (pH 4). Degradation was evaluated using compression testing, scanning electron microscopy (SEM), inductively coupled plasma (ICP) analysis, and weight measurements. Scaffolds were fabricated with a solid freeform fabrication (SFF) technique based on the robotic deposition of colloidal pastes. Scaffolds had a macrostructure resembling a lattice of rods. Scaffolds contained either macropores (270 or 680 microm in the x-y direction and 280 microm in the z-direction) and micropores (1-30-microm pores and pores <1 microm) or only macropores pores (270 microm in the x-y direction and 280 microm in the z-direction). A computer-aided design (CAD) program controlled the size and distribution of macropores; micropores were created by polymethylmethacrylate (PMMA) microsphere porogens (1-30-microm pore diameter) and controlled sintering (pores <1 microm). Percent weight loss of the scaffolds and calcium and phosphorus ion concentrations in solution increased as the degradation period increased for all scaffold types. After degradation, compressive strength and compressive modulus decreased significantly for those scaffolds with microporosity. For scaffolds without microporosity, the changes in strength and modulus after degradation were not statistically significant. The compressive strength of scaffolds without microporosity was significantly greater than the scaffolds with microporosity.

Bone inductive properties of rhBMP-2 loaded porous calcium phosphate cement implants inserted at an ectopic site in rabbits

Recombinant human bone morphogenetic protein-2 (rhBMP-2) is known for its osteoinductive potential in bone tissue engineering. Calcium phosphate (Ca-P) cements are injectable, osteoconductive ceramic materials in which a macroporous structure can be induced during the setting reaction. In this study, the osteoinductive capability of rhBMP-2 loaded porous Ca-P cement was evaluated. Porous Ca-P cement discs were made and loaded with rhBMP-2 in vitro and implanted subcutaneously in the back of New Zealand white rabbits. The implantation period was either 2 or 10 weeks. Histological analysis of retrieved specimens revealed evident bone formation in the rhBMP-2 loaded Ca-P cement discs (pore fill: 18+/-6%) after 10 weeks of implantation. Bone formation occurred only in rhBMP-2 loaded porous Ca-P cement discs. Degradation of the Ca-P cement could not be confirmed after 10 weeks of implantation. The scaffold maintained its shape and stability during this time period. We conclude that porous Ca-P cement is a suitable carrier material for ectopic bone engineering.

Bone response to 3D periodic hydroxyapatite scaffolds with and without tailored microporosity to deliver bone morphogenetic protein 2

Three types of model hydroxyapatite (HA) scaffolds were implanted in the metacarpal and metatarsal bones of goats. Scaffolds, consisting of a latticed pattern of rods, were fabricated with a solid freeform fabrication (SFF) technique. All scaffolds contained macropores; some were also fabricated with micropores (5.2 +/- 2.0 microm). Recombinant human bone morphogenetic protein-2 (rhBMP-2) was added to some microporous scaffolds. rhBMP-2 caused increased percent filled with bone tissue compared to microporous scaffolds without rhBMP-2. Lamellar bone in the scaffolds was aligned perpendicular to the long axis of the bone near the junctions of the rods that make up the scaffold but was more random away from the junctions of rods. Microporous scaffolds stained beneath areas of contact with new bone. This staining might indicate either extracellular matrix (ECM) in the rods, byproducts of ECM production, or reaction of cellular products with the scaffold.

An animal evaluation of a paste of chitosan glutamate and hydroxyapatite as a synthetic bone graft material

The objective of this study was to develop a synthetic bone graft in a paste form. Reported here are the results of the evaluation of a paste of chitosan glutamate (Protosan) and hydroxyapatite (referred to as a paste) used in a critical size defect model in rats. Eight-millimeter--diameter cranial defects were made in rat calvaria following a protocol approved by the animal review committee. Five groups were studied: (1) empty control, (2) defect filled with paste only, (3) defect filled with the paste containing bone-marrow aspirate, (4) defect filled with paste containing BMP-2, and (5) defect filled with paste containing osteoblasts cultured from bone-marrow aspirate. The sacrifice intervals were 9 and 18 weeks. Calvaria containing the defect were harvested, and the bone mineral density (BMD) was determined by dual energy X-ray absorptiometry. Push-out strength measurements were also performed. The BMD values of empty control were significantly lower than those of other groups at both 9 and 18 weeks. The mechanical properties, that is, push-out strengths and area under the push-out load and displacement were not significantly different between the samples. Histological examination of Goldner-trichromestained undecalcified sections showed the presence of mineralized bone spicules in the defect areas that were more prominent in those filled with paste and osteoblasts cultured from bone-marrow aspirate. Hence, this study demonstrated that the paste of chitosan glutamate and hydroxyapatite-containing osteoblasts cultured from bone-marrow aspirate would be an effective material to repair bone defects.

Tissue reactions to particles of bone-substitute materials in intraosseous and heterotopic sites in rats: discrimination of osteoinduction, osteocompatibility, and inflammation

Two rat models were used to characterize tissue-specific reactions to particles of bone-substitute materials: one for osteocompatibility in a healing tibial wound and the other in a heterotopic, subcutaneous site. Small, unicortical tibial wounds in rats healed spontaneously, beginning with the rapid proliferation of intramedullary woven bone. That temporary bone was resorbed by osteoclasts and finally, the cortical wound was healed with lamellar bone and the medullary space was repopulated with marrow. When various particulate materials were implanted into fresh wounds, three types of reactions were observed. (1) Demineralized bone powder (DBP) and non-resorbable calcium phosphate (nrCP) were incorporated into the reactive medullary and cortical bone. (2) Polymethylmetlhacrylate (PMMA) particles were surrounded with a fibrous layer, but did not impair bone healing. (3) Polyethylene (PE) shards and resorbable calcium phosphates (rCPs) were inflammatory and inhibited osseous repair. Subcutaneous sites showed osteoinductive, fibrotic, or inflammatory responses to these materials. Only DBP induced endochondral osteogenesis subcutaneously. The nrCP evoked a fibrous reaction. In contrast, rCPs, PMMA, and PE shards generated inflammatory reactions with each particle being surrounded by fibrous tissue and large multinucleated giant cells. In conclusion, only DBP showed osteoinductive as well as osteocompatible properties. The nrCP was osteocompatible. The rCPs stimulated various degrees of inflammatory responses. PMMA was osteocompatible and did not interfere with the bone healing process. PE was not osteocompatible and generated foreign body reactions in both sites. Use of the two sites distinguishes osteoinductive, osteocompatible, and inflammatory properties of particles of bone-substitute materials.

Enhancement of bone regeneration using resorbable ceramics and a polymer-ceramic composite material

The aim of this experimental study was to evaluate the use of resorbable implants for the repair of nonloaded skeletal defects. Porous ceramic implants of alpha-TCP, of glass-ceramic, and of solid composite implants of glass-ceramic/polylactic acid 8 mm in diameter and 2 mm in thickness were fabricated and implanted pressfit into biparietal, full-thickness defects of the calvaria of 60 adult rats. Twenty rats received unfilled defects and served as controls. Fluorochrome labeling of bone formation was performed during the observation period. Five animals from each group were evaluated after 6, 13, 26, and 52 weeks. The control defects showed incomplete regeneration, with bone formation extending 1.66 mm, on average, into the defect after 52 weeks. In the group of alpha-TCP implants, histologic evaluation indicated that the bone formed during initial stages had undergone resorption later on, so that bone repair after 52 weeks was not significantly enhanced, with an average depth of 1.83 mm of bone ingrowth. The glass-ceramic implants exhibited extensive bone formation and nearly complete repair of the calvarial defect, with 3.90 mm of bone ingrowth into the implant pores. Degradation of the ceramic was nearly complete, with a few remaining particles surrounded by soft tissue. The composite implants showed a negligible bone ingrowth of 0.63 mm, on average. Soft tissue had invaded the polylactic acid implant body, but no bone formation had taken place at the surface of the embedded ceramic particles. Degradation of the polymer was not complete after 52 weeks. It is concluded that the balance between degradation and bone formation is delicate and that chemical events and cellular reaction during degradation may counteract complementary bone ingrowth.

Radiomorphometry and biomechanical assessment of recombinant human bone morphogenetic protein 2 and polymer in rabbit radius ostectomy model

The study objective was to determine the mechanical integrity and radiopacity of regenerated bone within critical-sized defects (CSDs) in radii of rabbits using recombinant human bone morphogenetic protein 2 (rhBMP-2) with a porous, biodegradable poly(D,L-lactic acid) (PDLLA) carrier (designated PLA). Twenty millimeter, unilateral radial ostectomies were created in 96 skeletally mature New Zealand white rabbits. The rabbits were randomly assigned to six treatment groups with two euthanasia periods. Treatment groups included unfilled defect (n = 8), segmental autograft (n = 8), PLA + 0 microg rhBMP-2 (n = 8), PLA + 17 microg rhBMP-2 (n = 8), PLA + 35 microg rhBMP-2 (n = 8), and PLA + 70 microg rhBMP-2 (n = 8). The radiopacity was significantly greater for the 35- and 70-microg rhBMP-2 groups at 4 weeks compared to unfilled controls, PLA only, and 17-microg rhBMP-2 groups and equivalent to the autograft. At 8 weeks all groups receiving rhBMP-2 were equivalent to the autograft and significantly greater than unfilled defects and PLA alone. Similarly, the biomechanical analysis indicated significantly greater torque at failure for the 35-microg rhBMP-2 group compared to all other groups at 4 weeks. By 8 weeks all groups receiving rhBMP-2 and autograft had significantly greater torque than unfilled controls and PLA alone. These radiomorphometric and biomechanical results indicate PLA may be a suitable carrier for rhBMP-2 used for skeletal regeneration.

Evaluation of particulate Bioglass in a rabbit radius ostectomy model

Osseous defects and fractures may require supplimentation to support and promote healing. Bioglass (BG) may be a useful therapeutic for these conditions. Therefore, we executed a study to determine whether particulate BG could promote healing of 20-mm unilateral ostectomies in the radius of rabbits. Ostectomies were either treated with BG or remained untreated in the control (CTL) group. At 4 and 8 weeks post-treatment, ostectomies were assessed histomorphometrically and biomechanically. New bone formation was more intense contiguous to the host bone for both BG and CTL than centrally, yet BG animals displayed active mineralization throughout the ostectomy. The amount of bone within BG-filled defects was greater than CTLs at 4 weeks, whereas, at 8 weeks there was no difference. Biomechanically, the BG-treated limbs required more torque to break than did CTL limbs at 4 weeks; however differences were not significantly different. By 8 weeks, the BG-treated and CTLs, had comparable strength. Bioglass may be a useful therapy to produce the early phase of osseous repair. However, improvements in handling properties of the particles will be needed to enhance efficacy.

Reconstruction of calvarial defects by bioresorbable ceramics: an experimental study in rats

This study evaluated bioresorbable ceramics in the reconstruction of calvarial defects. Full-thickness defects were made in the calvaria of 40 adult Sprague-Dawley rats (350-450 g) with a standard 8-mm trephine drill. Three different materials were used for defect repair: (a) pure alpha-tricalcium phosphate (TCP), (b) surface-treated glass ceramic, (c) surface-treated glass ceramic plus 70/30 L/DL polylactic acid (volume ratio 45/55). The implants were pellets of 7.9 mm diameter and 2 mm thickness and were inserted press fit into the calvarial defects. Each of these materials was inserted into ten animals. Five animals were evaluated each after 6 weeks and 26 weeks. For each interval there was a control group of five animals. After 6 weeks the control defects exhibited negligible bone regeneration at the defect margins but showed substantially more bone regeneration after 26 weeks extending up to 2.5 mm into the defect space. The TCP specimens showed a number of multinuclear cells on the material surface and direct bone/implant contact in a few locations but no signs of gross degradation or volume reduction after 6 weeks. The amount of bone ingrowth and cellular behavior had not changed after 26 weeks with resorption still going on. Glass ceramic implants by contrast appeared to be even better tolerated after 6 weeks with remarkable bone ingrowth and broad osseous fixation of the pellet to the defect margins and beyond, while highly vascular connective tissue filled the remaining pores of the implant. After 26 weeks the material had been extensively degraded, leaving behind only a few remnants, which were surrounded by seams of highly vascularized and cell-rich resorptive connective tissue with newly formed bone tissue nearly bridging the defect. The polylactic acid/ceramic composite implants showed hardly any tissue ingrowth or degradation either after 6 or after 26 weeks. Hence all tested materials appeared to be well tolerated at the site of implantation. However, gradual replacement by bone ingrowth tended to occur only in implants without polylactic acid.

Ceramics: past, present, and future

The selection and application of synthetic materials for surgical implants has been directly dependent upon the biocompatibility profiles of specific prosthetic devices. The early rationale for ceramic biomaterials was based upon the chemical and biochemical inertness (minimal bioreactivity) of elemental compounds constituted into structural forms (materials). Subsequently, mildly reactive (bioactive), and partially and fully degradable ceramics were identified for clinical uses. Structural forms have included bulk solids or particulates with and without porosities for tissue ingrowth, and more recently, coatings onto other types of biomaterial substrates. The physical shapes selected were application dependent, with advantages and disadvantages determined by: (1) the basic material and design properties of the device construct; and (2) the patient-based functional considerations. Most of the ceramics (bioceramics) selected in the 1960s and 1970s have continued over the long-term, and the science and technology for thick and thin coatings have evolved significantly over the past decade. Applications of ceramic biomaterials range from bulk (100%) ceramic structures as joint and bone replacements to fully or partially biodegradable substrates for the controlled delivery of pharmaceutical drugs, growth factors, and morphogenetically inductive substances. Because of the relatively unique properties of bioceramics, expanded uses as structural composites with other biomaterials and macromolecular biologically-derived substances are anticipated in the future.

Role of bone substitutes

Approximately 500 million years ago, the Paleozoic era heralded an evolutionary marvel: the skeleton. Unique to this evolutionary development was the capacity for regeneration: the physiologic renewal of embryologically derived tissue. Many of the cellular and molecular components for bone regeneration have been identified (bone morphogenetic proteins), and their therapeutic manipulation will become common clinical practice. Moreover, synthetic materials produced in the laboratory and novel bone derivatives will be used to exploit the skeleton's capacity to regenerate and repair. The concept of repair may be viewed as the restoration of form and function to deficient osseous tissue. Materials that provoke repair can be categorized broadly as bone substitutes. In this review, bone substitutes are grouped into 2 categories, polymers and ceramics, and each is subclassified as biodegradable or nonbiodegradable. Examples of these materials are provided as well as some of their liabilities and virtues.

Poly(alpha-hydroxy acids): carriers for bone morphogenetic proteins

A broad spectrum of cells and cell products is associated with bone homeostasis and the renewal of bone following injury. The coupled interactions among cells provide the power behind sculpting of bone, sustaining form, and ensuring functionality. Local and systemic regulatory molecules (e.g. growth factors, hormones) direct cellular interactions through autocrine, paracrine, and hormonal pathways. Recently, genes for a class of osteogenic regulatory molecules have been cloned, and gene product expression has enabled investigators to assess safety and efficacy in animal studies. The molecules are known as bone morphogenetic proteins (BMPs). Therapeutic applications of BMPs depend on a carrier system. A carrier could spatially and temporally localize BMP for regional needs and be custom-tailored for acute craniofacial applications or for recalcitrant extremity non-unions. The poly(alpha-hydroxy acids) (PHAs) may be suitable for these applications. Therefore, the purposes of this paper are (i) to mention, briefly, basic concepts of the bone wound continuum and the possible therapeutic roles of BMPs; (ii) to outline several properties of selected PHAs relevant to bone regeneration dynamics; and (iii) to review selected preclinical studies with PHAs.

Resorbable synthetic polymers as replacements for bone graft

The potential of resorbable synthetic polymers derived from the poly(alpha-hydroxy acids), poly(lactide) and poly(glycolide), to fulfill a role as bone graft substitutes is reviewed. The various elements of the relationship between the degradation behaviour of resorbable implants and polymer synthesis and chain structure, implant morphology, processing and dimensions have been defined. The production of resorbable polymeric implants has been extensively documented so as to provide a wide basis for selection of an appropriate manufacturing technique. The key requirement of implant dimensional stability over the early stages of bone healing is emphasised so as to provide a stable surface on which osteoblasts and/or their precursor cells may migrate and secrete bone matrix. Minimisation of the content of slow resorbing polymers such as poly(L-lactide) is recommended, consistent with retention of an adequate implant degradation characteristic. The review concludes with a summary of alternative resorbable polymers such as the polyphosphazines which are interesting candidate materials for bone repair and reconstruction.

Biotechnology and bone graft substitutes

Trauma, disease, developmental deformities, and tumor resection frequently cause bone defects that seriously challenge the skills of orthopedic and maxillofacial surgeons. Currently, repairing osseous deficiencies involves various medical surgical techniques, including autogenous grafts, allografts, internal and external fixation devices, electrical stimulation, and alloplastic implants. The existing technology, though effective in many cases, still is beset with numerous difficulties and disadvantages. A critical need for improved treatment methods exists today. Biotechnology now provides access to new bone repair concepts via administration of protein growth and morphogenic factors. Implantable device and drug delivery system technologies also have advanced. The converging biopharmaceutical, device, and delivery technologies represent an opportunity to improve the quality of health care for individuals with orthopedic and maxillofacial deficiencies. This report reviews current concepts in fracture healing and bone repair and examines existing treatment modalities. It also addresses novel protein drugs that stimulate osseous regeneration and delivery systems for these drugs.

Mineralization of dentinal collagen sheets complexed with alkaline phosphatase and integration with newly formed bone following subperiosteal implantation over osseous defects in rat calvaria

We addressed the question to what extent alkaline phosphatase (ALP) can induce mineralization of a collagenous matrix implanted subperiosteally, and how the graft interacts with the underlying bone. Bovine intestinal ALP was bound to sheets of guanidine-extracted, demineralized bovine dentin by using the crosslinking agent 1-ethyl-3(3-dimethylaminopropyl)carbodiimide.HCl. The complexes (with active enzyme) and control grafts (no enzyme) were implanted over osseous defects in opposite halves of rat calvaria. After time intervals varying from 3-12 weeks, the calvaria were processed for light and electron microscopic examination and histomorphometric analysis. The ALP-containing sheets (but not their controls) rapidly accumulated mineral crystals. As the complexes mineralized, osteoblasts appeared and formed a layer of bone in direct contact with the grafted material. The results indicate that ALP induced the deposition of mineral crystals, and strongly suggest that it is this mineral component which influenced the formation of bone.

Use of a phosphophoryn-Ca(+2)-collagen composition that mimics a mineralization front in unicortical defects in long bones

The present study was designed to ascertain if dynamic ionic matrices that mimic the mineralization front could be used as active scaffolds for bone repair. Dentinal phosphophoryn calcium salts were extracted from unerupted bovine dentine using chatopic buffers and EDTA. The phosphophoryns were subsequently isolated following precipitation with CaCl2. The phosphophoryn-Ca+2 salts were then mixed with pepsin solubilized bovine skin collagen and lyophilized into hardened sponges. Three groups of 4 beagle dogs were employed such that one leg served as an experimental test site for a mechanical wound, while the contralateral leg served as a control. Animals were sacrificed at 1,3, and 6 month intervals. The test specimens were harvested, fixed, and processed for routine histology, examined with image histomorphometric analysis, and scored. Tabulation of these data indicated that phosphophoryn-Ca(+2)-collagen enhances the repair of mechanically formed osseous defects in the distal femur of beagle dogs. This enhanced rate of bone repair was manifest by earlier filling of bony voids with osteoid and trabecular bone. Eventually, this process was followed by recortification of the surface defects. These data suggest that components derived from a mineralization front may influence bone formation in unicortical defects within long bones.