Comparison of the physical properties and in vivo bioactivities of silkworm-cocoon-derived silk membrane, collagen membrane, and polytetrafluoroethylene membrane for guided bone regeneration

Relevant Properties and Potential Applications of Sericin in Bone Regeneration

The potential of sericin, a protein derived from silkworms, is explored in bone graft applications. Sericin's biocompatibility, hydrophilic nature, and cost-effectiveness make it a promising candidate for enhancing traditional graft materials. Its antioxidant, anti-inflammatory, and UV-resistant properties contribute to a healthier bone-healing environment, and its incorporation into 3D-printed grafts could lead to personalized medical solutions. However, despite these promising attributes, there are still gaps in our understanding. The precise mechanism through which sericin influences bone cell growth and healing is not fully understood, and more comprehensive clinical trials are needed to confirm its long-term biocompatibility in humans. Furthermore, the best methods for incorporating sericin into existing graft materials are still under investigation, and potential allergic reactions or immune responses to sericin need further study.

Collagen membrane from bovine pericardium for treatment of long bone defect

The treatment of bone regeneration failures has been constantly improved with the study of new biomaterials. Techgraft® is a collagen membrane derived from bovine pericardium, which has been shown to have biocompatibility and effectiveness in tissue repair. However, its use in orthopedics has not yet been evaluated. Therefore, the purpose of this study was to characterize a bovine pericardium collagen membrane and evaluate the effects of its use in the regeneration of a bone defect in rat tibia. Scanning electron microscopy, atomic force microscopy, weight lost and water uptake tests, and mechanical test were performed. Afterwards, the membrane was tested in an experimental study, using 12 male Sprague Dawley rats. A bone defect was surgically made in tibiae of animals, which were assigned to two groups (n = 6): bone defect treated with collagen membrane (TG) and bone defect without treatment (CONT). Then, tibiae were submitted to micro-CT. The membranes preserved their natural collagen characteristics, presenting great strength, high water absorption, hydrophilicity, and almost complete dissolution in 30 days. In the experimental study, the membrane enhanced the growth of bone tissue in contact with its surface. A higher bone volume and trabeculae number and less trabecular space was observed in bone defects of the membrane group compared to the control group at 21 days. In conclusion, the Techgraft membrane seems to have favorable characteristics for treatment of long bone repair.

Advances in Barrier Membranes for Guided Bone Regeneration Techniques

Guided bone regeneration (GBR) is a widely used technique for alveolar bone augmentation. Among all the principal elements, barrier membrane is recognized as the key to the success of GBR. Ideal barrier membrane should have satisfactory biological and mechanical properties. According to their composition, barrier membranes can be divided into polymer membranes and non-polymer membranes. Polymer barrier membranes have become a research hotspot not only because they can control the physical and chemical characteristics of the membranes by regulating the synthesis conditions but also because their prices are relatively low. Still now the bone augment effect of barrier membrane used in clinical practice is more dependent on the body’s own growth potential and the osteogenic effect is difficult to predict. Therefore, scholars have carried out many researches to explore new barrier membranes in order to improve the success rate of bone enhancement. The aim of this study is to collect and compare recent studies on optimizing barrier membranes. The characteristics and research progress of different types of barrier membranes were also discussed in detail.

Finding the Perfect Membrane: Current Knowledge on Barrier Membranes in Regenerative Procedures: A Descriptive Review

Guided tissue regeneration (GTR) and guided bone regeneration (GBR) became common procedures in the corrective phase of periodontal treatment. In order to obtain good quality tissue neo-formation, most techniques require the use of a membrane that will act as a barrier, having as a main purpose the blocking of cell invasion from the gingival epithelium and connective tissue into the newly formed bone structure. Different techniques and materials have been developed, aiming to obtain the perfect barrier membrane. The membranes can be divided according to the biodegradability of the base material into absorbable membranes and non-absorbable membranes. The use of absorbable membranes is extremely widespread due to their advantages, but in clinical situations of significant tissue loss, the use of non-absorbable membranes is often still preferred. This descriptive review presents a synthesis of the types of barrier membranes available and their characteristics, as well as future trends in the development of barrier membranes along with some allergological aspects of membrane use.

Finding the Perfect Membrane: Current Knowledge on Barrier Membranes in Regenerative Procedures: A Descriptive Review

Guided tissue regeneration (GTR) and guided bone regeneration (GBR) became common procedures in the corrective phase of periodontal treatment. In order to obtain good quality tissue neo-formation, most techniques require the use of a membrane that will act as a barrier, having as a main purpose the blocking of cell invasion from the gingival epithelium and connective tissue into the newly formed bone structure. Different techniques and materials have been developed, aiming to obtain the perfect barrier membrane. The membranes can be divided according to the biodegradability of the base material into absorbable membranes and non-absorbable membranes. The use of absorbable membranes is extremely widespread due to their advantages, but in clinical situations of significant tissue loss, the use of non-absorbable membranes is often still preferred. This descriptive review presents a synthesis of the types of barrier membranes available and their characteristics, as well as future trends in the development of barrier membranes along with some allergological aspects of membrane use.

Bone Grafts and Substitutes in Dentistry: A Review of Current Trends and Developments

After tooth loss, bone resorption is irreversible, leaving the area without adequate bone volume for successful implant treatment. Bone grafting is the only solution to reverse dental bone loss and is a well-accepted procedure required in one in every four dental implants. Research and development in materials, design and fabrication technologies have expanded over the years to achieve successful and long-lasting dental implants for tooth substitution. This review will critically present the various dental bone graft and substitute materials that have been used to achieve a successful dental implant. The article also reviews the properties of dental bone grafts and various dental bone substitutes that have been studied or are currently available commercially. The various classifications of bone grafts and substitutes, including natural and synthetic materials, are critically presented, and available commercial products in each category are discussed. Different bone substitute materials, including metals, ceramics, polymers, or their combinations, and their chemical, physical, and biocompatibility properties are explored. Limitations of the available materials are presented, and areas which require further research and development are highlighted. Tissue engineering hybrid constructions with enhanced bone regeneration ability, such as cell-based or growth factor-based bone substitutes, are discussed as an emerging area of development.

An introduction to bone tissue engineering

Bone tissue has the capability to regenerate itself; however, defects of a critical size prevent the bone from regenerating and require additional support. To aid regeneration, bone scaffolds created out of autologous or allograft bone can be used, yet these produce problems such as fast degradation rates, reduced bioactivity, donor site morbidity or the risk of pathogen transmission. The development of bone tissue engineering has been used to create functional alternatives to regenerate bone. This can be achieved by producing bone tissue scaffolds that induce osteoconduction and integration, provide mechanical stability, and either integrate into the bone structure or degrade and are excreted by the body. A range of different biomaterials have been used to this end, each with their own advantages and disadvantages. This review will introduce the requirements of bone tissue engineering, beginning with the regeneration process of bone before exploring the requirements of bone tissue scaffolds. Aspects covered include the manufacturing process as well as the different materials used and the incorporation of bioactive molecules, growth factors and cells.

Retrospective comparative clinical study for silk mat application into extraction socket

Background

Silk mats have been approved for clinical trials by the Korean Food and Drug Administration as membranes for guided tissue regeneration (GTR). In this study, silk mat application was compared to high-density polytetrafluoroethylene (dPTFE) membrane application or no membrane group.

Methods

To compare the silk mat group to the dPTFE group or the no membrane group, a retrospective sample collection was conducted. Bony defects were measured at the time of extraction (T0) and then at 3 months (T1) and 6 months after extraction (T2) on a digital panoramic view. Bone gain (BG) was calculated by subtracting from the bony defect at T0 to the bony defect at each follow-up.

Results

The BG at T2 was 2.44 ± 2.49 mm, 4.18 ± 1.80 mm, and 4.24 ± 2.05 mm in the no membrane group, silk mat group, and dPTFE group, respectively. Both membrane groups had significantly higher BG than BG in the no membrane group at T2 (P < 0.05).

Conclusions

Both membrane groups showed higher BG than the no membrane group.

Clinical Study for Silk Mat Application into Extraction Socket: A Split-Mouth, Randomized Clinical Trial

Silk mat originates from the cocoon of the silkworm and is prepared by a simple method. The material has been used for guided bone regeneration (GBR) in animal models. In this study, the silk mat used for a clinical application was compared with a commercially available membrane for GBR. A prospective split-mouth, randomized clinical trial was conducted with 25 patients who had bilaterally impacted lower third molars. High-density polytetrafluoroethylene (dPTFE) membrane or silk mat was applied in the extraction socket randomly. Probing depth (PD), clinical attachment level (CAL), and bone gain (BG) were measured at the time of extraction (T0) and then at three months (T1) and six months after extraction (T2). There was no missing case. GBR with silk mat was non-inferior to GBR with dPTFE for PD reduction at T1 and T2 (pnon-inferiority < 0.001). PD and CAL were significantly decreased at T1 and T2 when compared with those at T0 in both membrane groups (p < 0.001). BG at T2 was 3.61 ± 3.33 mm and 3.56 ± 3.30 mm in the silk mat group and dPTFE group, respectively. There was no significant complication from the use of silk mat for the patients. The results for patients undergoing GBR with silk mat for third-molar surgery were non-inferior to GBR with dPTFE for PD reduction.

Angioplasty Using 4-Hexylresorcinol-Incorporated Silk Vascular Patch in Rat Carotid Defect Model

The aim of this study was to evaluate and compare the efficacy of 4-hexylresorcinol (4-HR)-incorporated silk as a vascular patch scaffold to that of the commercial polytetrafluoroethylene (PTFE) vascular patch (GORE® ACUSEAL). The expression of the vascular endothelial cell growth factor-A (VEGF-A) after application of 4-HR was studied in RAW264.7 and HUVEC cells. In the animal study, a carotid artery defect was modeled in Sprague Dawley rats (n = 30). The defect was directly closed in the control group (n = 10), or repaired with the PTFE or 4-HR silk patch in the experimental groups (n = 10 per group). Following patch angioplasty, angiography was performed and the peak systolic velocity (PSV) was measured to evaluate the artery patency. The application of 4-HR was shown to increase the expression of VEGF-A in RAW264.7 and HUVEC cells. The successful artery patency rate was 80% for the 4-HR silk group, 30% for the PTFE group, and 60% for the control group. The PSV of the 4-HR silk group was significantly different from that of the control group at one week and three weeks post-angioplasty (p = 0.005 and 0.024). Histological examination revealed new regeneration of the arterial wall, and that the arterial diameter was well maintained in the 4-HR silk group in the absence of an immune reaction. In contrast, an overgrowth of endothelium was observed in the PTFE group. In this study, the 4-HR silk patch was successfully used as a vascular patch, and achieved a higher vessel patency rate and lower PSV than the PTFE patch.

Silk Protein-Based Membrane for Guided Bone Regeneration

Silk derived from the silkworm is known for its excellent biological and mechanical properties. It has been used in various fields as a biomaterial, especially in bone tissue engineering scaffolding. Recently, silk protein-based biomaterial has been used as a barrier membrane scaffolding for guided bone regeneration (GBR). GBR promotes bone regeneration in bone defect areas using special barrier membranes. GBR membranes should have biocompatibility, biodegradability, cell occlusion, the mechanical properties of space-making, and easy clinical handling. Silk-based biomaterial has excellent biologic and mechanical properties that make it a good candidate to be used as GBR membranes. Recently, various forms of silk protein-based membranes have been introduced, demonstrating excellent bone regeneration ability, including osteogenic cell proliferation and osteogenic gene expression, and promoting new bone regeneration in vivo. In this article, we introduced the characteristics of silk protein as bone tissue engineering scaffolding and the recent application of such silk material as a GBR membrane. We also suggested future studies exploring additional uses of silk-based materials as GBR membranes.

The effects of proteins released from silk mat layers on macrophages

Background

The objective of this study was to evaluate the changes in gene expression after incubation of cells with proteins released from different silk mat layers.

Methods

A silk cocoon from Bombyx mori was separated into four layers of equal thickness. The layers were numbered from 1 to 4 (from the inner to the outer layer). The proteins were released by sonication of a silk mat layer in normal saline. The concentration of proteins was determined by spectrophotometry. They were incubated with RAW264.7 cells, and changes in the expression of genes were evaluated by cDNA microarray analysis and quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR).

Results

Layer 1 and 4 groups had higher protein concentrations compared to those in layer 2 and 3 groups. The genes associated with inflammation and angiogenesis showed significantly higher expression in layer 1 and 4 groups. The results of qRT-PCR were in agreement with those of the cDNA microarray analysis.

Conclusions

The silk mat from the middle portion of the silkworm cocoon yielded a lower protein release and caused an insignificant change in the expression of genes that are associated with inflammation and angiogenesis.

Synthesis and Characterization of Polycaprolactone-Based Polyurethanes for the Fabrication of Elastic Guided Bone Regeneration Membrane

The aim of this research is to synthesize polycaprolactone-based polyurethanes (PCL-based PUs) that can be further used for the fabrication of guided bone regeneration (GBR) membranes with higher tensile strength and elongation at break than collagen and PTFE membranes. The PCL-based PUs were prepared by the polymerization of polycaprolactone (PCL) diol with 1,6-hexamethylene diisocyanate (HDI) at different ratios using either polyethylene glycol (PEG) or ethylenediamine (EDA) as chain extenders. The chemical, mechanical, and thermal properties of the synthesized polymers were determined using NMR, FTIR, GPC, DSC, and tensile tester. The PCL and polyurethanes were fabricated as nanofiber membranes by electrospinning, and their mechanical properties and SEM morphology were also investigated. In vitro tests, including WST-1 assay, SEM of cells, and phalloidin cytoskeleton staining, were also performed. It was shown that electrospun membranes made of PCL and PCL-HDI-PEG (2 : 3 : 1) possessed tensile strength of 19.84 MPa and 11.72 MPa and elongation at break of 627% and 362%, respectively. These numbers are equivalent or higher than most of the commercially available collagen and PTFE membrane. As a result, these membranes may have potential for future GBR applications.

Bone regeneration is associated with the concentration of tumour necrosis factor-α induced by sericin released from a silk mat

To understand the osteogenic effect of the middle layer of the silk cocoon, sericin was examined for its cellular effects associated with tumor necrosis factor-α (TNF-α) signaling in this study. The fragmented sericin proteins in the silk mat were evaluated for the TNF-α expression level in murine macrophages. The concentration of protein released from silk mats was higher in the outermost and the innermost layers than in the middle layers, and the protein released from the silk mat was identified as sericin. The level of TNF-α in murine macrophages was dependent on the applied concentration of sericin, and the expression of genes associated with osteogenesis in osteoblast-like cells was dependent on the applied concentration of TNF-α. In animal experiments, silk mats from the middle layers led to a higher regenerated bone volume than silk mats from the innermost layer or the outermost layer. If TNF-α protein was incorporated into the silk mats from the middle layers, bone regeneration was suppressed compared with unloaded silk mats from the middle layers. Accordingly, silk mats from the silk cocoon can be considered to be a fragmented sericin-secreting carrier, and the level of sericin secretion is associated with TNF-α induction and bone regeneration.

Biodegradable Polymer Membranes Applied in Guided Bone/Tissue Regeneration: A Review

Polymer membranes have been widely used in guided tissue regeneration (GTR) and guided bone regeneration (GBR). In this review, various commercially available membranes are described. Much attention is paid to the recent development of biodegradable polymers applied in GTR and GBR, and the important issues of biodegradable polymeric membranes, including their classification, latest experimental research and clinical applications, as well as their main challenges are addressed. Herein, natural polymers, synthetic polymers and their blends are all introduced. Pure polymer membranes are biodegradable and biocompatible, but they lack special properties such as antibacterial properties, osteoconductivity, and thus polymer membranes loaded with functional materials such as antibacterial agents and growth factors show many more advantages and have also been introduced in this review. Despite there still being complaints about polymer membranes, such as their low mechanical properties, uncontrollable degradation speed and some other drawbacks, these problems will undoubtedly be conquered and biodegradable polymers will have more applications in GTR and GBR.

Comparison of unprocessed silk cocoon and silk cocoon middle layer membranes for guided bone regeneration

Background

Silk cocoon is composed of multiple layers. The natural silk cocoon containing all layers was cut as a rectangular shape as defined as total group. The inner and outermost layers were removed from the total group and the remained mat was defined as the middle group. The objectives of this study was to compare the total group with the middle group as a barrier membrane for the guided bone regeneration.

Methods

The effects of these materials on the cellular proliferation and alkaline phosphatase (ALP) expression of MG63 cells were explored. For comparing bone regeneration ability, bilateral bone defects were created in calvarial areas in ten adult New Zealand white rabbits. The defects were covered with silk membranes of the middle group, with silk membrane of the total group used as the control on the contralateral side. The defects were allowed to heal for 4 and 8 weeks. Micro-computerized tomography (μCT) and histological examination were performed.

Results

The middle group exhibited a higher MTT value 48 and 72 h after treatment compared to the total group. ALP expression was also higher in the middle group. The results of μCT and histologic examination showed that new bone formation was significantly higher in the middle group compared to the total group 8 weeks postoperatively (P < 0.05).

Conclusions

In conclusion, the middle layer of the silk cocoon supports guided bone regeneration better than unprocessed silk cocoon.

Evaluation of bone formation and membrane degradation in guided bone regeneration using a 4-hexylresorcinol-incorporated silk fabric membrane

BACKGROUND

The aims of present study were (1) to evaluate new bone formation among the 4-hexylresorcinol (4HR)-incorporated silk fabric membrane (SFM), conventional SFM, and uncovered control groups and (2) to compare the amount of residual membrane between the 4HR-incorporated SFM and conventional SFM in a rabbit parietal defect model.

METHODS

Nine New Zealand white rabbits were used for this animal study. After the formation of a bilateral parietal bone defect (diameter 8.0 mm), either 4HR-incorporated SFM or conventional SFM was grafted into the defect. The defect in the control was left uncovered. New bone formation and the amount of residual membrane were evaluated by histomorphometry at 8 weeks after the operation.

RESULTS

The total amount of new bone was 37.84 ± 8.30 % in the control, 56.64 ± 15.74 % in the 4HR-incorporated SFM group, and 53.35 ± 10.52 % in the conventional SFM group 8 weeks after the operation. The differences were significant between the control and 4HR-incorporated SFM group (P = 0.016) and between the control and conventional SFM group (P = 0.040). The residual membrane was 75.08 ± 10.52 % in the 4HR-incorporated SFM group and 92.23 ± 5.46 % in the conventional SFM group 8 weeks after the operation. The difference was significant (P = 0.039).

CONCLUSIONS

The 4HR-incorporated SFM and conventional SFM groups showed more bone regeneration than the control group. The incorporated 4HR accelerated the partial degradation of the silk fabric membrane in a rabbit parietal defect model 8 weeks after the operation.

Membranes for the Guided Bone Regeneration

Many kinds of membrane have been used for the guided bone regeneration (GBR) technique. However, most membranes do not fulfill all requirements for the ideal membrane for the GBR technique. Among them, collagen membrane has been most widely used. However, its high price and weak tensile strength in wet condition are limitations for wide clinical application. Synthetic polymers have also been used for the GBR technique. Recently, silk based membrane has been considered as a membrane for the GBR technique. Despite many promising preclinical data for use of a silk membrane, clinical data regarding the silk membrane has been limited. However, silk based material has been used clinically as vessel-tie material and an electrospun silk membrane was applied successfully to patients. No adverse effect related to the silk suture has been reported. Considering that silk membrane can be provided to patients at a cheap price, its clinical application should be encouraged.