Low-temperature heat-deproteinated compact bone to heal large bone defects

Deproteinated bovine bone vs. beta-tricalcium phosphate as bone graft substitutes: histomorphometric longitudinal study in the rabbit cranial vault

OBJECTIVES

This article aims to study differences in the bone formation and the graft resorption of two bone graft substitutes (BGS). Besides, it is our attempt to observe possible qualitative and quantitative differences in the bone reparation of the outer layer covered by collagen membrane and the uncovered inner layer in close contact with dura mater.

MATERIAL AND METHODS

Twelve rabbits were employed. Deproteinized bovine bone (DBB) and β-tricalcium phosphate (BTCP) were used as BGS. Four subcritical round defects (7 mm) were drilled in the cranial vault, removing both cortical walls. One of the holes was filled with DBB, and other was filled with BTCP. Each symmetrical position to DBB and BTCP was left empty. The whole defect set was covered with a collagen membrane. Histological and morphometric analysis was performed for 1, 4, 8, 16, 32 and 52 weeks. Morphometry measurements were carried out taking into account the whole defect and splitting inner and outer areas.

RESULTS

In DBB sites, a rapid bone growth is observed, linking the remaining particles and integrating them into the bone matrix. Permanence of these DBB particles from week 16 onwards restrains the growth of bone fraction. A greater bone growth appears in areas repaired with BTCP than in those repaired with DBB, both in the outer layer (under-membrane) and the inner layer (over dura mater). In DBB sites, a slower growth is observed in the inner layer, with no significant differences in the final bone fraction at both strata.

CONCLUSIONS

Both materials favour the closure of the defects provoked. In both cases, a synergistic effect with the collagen membrane is observed. DBB remains integrated in the bone matrix, while BTCP displays a pattern of highly developed progressive resorption with an outstanding bone fraction development.

XANES analysis of dried and calcined bones

The structure of dried and calcined bones from chicken, bovine, deer, pig, sheep and chamois was examined using X-ray Absorption Near Edge Structure (XANES) spectroscopy. The oxygen K-edge absorption edge indicates that the surface of dried bone has a larger proportion of carbonate than the interior that is made up of phosphates. The phosphorus L and K edge clearly indicate that pyrophosphates, α-tricalcium phosphate (α-TCP) and hydrogen phosphates of Ca do not exist in either the dried bone or calcined bone and phosphorus exists as either β-tricalcium phosphate (β-TCP) or hydroxyapatite, both in the dried and calcined conditions. The Ca K-edge analysis indicates that β-TCP is the likely form of phosphate in both the dried and calcined conditions.

Fracture toughness and work of fracture of hydrated, dehydrated, and ashed bovine bone

Bone, a tri-phase composite, consists of nano-sized apatite minerals, an organic component, and water. Heat-treated bovine cortical bone has been proposed as a candidate for void-filling bone substitute. However, the toughness of heat-treated bone is not yet fully studied. Fracture toughness (K(c)) and work of fracture (W(f)) of hydrated, dehydrated, and ashed bovine bone were estimated using a single-edge V-notched beam method. Thermal gravimetric analysis and differential thermal analysis were used to determine the temperature at which the organics and water were removed. Dehydrated specimens were obtained by placing the samples in a 60 degrees C vacuum oven for 24h or a 110 degrees C furnace for 2h. Ashed specimens were obtained by heat-treating samples at 600 degrees C for 24h. K(c) of bovine specimens decreased from 5.5MPa.m(1/2) for hydrated bone, to 3.8MPa.m(1/2) for dehydrated specimens, and to 0.36MPa.m(1/2) for ashed specimens. W(f) decreased from 7.1 to 1.1kJ/m(2) for dehydrated specimens, and to 0.04kJ/m(2) for ashed specimens. The main reasons for the significant decreases in K(c) and W(f) may be attributed to water's ability in stabilizing collagen structure and to the organics' ability in making bone more ductile. Because of the large decrease in fracture toughness and work of fracture, we suggest that ashed bone is not appropriate for load-bearing bone substitute in areas where bone experiences loadings in flexure.

Effects of heat deproteinate bone and polynucleotides on bone regeneration: an experimental study on rat

This experimental study evaluated the effects of polynucleotides on bone regeneration on rats. Defects with a diameter of 2mm were prepared in the thickness of cortical bone of 32 rat tibiae and filled with different compounds: polynucleotide gel (PDRN), deproteinated porcine cortical bone (HDB) obtained by high temperature heating in the form of granules and a paste made of HDB granules and PDRN gel. Bone regeneration of the gaps was histologically analysed after a treatment time ranging from 1 to 12 weeks. Both PDRN and HDB stimulated bone growth and repair, but the paste prepared combining HDB granules and PDRN showed the best performance with faster filling, better osteconductive and biocompatible properties and easier handling. This study suggests that the paste prepared combining HDB and PDRN gel induces rapid bone regeneration in different clinical situations.

Characterization and osteoblast-like cell compatibility of porous scaffolds: bovine hydroxyapatite and novel hydroxyapatite artificial bone

Three different porous scaffolds were tested. The first two were prepared by sintering bovine bone. The third scaffold was prepared using three-dimensional gel-lamination, a new rapid prototyping method, and was named as hydroxyapatite artificial bone. X-ray diffraction and Fourier transform infrared spectroscopy analysis confirmed that the samples were mainly highly crystalline hydroxyapatite ceramics. Scanning electron microscopy and mercury intrusion porosimetry measurement showed that the pores were interconnected and pore sizes ranged from several microns to hundreds of microns. Mouse osteoblast-like cells grown on the three scaffolds retained their characteristic morphology. Cell proliferation and differentiation, analyzed by methylthiazol tetrazolium (MTT) and alkaline phosphatase activity assays, were significantly higher on the hydroxyapatite artificial bone than on the other two scaffolds tested. All the scaffolds provided good attachment, proliferation and differentiation of bone cells. These results indicate that the scaffolds have a favorable interaction with cells, they support cell growth and functions, and therefore these scaffolds may have great potential as bone substitutes. The three-dimensional gel-lamination method is proven to be an attractive process to design and fabricate bone scaffolds with favorable properties, and therefore, has promising potential for bone repair applications.

The Influence of Sintering Temperature on Mechanical and Microstructural Properties of Bovine Hydroxyapatite

The influence of sintering temperature on densification, microstructure and the mechanical properties of bovine hydroxyapatite (BHA), produced by a calcination method, was investigated. Densification and mechanical properties increased over increasing sintering temperature in the range between 1000°C and 1300°C, and there are evidences of optimum sintering temperature at 1200°C. The measured mechanical properties indicate sintered BHA-bodies as interesting biomaterials for further investigation in biomedical applications.

Bone mineral change during experimental heating: an X-ray scattering investigation

The effects of heating and burning on bone mineral have previously been studied using techniques such as X-ray diffraction (XRD) with the aim of discerning a characteristic signature of crystal change. This would enable a better understanding of alteration to bone mineral during heating, which would in turn impact on the preparation and use of natural bone hydroxyapatite as a biomaterial resource. In addition, this knowledge could prove invaluable in the investigation of burned human remains from forensic and archaeological contexts in cremation and funerary practice. Here we describe a complementary method, small-angle X-ray scattering (SAXS), to determine more accurately the changes to bone crystallite size and shape during an experimental heating regimen. Samples were subjected to controlled heating at 500 degrees C, 700 degrees C, or 900 degrees C for 15 or 45 min. Our results show bone crystallites begin to alter in the first 15 min of heating to 500 degrees C or above. They then appear to stabilise to a temperature-specific thickness and shape with prolonged heating. While the samples heated to lower temperatures or for shorter periods produce XRD traces showing little alteration to the apatite, corresponding information obtained from SAXS shows an early, subtle change in crystal parameters.

Chemical, structural properties, and osteoconductive effectiveness of bone block derived from porcine cancellous bone

The purpose of this study is to determine the efficacy of bioactive calcium phosphate obtained from porcine cancellous bone for the treatment of bone defects and nonunion. Porcine cancellous bone blocks were heat treated at 1300 degrees C for 2 h. The chemical composition, calcium-to-phosphate ratio, and microstructure of the porcine bone blocks were examined. For in vivo implantation, bone defects were created on the anteromedial aspect of the proximal tibia in seven beagle dogs and the xenograft bone blocks were placed into these defects. Plain radiographs were taken at 2-week intervals for roentgenographic evaluation. At 12 weeks, the specimens were stained with hematoxylin and eosin (H&E). The composition and morphology of heat-treated porcine cancellous bone were found to be similar to heat-treated human cancellous bone. Radiographs showed union between the host bone/bone-block interfaces. At 12 weeks, uniform and substantial new bone formation was observed. It is concluded that heat-treated porcine cancellous bone demonstrated effective osteoconductivity. This high-temperature heat-treatment technique has several advantages, including decreased risk of disease transmission and immunoreactivity, while also offering excellent biocompatibility.

Effect of deproteination on bone mineral morphology: implications for biomaterials and aging

Bone mineral morphology is altered by processing and this is rarely considered when preparing bone as a bioimplant material. To examine the degree of transformation, a commercial, coarsely particulate bone mineral biomaterial produced by prolonged deproteination, defatting, dehydration, and heating (donor material) was compared with similar particles of human bone (recipient material) prepared optimally by low-temperature milling. The two powders were freeze-substituted and embedded without thawing in Lowicryl K4M before sectioning for transmission electron microscopy (TEM) (other aliquots were processed by traditional TEM methods). To maximize resolution, electron micrographs were image-enhanced by digitization and printed as negatives using a Polaroid Sprint Scan 45. In addition to their morphology, the particles were examined for antigenicity (specific by reference to fluorescein isothiocyanate [FITC]-conjugated fibronectin, and nonspecific by reference to general FITC-conjugated immunoglobulins). Results showed that the optimally prepared human bone fragments stained discretely for fibronectin with negligible background autofluorescence. In contrast, the bioimplant fragments stained extensively with this and any other FITC-conjugated antibody and, unlike fresh bone, it also autofluoresced a uniform yellow. This difference was also expressed structurally and, although the bioimplant mineral consisted of rhomboidal plates up to 200 nm across and 10 nm thick, the optimally prepared bone mineral was composed of numerous clusters of 5-nm-wide sinuous calcified filaments of variable density and indeterminate length (which became straight needles 50 nm long and 5 nm thick following traditional chemical TEM fixation/staining). It was concluded that the inorganic phase of bone is both morphologically and immunologically transmutable and that, in biomaterials, the transformation is apparently so great that a broad indigenous antigenicity is unmasked, increasing the likelihood of resorption or rejection. This marked change may also provide preliminary insight into a more modest natural aging phenomenon with the localized lateral fusion of calcified filaments into less flexible, more immunologically reactive fenestrated plates.

Electromagnetic stimulation on the bone growth using backscattered electron imaging

The events at the hydroxyapatite implant material/tissue interface following electromagnetic stimulation were studied in the rabbit. Two kinds of hydroxyapatite were used: natural (NA) and synthetic (HA) both with a grain size of <50 microm. Bone defects, artificially created in rabbit tibiae, were filled with the material examined. One group of animals was exposed immediately after surgery and every 12h thereafter to 30-min treatments with electromagnetic fields (PEMFs). A second group was used as a control (untreated). Two and 4 weeks after implantation, animals were sacrificed and bone samples processed for LM, TEM and SEM using a backscatter electron detector for the evaluation of bone growth. This study indicates that HA has more osteoconductivity than NA, and shows that PEMF-treatment results in a benefit in accelerating bone formation at early time periods.

Qualitative assessment of natural apatite in vitro and in vivo

Among the natural and synthetic materials investigated as bone graft substitutes, much interest has been focused on natural apatite obtained from low temperature heat-deproteinated compact bone. Previous research demonstrates that, when treated at a temperature below 500 degrees C, this material maintains its characteristic ultrastructural features, with a high surface/volume ratio, while as an implant material, it offers the host tissue a large surface of interaction. In vitro and in vivo tests showed that natural apatite is well tolerated and is a good osteoconducing material. The present in vivo study in rabbits was carried out to first investigate the behavior and capacity of natural apatite implants to stimulate bone ingrowth, and then to analyze the cells located at the bone/material interface. Synthetic hydroxyapatite was used as a control material. In a parallel in vitro study, we investigated the activity of differentiated osteoblasts and periosteal cells obtained from rats and new-born rabbits, incubated with natural apatite and synthetic hydroxyapatite. The in vivo study showed that natural apatite allows osteoblasts to form new bone tissue, adhering to the implant with ingrowth into the implant structure. In the presence of synthetic hydroxyapatite, a less pronounced osteoblastic activity was observed. In agreement with these observations, the in vitro study showed that natural apatite is more effective in attracting cells, favoring their proliferation and stimulating alkaline phosphatase activity. These findings suggest that natural apatite is more suitable for bone filling or bone regeneration than synthetic hydroxyapatite.

Characterization of the mechanical and ultrastructural properties of heat-treated cortical bone for use as a bone substitute

Heat-treated bovine cortical bone has been proposed as an alternative to bone grafts and synthetic bone substitutes because it may combine the advantages of allografts (high stiffness and strength) and synthetic materials (abundant supply, reduced risk of rejection and disease transfer). Its mechanical properties and ultrastructure, however, are not well characterized. To address this, we compared the compressive (n = 20, bovine bone) and tensile (n = 26, bovine bone) mechanical properties and the ultrastructure (n = 12, human bone) of intact versus 350 degrees C heat-treated cortical bone. The 350 degrees C heat-treated bone had a mean +/- SD elastic modulus similar to the intact bone for both compression (16.3 +/- 2.2 GPa, pooled; p = 0.68) and tension (16.3 +/- 3.7 GPa, pooled; p = 0.95). It also maintained 63% of the intact strength in compression but only 9% in tension (p < 0.001). Infrared scans and X-ray diffraction patterns showed no differences between the 350 degrees C heat-treated and intact bone but large differences between ashed (700 degrees C) and intact bone. Similarly, heat-treated bone previously has been shown to be biocompatible and osteoconductive. We conclude, therefore, that 350 degrees C heat-treated cortical bone may be an excellent load-bearing bone substitute provided that it is loaded in compression only in vivo and is shown by future work to have acceptable fatigue properties.