Ceramic-based 3D printed bone graft in bone tissue reconstruction: a systematic review and proportional meta-analysis of clinical studies

INTRODUCTION

This systematic review and proportional meta-analysis aims to evaluate the postoperative complication rate (CR%) of ceramic-based 3D-printed bone grafts based on the reported scientific articles conducted with human individuals.

METHODS

MEDLINE and SCOPUS were used as information sources. The synthesis of the study was carried out from studies with human individuals and the use of 3D-printed bone graft-ceramic as inclusion criteria. Cohen's kappa (κ) was calculated for interrater reliability. Qualitative analysis was performed based on the characteristics and outcomes of the individual study, and quantitative analysis was performed using proportional meta-analysis for CR%.

RESULTS

A total of 1352 records were identified through databases and resulted in 11 included studies (κ = 0.81-1.00) consisting of prospective clinical trials (64.63%), case series (16.67%), and case reports (18.18%). The overall postoperative complication rate was 14.3% (95% Cl: 0.19-53.6). The postoperative complication rate for studies conducted on the cranial defect, the maxillofacial-zygomatic defect, and the tibial-femoral defect was 2.7%, 11.1%, and 15.6%, respectively. This review also highlights common 3D printing techniques, materials, and grafs' characteristics, as well as their clinical applications.

CONCLUSIONS

Ceramic-based 3D-printed bone grafts show potential as alternatives for bone tissue reconstruction.

Preparation and Biological Evaluation of Porous Tantalum Scaffolds Coated with Hydroxyapatite

Orthopedic implants, such as porous scaffolds, are an effective way to repair bone defects. However, the lack of osseointegration and osteoinduction limits the achievement of an ideal therapeutic effect. This study aimed to prepare hydroxyapatite (HA) coatings for the surface of porous tantalum (Ta) scaffolds and to assess the effectively improved biological activities of the coated scaffolds. The porous Ta scaffolds were prepared by chemical vapor deposition, and then the porous Ta scaffolds were coated with HA via electrochemical deposition. The elements and phase compositions of the coatings were analyzed by energy-dispersive X-ray spectroscopy, X-ray diffraction, and X-ray photoelectron spectroscopy. The results showed that the coating covered the whole surfaces of porous Ta scaffolds with a uniform and compact distribution and did not exert any obvious effect on the porous structure. The biological activity of porous Ta scaffolds after surface modification increased and the water contact angle decreased, indicating that hydrophilicity was significantly improved. Cell live/dead staining, cytoskeletal fluorescence staining, and alkaline phosphatase immunofluorescence staining showed that the coating exhibited no cytotoxicity and notably improved cell proliferation, spreading, and osteogenic differentiation. In addition, in vivo experiments in animals have demonstrated that HA-coated porous Ta scaffolds contribute to bone formation. In conclusion, the HA coating notably improves the biological activities of the porous Ta scaffolds, achieving the goal of the present study. The HA coating presents great potential for the modification of porous Ta implants to improve their osteogenesis and osseointegration.

The administration of bovine hydroxyapatite-alendronate implant accelerates bone defect healing in an osteoporotic rat

BACKGROUND

Bone fracture is the main consequence of osteoporosis, which may become a neglected disease.

OBJECTIVE

This study aims to fabricate bovine hydroxyapatite-gelatine (BHA-GEL) based bone-implant with alendronate (ALE) in vivo.

METHODS

Wistar rats were used for an osteoporotic animal model induced by ovariectomy. There were three groups: negative control, BHA-GEL implant, and BHA-GEL-ALE implant. Each group performed a defect by drilling the femur (diameter of 2.2 mm and depth of 2 mm). Observations on the closure of bone defects were performed by X-ray radiography at the second and sixth week after surgery. The mechanism of bone healing was observed by using hematoxylin-eosin (HE) staining and immunohistochemical technique with anti-vascular endothelial growth factor (VEGF) and anti-alkaline phosphatase (ALP) antibodies.

RESULTS

The radiograph examination showed the implanted group had accelerated bone growth. In addition, the osteoblast, osteoclast and osteocyte had accelerated migration to the defect area. Moreover, the immunoreactive score (IRS) of VEGF at the sixth week in the BHA-GEL-ALE group was lower than the other groups. Meanwhile, the IRS of ALP in BHA-GEL-ALE was higher compared to other groups.

CONCLUSION

The BHA-GEL-ALE implant accelerates the healing of bone defect in the osteoporotic rat by increasing the ALP expression and the total number of cells.

Acceleration of Bone Fracture Healing through the Use of Bovine Hydroxyapatite or Calcium Lactate Oral and Implant Bovine Hydroxyapatite-Gelatin on Bone Defect Animal Model

Bone grafts a commonly used therapeutic technique for the reconstruction and facilitation of bone regeneration due to fractures. BHA-GEL (bovine hydroxyapatite-gelatin) pellet implants have been shown to be able accelerate the process of bone repair by looking at the percentage of new bone, and the contact between the composite and bone. Based on these results, a study was conducted by placing BHA-GEL (9:1) pellet implants in rabbit femoral bone defects, accompanied by 500 mg oral supplement of BHA or calcium lactate to determine the effectiveness of addition supplements. The research model used was a burr hole defect model with a diameter of 4.2 mm in the cortical part of the rabbit femur. On the 7th, 14th and 28th days after treatment, a total of 48 New Zealand rabbits were divided into four groups, namely defect (control), implant, implant + oral BHA, and implant + oral calcium lactate. Animal tests were terminated and evaluated based on X-ray radiology results, Hematoxylin-Eosin staining, vascular endothelial growth Factor (VEGF), osteocalcin, and enzyme-linked immunosorbent assay (ELISA) for bone alkaline phosphatase (BALP) and calcium levels. From this research can be concluded that Oral BHA supplementation with BHA-GEL pellet implants showed faster healing of bone defects compared to oral calcium lactate with BHA-GEL pellet implants.

Toward Innovation and Policies: Mapping the Demand of Orthopedic Implants in Public Hospital Margono Purwokerto, Central Java, Indonesia

Most of the needs for orthopedic implants in Indonesia are met by the imported product. So that innovation is needed to produce local products that suit the needs of the Indonesian people. The first step before innovating is the need analysis. It is necessary to map and forecast certain implant products to understand which products that are important to be developed before they become a national innovation. In addition, there has not been an article yet that reported data regarding implant product and their forecasting. The main objective of this research is to capture the actual demand product by mapping and forecasting the orthopedic implants in a public hospital. The mapping process was carried out using the descriptive analysis method to organize and summarize the data to get more information about the orthopedic implants that were widely used. In addition, the mapping process is also carried out using the double moving average method to see the trend of demand for orthopedic implants in the future. The data used in this research was the number of orthopedic implants used by the Margono hospital for five years starting from 2016 to 2020. Based on the collected data, forty-two varieties of orthopedic implants had been mapped regarding implant demand. Furthermore, twenty-two of forty-two implants had been analyzed based on several applications that always appeared within five years. This research type of implant is classified into five categories which are screw, plate, wire, rod, and prosthesis. It is found that cortical screw, straight plate, K wire, rod union, and bipolar cemented were noted as the highest demand implant represent their category. The demand forecasting process is carried out for cortical screw, K wire, and rod union. By using the double moving average method and MAPE for measuring the accuracy, it was found that the method has a significant result because the MAPE value is still quite good. The value of MAPE for cortical screw, K wire, and rod union are 0.3985, 1.0726, and 0.4332, respectively. The trend of increasing demand occurs in the product cortical screw and rod union. This data could perform as the recommendation and references leading to the research road map, especially in the orthopedic research field in Indonesia.

Combination of Nanocrystalline Hydroxyapatite and Injectable Platelet-Rich Fibrin on Bone Graft Materials for Alveolar Bone Preservation

Alveolar bone resorption is one of post-extraction complications with a reduction in the dimensions and quality of the alveolar bone, which will make it challenging to install dental implants in the future. The resorption can be prevented by preserving the alveolar bone using bone grafts. Nanocrystalline hydroxyapatite (HA) is a widely developed material as a bone graft. However, there are still some limitations because it only has osteoconductive properties. The addition of injectable platelet-rich fibrin to HA can increase this material’s osteoinductive, antibacterial, and anti-inflammatory properties, making it suitable for use as bone graft material for the preservation of alveolar bone.

Signaling Pathway and Transcriptional Regulation in Osteoblasts during Bone Healing: Direct Involvement of Hydroxyapatite as a Biomaterial

Bone defects and periodontal disease are pathological conditions that may become neglected diseases if not treated properly. Hydroxyapatite (HA), along with tricalcium phosphate and bioglass ceramic, is a biomaterial widely applied to orthopedic and dental uses. The in vivo performance of HA is determined by the interaction between HA particles with bone cells, particularly the bone mineralizing cells osteoblasts. It has been reported that HA-induced osteoblastic differentiation by increasing the expression of osteogenic transcription factors. However, the pathway involved and the events that occur in the cell membrane have not been well understood and remain controversial. Advances in gene editing and the discovery of pharmacologic inhibitors assist researchers to better understand osteoblastic differentiation. This review summarizes the involvement of extracellular signal-regulated kinase (ERK), p38, Wnt, and bone morphogenetic protein 2 (BMP2) in osteoblastic cellular regulation induced by HA. These advances enhance the current understanding of the molecular mechanism of HA as a biomaterial. Moreover, they provide a better strategy for the design of HA to be utilized in bone engineering.