Formation of a calcium phosphate-rich layer on absorbable calcium carbonate bone graft substitutes

The Matrix Protein Cysrichin, a Galaxin-like Protein from Hyriopsis cumingii, Induces Vaterite Formation In Vitro

In this study, we cloned a novel matrix protein, cysrichin, with 16.03% homology and a similar protein structure to the coral biomineralized protein galaxin. Tissue expression analysis showed that cysrichin was mainly expressed in mantle and gill tissues. In situ hybridization indicated that cysrichin mRNA was detected in the entire epithelium region of mantle tissue. RNAi analysis and shell notching experiment confirmed that cysrichin participates in the prismatic layer and nacreous layer formation of the shell. An in vitro crystallization experiment showed that the cysrichin protein induced lotus-shaped and round-shaped crystals, which were identified as vaterite crystals. These results may provide new clues for understanding the formation of vaterite in freshwater shellfish.

Yolk shell nanocomposite particles as bioactive bone fillers and growth factor carriers

The efficient delivery of bioactive molecules via rationally designed nanoparticles is an important focus in regenerative medicine. The yolk shell nanocomposite particles described herein are composed of silk fibroin movable cores formed within voided calcium carbonate shells to load and control the release of labile cytokines. These particles are excellent carrier vehicles of potent molecules as they sustained the release of bioactive Bone Morphogenetic Protein 2 (BMP-2) for more than 28 days in vitro. Implantation into bone defects in rabbits corroborates the in vitro results and also reveals that upon contact with phosphate containing body fluids, implanted yolk shell particles agglomerate and transform into a filler that adapts to defect contour to further act as an absorbable hemostatic agent. Taken together, the fabrication of these yolk shell particle-based "bone fillers" could expand the horizon for the development of newer generations of advanced bioactive materials in tissue regeneration applications.

Mechanics, degradability, bioactivity, in vitro, and in vivo biocompatibility evaluation of poly(amino acid)/hydroxyapatite/calcium sulfate composite for potential load-bearing bone repair

A ternary composite of poly(amino acid), hydroxyapatite, and calcium sulfate (PAA/HA/CS) was prepared using in situ melting polycondensation method and evaluated in terms of mechanical strengths, in vitro degradability, bioactivity, as well as in vitro and in vivo biocompatibility. The results showed that the ternary composite exhibited a compressive strength of 147 MPa, a bending strength of 121 MPa, a tensile strength of 122 MPa, and a tensile modulus of 4.6 GPa. After immersion in simulated body fluid, the compressive strength of the composite decreased from 147 to 98 MPa for six weeks and the bending strength decreased from 121 to 75 MPa for eight weeks, and both of them kept stable in the following soaking period. The composite could be slowly degraded with 7.27 wt% loss of initial weight after soaking in phosphate buffered solution for three weeks when started to keep stable weight in the following days. The composite was soaked in simulated body fluid solution and the hydroxyapatite layer, as flower-like granules, formed on the surface of the composite samples, showing good bioactivity. Moreover, it was found that the composite could promote proliferation of MG-63 cells, and the cells with normal phenotype extended and spread well on the composite surface. The implantation of the composite into the ulna of sheep confirmed that the composite was biocompatible and osteoconductive in vivo, and offered the PAA/HA/CS composite promising material for load-bearing bone substitutes for clinical application.

CA1 contributes to microcalcification and tumourigenesis in breast cancer

Background

Although mammary microcalcification is frequently observed and has been associated with poor survival in patients with breast cancer, the genesis of calcification remains unclear. Carbonic anhydrase I (CA1) has been shown to promote calcification by catalysing the hydration of CO₂. This study aimed to determine whether CA1 was correlated with microcalcification and with other processes that are involved in breast cancer tumourigenesis.

Methods

CA1 expression in breast cancer tissues and blood samples was detected using western blotting, real-time PCR, immunohistochemistry and ELISA. Calcification was induced in the cultured 4T1 cell line originating from mouse breast tumours, using ascorbic acid and β-glycerophosphate. Acetazolamide, a chemical inhibitor of CA1, was also added to the culture to determine the role of CA1 in calcification. The MCF-7 human breast cancer cell line was treated with anti-CA1 siRNA and was assessed using a CCK-8 cell proliferation assay, an annexin V cell apoptosis assay, transwell migration assay and a human breast cancer PCR array. The tag SNP rs725605, which is located in the CA1 locus, was genotyped using TaqMan® genotyping.

Results

Increased CA1 expression was detected in samples of breast carcinoma tissues and blood obtained from patients with breast cancer. A total of 15.3 % of these blood samples exhibited a 2.1-fold or higher level of CA1 expression, compared to the average level of CA1 expression in samples from healthy controls. Following the induction of calcification of 4T1 cells, both the number of calcium-rich deposits and the expression of CA1 increased, whereas the calcification and CA1 expression were significantly supressed in the presence of acetazolamide. Increased migration and apoptosis were observed in MCF-7 cells that were treated with anti-CA1 siRNA. The PCR array detected up-regulation of the androgen receptor (AR) and down-regulation of X-box binding protein 1 (XBP1) in the treated MCF-7 cells. Significant differences in the allele and genotype frequencies of rs725605 were detected in the cohort of patients with breast cancer but not in other tumours.

Conclusion

The results of this study suggested that CA1 is a potential oncogene and that it contributes to abnormal cell calcification, apoptosis and migration in breast cancer.

Electronic supplementary material

The online version of this article (doi:10.1186/s12885-015-1707-x) contains supplementary material, which is available to authorized users.

Pre-Clinical Evaluation of a New Coral-Based Bone Scaffold

Coral is used worldwide for bone reconstruction. The favorable characteristics that make this material desirable for implantation are (i) osteoinduction, (ii) and osteoconduction. These proprieties have been demonstrated by in vivo studies with animal models and clinical trials over a twenty-year period. Also poly(2-hydroxyethylmethacrylate) [poly(HEMA)] is a widely used biomaterial. By using coral and poly(HEMA), a scaffold for bone reconstruction application has been recently synthesized. Cytological, histological and genetic analyses were performed to characterize this new alloplastic material. Four samples were analyzed: (a) white coral (WC), (b) red coral (RC), (c) WC plus polymer (WCP) and (d) RC plus polymer (RCP). Quantification of mitochondrial dehydrogenase activity by MTT assay was performed as indirect detector of cytotoxicity. In vivo effects were revealed by implanting corals and coral-based polymers in rabbit tibia. Samples were collected after 4 weeks and subjected to histological analysis. To evaluate the genetic response of cells to corals and coral-derived polymers an osteoblast-like cell line (i.e. MG63) was cultured in wells containing (a) medium, (b) medium plus corals and (c) medium plus two types of scaffolds (RCP or WCP). RNAs extracted from cells were retro-transcribed and hybridized on DNA 19.2K microarrays. No cytotoxicity was detected in corals and coral-based biopolymers. No inflammation or adverse effect was revealed by histological examination. By microarray analysis 154 clones were differentially expressed between RC and WC (81 up and 73 down regulated) whereas only 15 clones were repressed by the polymer. Histological evaluation not only confirmed that coral is a biocompatible material, but also that the polymer has no adverse effect. Microarray results were in agreement with cytological and histological analyses and provided further data regarding the genetic effects of RC, WC and the new polymer.

Expression of galaxin and oncogene homologs in growth anomaly in the coral Montipora capitata

Growth anomaly (GA) is a coral disease characterized by enlarged skeletal lesions. Although negative effects of GA on several of coral's biological functions have been determined, the etiology and molecular pathology of this disease is very poorly understood. We studied the expression of 5 genes suspected to play a role in pathological development of GA in the endemic Hawaiian coral Montipora capitata, which is particularly susceptible to this disease. Transcript abundances of the 5 target genes in healthy tissue, GA-affected tissue, and unaffected tissue (apparently healthy tissue adjacent to GA) relative to 3 internal control genes (actin, NADH, and rpS3) were compared using quantitative reverse transcriptase PCR. Galaxin, which codes for a protein suspected to be involved in calcification and thus hypothesized to be differentially expressed in GA, was up-regulated in unaffected tissue but remained at baseline levels in GA tissue. The gene expressions of murine double minute 2 (MDM2) and tumor necrosis factor (TNF) remained unchanged in GA tissue. The expression of tyrosine protein kinase (TPK) and βγ-crystallin (BGC) were both down-regulated. These expression patterns were all inconsistent with the expression patterns of homologous genes in neoplastic diseases featuring similar morphological symptoms in humans. These expression data therefore suggest that the calcification mechanism is likely not enhanced in coral GA and that coral GA is not a malignant neoplasia.

Carbonic anhydrase I (CA1) is involved in the process of bone formation and is susceptible to ankylosing spondylitis

Introduction

Ankylosing spondylitis (AS) is characterized by abnormal bone formation in the spine and the sacroiliac joints. In vitro assays demonstrate that carbonic anhydrase I (CA1) promotes calcium precipitation. This study investigated the function of CA1 for bio-mineralization and determined if common polymorphisms in the CA1 gene might contribute to AS risk.

Methods

Calcification was induced in Saos-2 cells, a human osteosarcoma cell line, with ascorbic acid and β-glycerophosphate. Calcification was determined by Alizarin Red-S (AR-S) staining. Expressions of CA1, alkaline phosphatase (ALP), bone sialoprotein (BSP), osteocalcin (OCN), osterix (OSX) and runt-related transcription factor-2 (Runx2) were determined by real-time PCR and western blotting. The cells were also treated with acetazolamide, an anti-carbonic anhydrase drug. Genotyping was performed using Illumina VeraCode microarray in a case-control study including 51 AS patients, 267 rheumatoid arthritis (RA) patients and 160 healthy controls. The result was confirmed by Taqman assay, including 258 AS patients, 288 RA patients and 288 healthy controls.

Results

Following the induction of calcification, Saos-2 cells produced large amounts of calcium-rich deposits. Increased transcriptions of CA1, ALP, BSP, OCN, OSX and Runx2, essential genes for ossification, were detected in the cultured cells. Following treatmen with acetazolamide, the expression of CA1 obviously declined and mineralized nodule formation was also decreased. Illumina microarray indicates that SNP at rs7841425 also showed significant differences in allelic frequency (P = 0.01396) and genotypic frequency (P = 0.005902) between AS cases and controls. In addition, SNP at rs7827474 showed significant differences in allelic frequency (P = 5.83E-04) and genotypic frequency (P = 0.000186) between RA cases and controls (P values were adjusted to multiple comparisons). The Taqman assay revealed that rs725605 demonstrated statistically significant evidence of allele frequency (P = 0.022307) and gene frequency (P = 0.007731) for association with AS. This SNP did not show significant differences in allelic frequencies and gene frequencies between RA patients and controls.

Conclusions

CA1 may play an essential role in bio-mineralization and new bone formation. The gene encoding CA1 is susceptible to AS.

Bioinorganics and biomaterials: bone repair

The field of bioinorganics is well established in the development of a variety of therapies. However, their application to bone regeneration, specifically by way of localized delivery from functional implants, is in its infancy and is the topic of this review. The toxicity of inorganics is species, dose and duration specific. Little is known about how inorganic ions are effective therapeutically since their use is often the result of serendipity, observations from nutritional deficiency or excess and genetic disorders. Many researchers point to early work demonstrating a role for their element of interest as a micronutrient critical to or able to alter bone growth, often during skeletal development, as a basis for localized delivery. While one can appreciate how a deficiency can cause disruption of healing, it is difficult to explain how a locally delivered excess in a preclinical model or patient, which is presumably of normal nutritional status, can evoke more bone or faster healing. The review illustrates that inorganics can positively affect bone healing but various factors make literature comparisons difficult. Bioinorganics have the potential to have just as big an impact on bone regeneration as recombinant proteins without some of the safety concerns and high costs.

The influence of physical, chemical and biological manipulations on surface potential of calcium phosphate coatings on metal substrates

The electret voltage indices of artificial surfaces are dependent on coatings formation technology and may be regulated by means of change in their physical-chemical parameters. Chemical modification of radio frequency magnetron calcium phosphate coatings (RFMCPC) by means of silicious incorporation led to an augmentation of pieces’ electrostatic potential. A complication of RFMCPC relief that was fixed by roughness index Ra is accompanied by increase in electret voltage index of artificial surface and its statistical deviation. Bone marrow cells suspension in model biological electrolyte populated RFMCPC dimples. In this manner it modulated the amplitude and leveled out the differences of surface electrostatic potential.

Influence of different biomaterials on the viability of Aggregatibacter actinomycetemcomitans

OBJECTIVES

The aim of the present in vitro study was to evaluate the effects of different biomaterials used for regenerative periodontal surgery on the growth of the periodontopathogen Aggregatibacter actinomycetemcomitans.

METHODS

Three commercially available biomaterials of synthetic origin (hydroxyapatite/beta-tricalcium phosphate, nanostructured hydroxyapatite paste, oily calcium hydroxide suspension), a bovine-derived xenograft as well as an enamel matrix derivative (EMD) were added in different concentrations to calibrated suspensions of A. actinomycetemcomitans ATCC 43718/33384 (serotype b/c). Equal aliquots (0.1 ml) for the viability assay were taken after 5 min, 1h, 3h, 8h and 24h, plated on blood agar and incubated in an anaerobic environment for 48 h at 37°C. Viable cell counts were expressed as colony forming units (cfu)/0.1 ml.

RESULTS

The results demonstrated that none of the investigated biomaterials could inhibit the growth of A. actinomycetemcomitans serotype b. A marked growth reduction of A. actinomycetemcomitans serotype c was observed in the presence of oily calcium hydroxide suspension and nanostructured hydroxyapatite. In contrast, no significant growth inhibition could be observed in the presence of hydroxyapatite/beta-tricalcium phosphate, enamel matrix derivative and bovine-derived xenograft.

CONCLUSIONS

The results of the present study suggest that none of the investigated biomaterials possesses antimicrobial properties against A. actinomycetemcomitans serotype b. Therefore, the use of these biomaterials for regenerative procedures should be weighted critically in the presence of A. actinomycetemcomitans serotype b.

A meta-analysis of histomorphometric results and graft healing time of various biomaterials compared to autologous bone used as sinus floor augmentation material in humans

BACKGROUND

To date, no studies have been published in which histomorphometric data from a large group of patients comparing various biomaterials for sinus floor augmentation procedures were evaluated.

MATERIALS AND METHODS

A meta-analysis of the English literature from January 1993 till April 2009 was carried out. Out of 147 titles, according to our criteria, 64 articles were selected for analysis describing the use of autologous bone and their alternatives, such as allogenic, xenogenic, and alloplastic materials.

RESULTS

On the basis of autologous bone grafting, a reference value for total bone volume (TBV) of 63% was found. Particulation of the bone graft resulted in a general reduction of −18% in TBV. Delayed implant placement reduced the TBV with −7%. Overall TBV was 8% or 6% higher if a biopsy was, respectively, taken before 4.5 months or after 9.0 months after initial sinus augmentation surgery. Allogenic, xenogenic, alloplastic, or combinations of graft materials all resulted in a significant lower amount of TBV compared to autologous bone grafting ranging from −7% to −26%. Inventorying the effect of "biopsy time" for autologous bone, the TBV was significantly higher before 4.5 and after 9.0 months of healing time compared to period in between. Surprisingly, no significant differences in TBV with respect to "biopsy time" for bone substitutes were found.

CONCLUSIONS

On the basis of the aspect of TBV autologous bone still has to be considered to be the gold standard in sinus augmentation surgery. However, the consequence of the TBV for implant survival is still unraveled yet.

A new biphasic osteoinductive calcium composite material with a negative Zeta potential for bone augmentation

The aim of the present study was to analyze the osteogenic potential of a biphasic calcium composite material (BCC) with a negative surface charge for maxillary sinus floor augmentation. In a 61 year old patient, the BCC material was used in a bilateral sinus floor augmentation procedure. Six months postoperative, a bone sample was taken from the augmented regions before two titanium implants were inserted at each side. We analyzed bone neoformation by histology, bone density by computed tomography, and measured the activity of voltage-activated calcium currents of osteoblasts and surface charge effects. Control orthopantomograms were carried out five months after implant insertion. The BCC was biocompatible and replaced by new mineralized bone after being resorbed completely. The material demonstrated a negative surface charge (negative Zeta potential) which was found to be favorable for bone regeneration and osseointegration of dental implants.

Back-scattered electron imaging and elemental microanalysis of retrieved bone tissue following maxillary sinus floor augmentation with calcium sulphate

OBJECTIVES

To investigate the presence and composition of residual bone graft substitute material in bone biopsies from the maxillary sinus of human subjects, following augmentation with calcium sulphate (CaS).

MATERIAL AND METHODS

Bone cores were harvested from the maxillary sinus of patients who had undergone a sinus lift procedure using CaS G170 granules 4 months after the initial surgery. Samples from seven patients, which contained residual biomaterial particles, were examined by field emission scanning electron microscopy and energy dispersive X-ray spectroscopy was used to determine the composition of the remaining bone graft substitute material.

RESULTS

Residual graft material occurred in isolated areas surrounded by bone and consisted of individual particles up to 1 mm in length and smaller spherical granules. On the basis of 187 separate point analyses, the residual material was divided into three categories (A, B and C) consisting of: A, mainly CaS (S/P atomic% ratio > or =2.41); B, a heterogeneous mixture of CaS and calcium phosphate (S/P=0.11-2.4) and C, mainly calcium phosphate (S/P< or =0.11; C), which had a mean Ca : P ratio of 1.63+/-0.2, consistent with Ca-deficient hydroxyapatite. Linescans and elemental maps showed that type C material was present in areas which appeared dense and surrounded, or were adjacent to, more granular CaS-containing material, and also occurred as spherical particles. The latter could be disintegrating calcium phosphate in the final stages of the resorption process.

CONCLUSIONS

CaS resorption in the human maxillary sinus is accompanied by CaP precipitation which may contribute to its biocompatibility and rapid replacement by bone.

Maxillary sinus floor elevation using a tissue-engineered bone complex with OsteoBone and bMSCs in rabbits

OBJECTIVES

To evaluate the effects of maxillary sinus floor elevation by a tissue-engineered bone complex with OsteoBone(trade mark) and bone marrow stromal cells (bMSCs) in rabbits.

MATERIAL AND METHODS

Autologous bMSCs from adult New Zealand rabbits were cultured and combined with OsteoBone(trade mark) at a concentration of 20 x 10(6) cells/ml in vitro. Twenty-four animals were used and randomly allocated into groups. For each time point, 16 maxillary sinus floor elevation surgeries were made bilaterally in eight animals and randomly repaired by bMSCs/material (i.e. OsteoBone), material, autogenous bone and blood clot (n=4 per group). A polychrome sequential fluorescent labeling was also performed post-operatively. The animals were sacrificed 2, 4 and 8 weeks after the procedure and evaluated histologically as well as histomorphometrically.

RESULTS

New bone area significantly decreased from weeks 2 to 8 in the blood clot group, while bone area in the autologous bone reduced from weeks 4 to 8. In both groups, a significant amount of fatty tissue appeared at week 8. Accordingly, augmented height in both groups was also significantly decreased from weeks 2 to 8. The bone area in the material-alone group as well as in the bMSCs/material group, on the other hand, increased over time. Significantly more newly formed bone area and mineralization was observed in the center of the raised space in the bMSCs/material group than in the material-alone group. The augmented height was maintained in these two groups throughout the course of this study.

CONCLUSION

These results suggest that OsteoBone can successfully be used as a bone graft substitute and that the combination of this material with bMSCs can effectively promote new bone formation in sinus elevation.

Long term outcome of anterior cervical discectomy and fusion using coral grafts

BACKGROUND

To determine the long term efficacy of coral grafts in anterior cervical discectomy and fusion.

METHODS

In this prospective longitudinal study, All patients presenting with myelopathy and/or radiculopathy due to discal hernia or cervical spondylosis underwent anterior cervical microdiscectomy, arthrodesis with coral, and stabilization with anterior cervical locking plates. Clinical and radiological post-operative evaluations were performed at 2 days, 3, 6, and 12 months, and then yearly. The visual analogue scale was used for the evaluation of pain. Fusion was defined as the absence of motion on dynamic imaging combined with the disappearance of radio-lucent lines around the graft. The mean follow-up period was 44 months. In 83.3%, 91.2% and 93.7% of patients there was a satisfactory outcome for neck pain, arm pain, and motor deficit, respectively. The overall complication rate was 17.5%, all of which were transient. Additional surgery was required in nine cases. The occurrence of complications is correlated with less satisfactory outcomes for both neck and arm pain. While 95.5% of patients expressed overall satisfaction with their surgery, 70.5% stated that they had returned to their previous activities. The fusion rate was 45%; which was not correlated with clinical outcome and more likely in patients with of cervical spondylosis and one-level arthrodesis.

CONCLUSIONS

Despite satisfactory clinical results and a long follow-up period, coral implants yield low fusion rates, particularly in patients with discal hernia of two-level arthrodesis. The use of coral grafts cannot be recommended when fusion is one of the post-operative endpoints.

Differentiation of Calcium Carbonate Polymorphs by Surface Analysis Techniques - An XPS and TOF-SIMS study

Calcium carbonate has evoked interest owing to its use as a biomaterial, and for its potential in biomineralization. Three polymorphs of calcium carbonate, i.e. calcite, aragonite, and vaterite were synthesized. Three conventional bulk analysis techniques, Fourier transform infrared (FTIR), X-ray diffraction (XRD), and SEM, were used to confirm the crystal phase of each polymorphic calcium carbonate. Two surface analysis techniques, X-ray photoelectron spectroscopy (XPS) and time-of-flight secondary ion mass spectroscopy (TOF-SIMS), were used to differentiate the surfaces of these three polymorphs of calcium carbonate. XPS results clearly demonstrate that the surfaces of these three polymorphs are different as seen in the Ca(2p) and O(1s) core-level spectra. The different atomic arrangement in the crystal lattice, which provides for a different chemical environment, can explain this surface difference. Principal component analysis (PCA) was used to analyze the TOF-SIMS data. Three polymorphs of calcium carbonate cluster into three different groups by PCA scores. This suggests that surface analysis techniques are as powerful as conventional bulk analysis to discriminate calcium carbonate polymorphs.

Calcium sulfate acts on the miRNA of MG63E osteoblast-like cells

Calcium sulfate (CaS) is a highly biocompatible material and enhances bone formation in vivo. However, how CaS alters osteoblast activity to promote bone formation is incompletely understood. We therefore investigated the translation regulation in osteoblasts exposed to CaS by using microRNA microarray techniques. Transduction, transcription, and translation are the three levels of regulation of cell activity. Recently, a new type of translation regulation has been identified: RNA interference (RNAi). RNAi is a process in which microRNA, (miRNA), that is, noncoding RNAs of 19-23 nucleotides can induce sequence-specific mRNA degradation and/or translational repression. The human genome encodes a few hundred miRNAs that can post-transcriptionally repress thousands of genes. The miRNA oligonucleotide microarray provides a novel method of carrying out genome-wide miRNA profiling in human samples. By using miRNA microarrays containing 329 probes designed from Human miRNA sequences, we identified in osteoblast-like cells line (MG-63) cultured with CaS (Surgiplaster, Classimplant, Roma, Italy) several miRNA whose expression is significantly modified. The data reported are, to our knowledge, the first study on translation regulation in osteoblasts exposed to CaS. They could be relevant to a better understanding of the molecular mechanism of bone regeneration and as a model for comparing other materials with similar clinical effects.

In vivo bone response to 3D periodic hydroxyapatite scaffolds assembled by direct ink writing

The in vivo bone response of 3D periodic hydroxyapatite (HA) scaffolds is investigated. Two groups of HA scaffolds (11 mm diameter x 3.5 mm thick) are fabricated by direct-write assembly of a concentrated HA ink. The scaffolds consist of cylindrical rods periodically arranged into four quadrants with varying separation distances between rods. In the first group, HA rods (250 microm in diameter) are patterned to create pore channels, whose areal dimensions are 250 x 250 microm(2) in quadrant 1, 250 x 500 microm(2) in quadrants 2 and 4, and 500 x 500 microm(2) in quadrant 3. In the second group, HA rods (400 microm in diameter) are patterned to create pore channels, whose areal dimensions of 500 x 500 microm(2) in quadrant 1, 500 x 750 microm(2) in quadrants 2 and 4, and 750 x 750 microm(2) in quadrant 3. Each group of scaffolds is partially densified by sintering at 1200 degrees C prior to being implanted bilaterally in trephine defects of skeletally mature New Zealand White rabbits. Their tissue response is evaluated at 8 and 16 weeks using micro-computed tomography, histology, and scanning electron microscopy. New trabecular bone is conducted rapidly and efficiently across substantial distances within these patterned 3D HA scaffolds. Our observations suggest that HA rods are first coated with a layer of new bone followed by subsequent scaffold infilling via outward and inward radial growth of the coated regions. Direct-write assembly of 3D periodic scaffolds composed of micro-porous HA rods arrayed to produce macro-pores that are size-matched to trabecular bone may represent an optimal strategy for bone repair and replacement structures.

Characteristics of calcium sulfate/gelatin composite biomaterials for bone repair

A novel hybrid biomaterial composed of calcium sulfate (CS) and gelatin (GEL) was prepared with the potential of being used as bone filler or scaffold owing to its osteoconduction. Such composite biomaterial, cross-linked or un-cross-linked, could provide a suitable absorbing rate and prevent the CS crystals migrating from the implant for tissue engineering. The structure of the composite was analyzed with infrared (IR) spectroscopy, X-ray diffraction (XRD) and scanning electron microscopy (SEM). The results indicated that the crystal pattern of CS was affected by the addition of GEL. The GEL part affected the development of the CS dihydrate (CSD) crystal by slowing the conversion from CS hemihydrate (CSH) to CSD; thus, the composite actually contained CSD, CSH and GEL. The compressive strength of the CS/CLGEL composite was also investigated. The compressive strength was correlated to the weight proportions of CS in the CS/cross-linked GEL (CS/CLGEL) composite, and the highest compressive strength of 82 MPa was obtained for the composite containing 40 wt% CS. The in vitro absorption test and the SEM results showed that a porous scaffold was formed in situ with the absorption of CS in the CS/CLGEL composite in a certain time. Therefore, the CS/CLGEL composite material can be used as an in situ porous scaffold with a high initial mechanical strength, and the remaining porous GEL scaffold will enable further in-growth of cells. Human osteoblasts were cultured in contact with the CS/CLGEL composite and the primary results suggested that human osteoblasts could attach and spread on the surface of CS/CLGEL films. The preliminary animal model experiment was operated for assessing the potential of the CS/CLGEL composite as a biodegradable bone substitute. The primary results showed that the CS/CLGEL composite filler could promote new bone in-growth, which will stimulate further study.

Peri-Implant Bone Regeneration With Calcium Sulfate: A Light and Transmission Electron Microscopy Case Report

BACKGROUND

Calcium sulfate is a simple, biocompatible material with a very long, safe clinical history in several different fields of medicine. It is a rapidly resorbing material that leaves behind calcium phosphate lattice, which promotes bone regeneration.

OBJECTIVE

The aim of this study was a histological and ultrastructural evaluation of the tissues in a peri-implant site regenerated with calcium sulfate.

MATERIALS AND METHODS

The specimens were processed for observation under light and transmission electron microscopes.

RESULTS

In light microscopy, trabecular bone was present. No remnants of calcium sulfate were present. Transmission electron microscopy showed, in the areas of the interface with the implant surface, features of mature bone with many osteocytes. An amorphous layer and/or osteoid seam separated this mature bone from the metal surface.

CONCLUSION

The results confirm the high biocompatibility and rapid resorption of calcium sulfate.

Maxillary sinus augmentation with different biomaterials: a comparative histologic and histomorphometric study in man

OBJECTIVE

Rehabilitation of the edentulous posterior maxilla with dental implants can be difficult because of insufficient bone volume caused by pneumatization of the maxillary sinus and crestal bone resorption. Different biomaterials have been used for sinus augmentation. The aim of the study was to compare different materials in maxillary sinus augmentation in man.

METHODS

A total of 94 patients participated in this study. Inclusion criteria were maxillary partial (unilateral or bilateral) edentulism involving the premolar/molar areas, and the presence of 3-5-mm crestal bone between the sinus floor and alveolar ridge. A total of 362 implants were inserted. There were 9 biomaterials used in the sinus augmentation procedures. Each patient underwent 1 biopsy after 6 months. A total of 144 specimens were retrieved.

RESULTS

None of the 94 patients had complications. All implants were stable, and x-ray examination showed dense bone around the implants. Mean follow-up was 4 years. There were 7 implants that failed. Histologic resultsshowed that almost all the particles of the different biomaterials (i.e., autologous bone, demineralized freeze-dried bone allograft Biocoral [Inoteb, St. Gonnery, France], Bioglass [US Biomaterials, Alachua, FL], Fisiograft [Ghimas, Bologna, Italy], PepGen P-15 [Dentsply Friadent CeraMed, Lakewood, CO], calcium sulfate, Bio-Oss [Geistlich Pharma AG, Wohlhusen, Switzerland], and hydroxyapatite) were surrounded by bone. Some biomaterials were more resorbable than others. Included are the histomorphometry clarified features of the newly formed bone around the different grafted particles.

CONCLUSION

All biomaterials examined resulted in being biocompatible and seemed to improve new bone formation in maxillary sinus lift. No signs of inflammation were present. The data are very encouraging because of the high number of successfully treated patients and the good quality of bone found in the retrieved specimens.

Some considerations on biomaterials and bone

Osteoinduction is a property not traditionally attributed to Calcium Phosphate ceramics. Histologic, SEM and X-ray microanalyses of a biopsy of pulmonary alveolar microlithiasis allow to discredit this opinion. Bone, even lamellar type, was ectopically formed on microliths undergoing osteoclastic erosion. The SEM and X-ray microanalyses of coral granules implanted in humans indicate an osteoconductive property for both Calcium and Phosphorus. Analysis of in vitro allows to propose an enhancement of the osteocapability of coral. Lamellar bone formation in the near absence of loads undermines the opinion which sees a correlation between lamellar bone and mechanical loads. Analysis of the bone surrounding an uncemented titanium hip prosthesis highlights that both remodeled and newly formed bone have lamellae oriented parallel to prosthesis surfaces, i.e. orthogonal to loads, as opposed to that of lamellar bone of osteons which are oriented parallel to loads. Analysis of longitudinal sections of cortical bone under polarized light points out that lamellae are displaced parallel to the cement line surface both in the conic end of osteons and in Volkman's canals with thick wall, i.e. undergoing sloped load directions. In conclusion, there may be a relationship between lamellae formation and gravity.

Calcium sulfate: analysis of MG63 osteoblast-like cell response by means of a microarray technology

Calcium sulfate (CaS) is an highly biocompatible material that has the characteristic of being one of the simplest as well as one of the synthetic bone-like graft with the longest clinical history, spanning more than 100 years. Solidified or crystallized CaS is very osteogenic in vivo. As the surface CaS dissolves in body fluid, the calcium ions form calcium phosphate that reprecipitates on the surface forming an osteoblast "friendly" environment. How this "friendly" environment alters osteoblast activity to promote bone formation is poorly understood. We therefore attempted to address this question by using microarray techniques to identified genes that are differently regulated in osteoblasts exposed to CaS. By using DNA microarrays containing 19,200 genes, we identified in osteoblast-like cells line (MG-63) cultured with CaS (Surgiplaster, Classimplant, Roma, Italy) several genes that expression was significantly upregulated. The differentially expressed genes cover a broad range of functional activities: (a) immunity, (b) lysosomal enzymes production, (c) cell cycle regulation, (d) and signaling transduction. It was also possible to detect some genes whose function is unknown. The data reported are, to our knowledge, the first genetic portrait of CaS effects. They can be relevant to better understand the molecular mechanism of bone regeneration and as a model for comparing other materials with similar clinical effects.

Fabrication of calcium sulfate/PLLA composite for bone repair

The bone-repairing composite material CS/PLLA was fabricated by mixing poly-L-lactic acid (PLLA) and calcium sulfate hemihydrate (CSH). The structure of the composite was analyzed with Infrared spectroscope, X-ray diffraction, and scanning electron microscope. The results indicated that the crystal pattern of calcium sulfate was affected by the addition of PLLA. PLLA part impacted the development of calcium sulfate dihydrate (CSD) crystal by slowing the conversion from CSH to CSD, so the composites are actually composed of CSH, CSD, and PLLA. The absorbing test in vitro showed that CS/PLLA composite absorbed more slowly than pure CS, suggesting the addition of PLLA can adjust the absorption rate of CS to meet different requirements. The pH value changes of the media had similar trends for different composites during the absorbing test of CS/PLLA samples in aqueous medium, which was connected to the absorption of calcium sulfate. The absorption of calcium sulfate in a certain time left a porous PLLA scaffold that will enable cells to further grow in. The surface of CS/PLLA pellets was inoculated with human osteoblasts, and the primary results showed that the osteoblasts could attach and spread on the surface, which will stimulate our desire for further study.

In vivo evaluation of resorbable bone graft substitutes in a rabbit tibial defect model

Calcium sulfate as a bone graft substitute is rapidly resorbed in vivo releasing calcium ions but fails to provide long-term three-dimensional framework to support osteoconduction. The setting properties of calcium sulfate however allow it to be applied in a slurry form making it easier to handle and apply in different situations. This study examines the in vivo response of calcium sulfate alone and as a carrier for a coralline hydroxyapatite in an established bilateral corticocancellous defect model in rabbits. Defects were filled flush to the anterior cortex with a resorbable porous ceramic alone and in combination with calcium sulfate slurry, calcium sulfate slurry alone or calcium sulfate pellets and examined at time points up to 52 weeks. Specimens where assessed using Faxitron X-ray, light and electron microscopy. Calcium sulfate in either slurry or pellet form does indeed support new bone formation alone however, complete filling of the bone defect is not observed. Calcium sulfate in slurry form does however improve the surgical handling of particulate bone graft substitutes such as Pro Osteon 200 R, which remained as an osteoconductive scaffold for up to 52 weeks and may have played an important role in the ultimate closure of the cortical windows.

Bone-defect healing with calcium-sulfate particles and cement: An experimental study in rabbit

Calcium sulfate (CaS) has been shown to be a reasonable alternative to autogenous bone graft for treating bone lesions in dentistry. The aim of this work was an histological study of the bone healing of defects treated with calcium sulfate in the form of cement or beads, in animal. Eight New Zealand rabbits, weighing about 2.5 Kg were used in this study. In each rabbit, four 6 mm bone defects were created in the tibial metaphysis. The 2 defects in the right tibia were filled with calcium sulfate as cement, while the 2 defects in the left one were filled with calcium sulfate as beads. Four rabbits were killed after respectively 2 and 4 weeks, with an intravenous injection of Tanax, and the block sections, containing the bone defects, were retrieved. A total of 16 defects filled by cement and a total of 16 defects filled by beads were retrieved. The specimens were processed to obtain thin ground sections with the Precise 1 Automated System. In the first phases of healing it was possible to observe an intense osteoblastic activity, and in some areas osteoid matrix was present. After two weeks the calcium sulfate (both cement and beads) was still present, and biological fluids and cells were present inside the material. Newly formed bone surrounded the calcium sulfate and filled about 10% of the defect. After four weeks the calcium sulfate was almost completely resorbed and substituted by new bone. Approximately 34% of the defects were filled by newly formed bone. BEI and XRM evaluations showed the structural components of the filled defects. In none of the specimens were inflammatory cells present. No significant differences were found using both calcium sulfate as cement and beads, and they both have shown a high biocompatibility, appearing to promote newly bone formation in the rabbit model, and they did not induce any untoward effect on the bone regeneration processes.

The influence of nacre surface and its modification on bone apposition: a bone development model in rats

BACKGROUND

Bone graft substitutes are currently used individually or in various combinations in reconstructing bone defects. Nacre, marine mineralized structure, was recently proposed as a very biocompatible and osteoinductive material for use in periodontal and implant surgery. Our aim was to investigate the interaction between natural nacre and fresh bone marrow, during bone development, in an ectopic site of DA rats. Surface modifications of nacre were tested.

METHODS

Demineralized bone matrix (DBM) cylinders (demineralized cortex of diaphysis) prepared from rat femurs were filled with fresh marrow, which was removed from other 2-month old DA rat femurs. Natural nacre particle or nacre which was treated with HCl, phosphate buffer saline (PBS), and Ca(OH)2 to modify its surface was placed into the DBM cylinders. The cylinders were implanted subcutaneously at the thoracic region of growing DA rats. After 4 weeks the cylinders were surgically removed, fixed in buffered formalin, and x-rayed. Scans of the microradiographs and histological evaluation of the DBM cylinders including bone developed at the interface of nacre and its surface modifications were compared to marrow controls.

RESULTS

The results show that natural nacre is a poor conductive biomaterial in a bone developmental environment. Nacre surface treated with Ca(OH)2 and PBS was found to be most biocompatible. In this group, new bone was apposed directly on the nacre surface and the total amount of bone was highest in comparison to other treatment groups.

CONCLUSIONS

This study does not support previous observations that nacre is osseoinductive. Our model system seems to be very sensitive and capable of testing interaction between surface modifications of biomaterials and fresh marrow in the process of new bone development.

Calcium sulphate as a bone substitute for various osseous defects in conjunction with apicectomy

AIM

The purpose of this study was to investigate the effect of calcium sulphate on various osseous defects when used in conjunction with apicectomy.

METHODOLOGY

Mandibular third and fourth premolars of 11 beagle dogs were used. After root-canal treatment and apicectomy, three types of osseous defects were prepared on both sides of the mandible as follows: type 1, osseous defect communicating with the gingival sulcus: type 2, large osseous defect including two roots; type 3, 'through and through' osseous defect. The experimental side was allocated randomly, and the osseous defects were filled with medical grade calcium sulphate. The defects on the opposite side were left unfilled as controls. The dogs were sacrificed at 8 and 16 weeks postoperatively. Undemineralized sections were obtained and examined histomorphometrically.

RESULTS

In type 1 defects, bone was not observed on the buccal side of the root on either experimental or control side at 8 and 16 weeks. In both type 2 and 3 defects, bone volume/tissue volume (BV/TV) values on the experimental side were significantly higher than those on the control side (P < 0.01), and mineral apposition rate (MAR) values on the experimental side were significantly higher than those on the control side (P < 0.01).

CONCLUSIONS

The use of calcium sulphate was effective in bone regeneration on both large osseous defects and 'through and through' osseous defects. It was less effective in osseous defects communicating with the gingival sulcus.

Fibrin glue as an osteoinductive protein in a mouse model

Fibrin sealant or fibrin glue (FG) has been found to be effective as a wound-healing substance in surgery. However, its role in bone fracture healing and osseous tissue response is not fully understood. This ambiguity questions the potential of FG as an inductive protein. The present study was undertaken to evaluate the osteoinductive property of FG when coated with calcium phosphate and glass ceramics and implanted in the extraskeletal site of male Swiss albino mice. Implant materials used for this study were hydroxyapatite (HA) porous granules (300-350 microm), bioactive glass system (BGS)-AW type and calcium phosphate calcium silicate system (HABGS) non-porous granules (300-350 microm). Uncoated granules (control) and coated granules with 2.5 mg FG and 5 mg FG were implanted in the quadriceps muscle of mice and sacrificed after 28 days. Histologically, HA, BGS and HABGS implanted animal groups showed good healing response. However, neo-osteogenesis was observed only in the BGS and HABGS granules impregnated with FG. Furthermore, bone formation was observed to be more conspicuous in 5 mg FG coated BGS and HABGS granules when compared with 2.5 mg FG coated BGS and HABGS granules. Fluorochrome labeling proved that mineralization had already started by day 15 with FG preadsorbed BGS and HABGS granules. On the contrary, the uncoated granules did not show any de novo bone formation. This experimental study provides an evidence of the positive role of FG as a potential osteoinductive biologic tissue adhesive.

Effects of organic matrix proteins on the interfacial structure at the bone-biocompatible nacre interface in vitro

The biocompatibility and potential osteoinductivity of nacre have favored its use as a bone-grafting material. The present study is to investigate the interfacial structure at the bone-nacre interface resulting from organic matrix proteins, which emphasizes the mechanism of bone-bonding ability and biocompatibility of the shell tissues such as nacre and biogenic calcite. To understand the interfacial reaction, the zeta potential measurements, provide for a unique method to quantify the actual state of the interface in situ, were used for synthetic and biogenic calcium carbonate suspensions with respect to pH and the organic matrix as an additive. The zeta potentials and surface charge density show that the organic matrix proteins are main charge regulators, resulting in the stabilized tissue properties as compared with synthetic crystals. Also, in forming calcium carbonate crystals with the additives, the conformation of organic matrix has an important role in the understanding of the newly formed interfacial structure. The result provides the primary role of the organic matrix proteins in controlling the formation of interfacial structure and biocompatibility with bone as well as the stability of biogenic tissues. And it gives a new insight into the usefulness of zeta potential measurement to describe the in vivo interaction between the bone and implants.

Resorption kinetics of eggshell: an in vivo study

Eggshell has been recently introduced as a bone substitute candidate in reconstructive surgery. The aim of this experimental study study was to determine its degradation rate in both a skeletal and extraskeletal site. In experiment 1, eggshell particles with four different sizes (50, 75, 150, and 300 microns in diameter) were implanted in subcutaneous pouches of 30 rats. In experiment 2, a fragment of ostrich eggshell was implanted on the nasal dorsum of 10 rats. Animals were sacrificed at 1 (N = 10), 2 (N = 10), and 4 months (N = 10) during the first stage of the study, and at 1 year during the second stage of the study. The results were assessed by X-ray examination and routine histological techniques. In experiment 1, all animals healed uneventfully. At 1 month, only 50-micron particles had undergone resorption. At 2 months, both 50- and 75-micron particles had undergone resorption. At 4 months, the 150- and 300-micron particles were resorbed incompletely. Histologically, the eggshell elicited a mild inflammatory reaction at 1 month that decreased progressively at further stages. In experiment 2, all animals except one healed uneventfully. Radiologically, the eggshell implant displayed a noticeable stability. Histologically, seven of nine implants were encapsulated, but two of them were surrounded by a bony rim. In conclusion, eggshell is a resorbable implant, but the degradation kinetic is size dependent. Large ostrich grafts are also suitable as onlay graft, but a complementary osteosynthesis is recommended to enhance osteointegration.

Bone cells and matrices in orthopedic tissue engineering

The ability to harvest and manipulate osteogenic cells gives clinicians the opportunity to harness capacity of these cells for targeted regeneration and repair of skeletal tissues. Further opportunities to optimize use of cells exist in the ability to design specialized matrices that act as conductive scaffolds. Realization of the full potential of engineered matrix materials and cell-matrix composites can provide new solutions to many clinical problems in skeletal reconstruction.

Addition of fibrin sealant to ceramic promotes bone repair: long-term study in rabbit femoral defect model

Despite their impact on the healing of soft connective tissue, fibrin sealants have not been shown conclusively to have an important role in the healing of bone defects. We report the positive influence of fibrin sealants on repair of cancellous bone cavities filled with a porous, resorbable ceramic. We studied two fibrin sealants: Autocolle and Tissucol. Autocolle is enriched in platelet factors during its preparation. Tissucol is a commercially available fibrin glue prepared from pooled human plasma that has no enrichment in platelet factors. Cavities 10 mm in depth and 5 mm in diameter were drilled in lateral condyles of 45 New Zealand rabbits. These defects were filled with either coral granules or a mixture of fibrin sealant (Autocolle or Tissucol) and coral granules or left empty. At 1 month addition of a fibrin sealant (Autocolle or Tissucol) to the coral led to a significant increase in bone formation in comparison to coral alone. At 2 months significant fibrin sealant mediated enhancement of bone repair was observed with Autocolle only. At 6 months bone formation was similar to the adult bone amount in nonoperated animals, whatever the initial material. Control cavities, on the other hand, were invaded with fibrous tissue only at each time period.

Tissue responses to natural aragonite (Margaritifera shell) implants in vivo

The purpose of this study was to access tissue reactions to the outer prismatic (prism) and the inner nacreous (nacre) layers of the fresh water Margaritifera shell. The materials, in granule form, were implanted into the back muscles and femurs of rats for 1, 2, 4, 8 and 16 weeks. In the back muscles, a foreign body reaction was observed around the implants, starting from one week after implantation and reaching maximal proportions at two weeks. After four weeks, a thin layer of fibrous tissue encapsulated the implanted particles. The external surface of the material stained strongly with acid fuchsin, indicating degradation of implant. At femoral sites, newly formed bone was directly applied to the implant surfaces. The outer-most parts of the organic sheets in prisms were not degraded until 16 weeks after implantation and were embedded in the newly formed bone. The interface between bone and the implants showed close fusion by scanning electron microscopy (SEM). Energy dispersive X-ray analysis (EDAX) demonstrated a phosphorous-rich zone in the interface between bone and the implants, and no electron-dense layer in the interface was found by transmission electron microscopy (TEM). We conclude that Margaritifera shells are biocompatible, biodegradable and osteoconductive materials. Bonding between this natural aragonite and bone seems to occur via a phosphorous-rich intermediate layer.

Coralline bone graft substitutes

Coralline porous ceramics are biocompatible and osteoconductive implants. They have proven to be effective as bone graft substitutes in large animal models and in humans. Bone and supporting soft tissue grow into and throughout their porosity if the implant is placed in direct apposition to viable bone and the interfaces are stabilized. The bone within the implant remodels in response to Wolff's law. Both the implant properties (chemistry and porosity) and the biologic environment modulate the rate of implant resorption. Composite technology with resorbable polymers can improve the mechanical properties of these ceramics.

Osteoconductive materials and their role as substitutes for autogenous bone grafts

The term osteoconduction applies to a three-dimensional process that is observed when porous structures are implanted into or adjacent to bone. Capillaries, perivascular tissues, and osteoprogenitor cells migrate into porous spaces and incorporate the porous structure with newly formed bone. The observed process is characterized by an initial ingrowth of fibrovascular tissue that invades the porous structure followed by the later development of new bone applied directly within it. This article reviews observations of commonly used osteoconductive matrices to increase understanding of this process.

Current understanding of osteoconduction in bone regeneration

Bone tissue is osteoconductive. In particular, cancellous bone with its porous and highly interconnected trabecular architecture allows easy ingrowth of surrounding tissues. When placed in an osseous environment, living tissue for the host bed migrates into the cancellous structure, which results in new bone formation and incorporation of that structure. This is the process of osteoconduction. The mineral and collagenous components of bone are osteoconductive. Osteoconduction also is observed in fabricated materials that have porosity similar to that of bone structure. Corallin ceramics, hydroxyapatite beads, and combinations of hydroxyapatite and collagen all have osteoconductive properties, and porous metals and biodegradable polymers. Osteoconduction appears to be optimized in devices that mimic not only bone structure, but also bone chemistry. The incorporation of calcium salts and collagen by osteoconductive matrices leads to more complete ingrowth with new bone formation.

Clinical and histological results in alveolar ridge enlargement using coralline calcium carbonate

A very important parameter during the insertion of dental implants is the amount of bone present in a site. A regenerative procedure to increase the width and the height of bone is proposed with the use of occlusive barrier membranes and biomaterials. The authors used, in six patients with deficient alveolar ridges, prior to implant insertion, Biocoral gel particles in connection with expanded polytetrafluoroethylene membranes. After 6 months it was observed that a tissue similar to mature bone had regenerated under the membrane and microscopically it was observed that the Biocoral particles were still present and almost all were completely surrounded by mature bone.

Hydroxyapatite and fluorapatite coatings for fixation of weight loaded implants

Survivor analysis of total hip replacement recently has shown disappointing results in younger patients. To improve this, ceramic coatings have been applied to prostheses for cementless use. A new fluorine containing coating, fluorapatite, has been shown to increase bone ingrowth compared with hydroxyapatite in unloaded models. In a weight loaded model, the effects of hydroxyapatite and fluorapatite coated implants on implant fixation and bone ingrowth were evaluated. Eight hydroxyapatite and fluorapatite coated implants with porous surface were inserted into the medial femoral condyles of 8 mature dogs in a paired design. The implants initially were surrounded by a gap communicating with the joint space and were loaded during each gait cycle. After 25 weeks, no differences in pushout data or bone ingrowth between hydroxyapatite and fluorapatite coated implants were found. An important finding was the absence of foreign body reaction in the bone. Neither hydroxyapatite nor fluorapatite coatings delaminated during implantation or as a result of the pushout test. Bone repair activity remained in the initial gap zone, but most of the bone was of the lamellar type. No difference in bone remodeling between the hydroxyapatite and fluorapatite coated implants was found in the initial gap zone. Microprobe analysis showed no increase in fluorine content around the fluorapatite coated implants. The hydroxyapatite and fluorapatite coatings seem efficacious after a 25-week implantation period under weight loaded conditions.

Adaptive crystal formation in normal and pathological calcifications in synthetic calcium phosphate and related biomaterials

Mineralization and crystal deposition are natural phenomena widely distributed in biological systems from protozoa to mammals. In mammals, normal and pathological calcifications are observed in bones, teeth, and soft tissues or cartilage. We review studies on the adaptive apatite crystal formation in enamel compared with those in other calcified tissues (e.g., dentin, bone, and fish enameloids) and in pathological calcifications, demonstrating the adaptation of these crystals (in terms of crystallinity and orientation) to specific tissues that vary in functions or vary in normal or diseased conditions. The roles of minor elements, such as carbonate, magnesium, fluoride, hydrogen phosphate, pyrophosphate, and strontium ions, on the formation and transformation of biologically relevant calcium phosphates are summarized. Another adaptative process of crystals in biology concerns the recent development of calcium phosphate ceramics and other related biomaterials for bone graft. Bone graft materials are available as alternatives to autogeneous bone for repair, substitution, or augmentation. This paper discusses the adaptive crystal formation in mineralized tissues induced by calcium phosphate and related bone graft biomaterials during bone repair.