Osteointegration of poly(L: -lactic acid)PLLA and poly(L: -lactic acid)PLLA/poly(ethylene oxide)PEO implants in rat tibiae

Synthetic Blocks for Bone Regeneration: A Systematic Review and Meta-Analysis

This systematic review is aimed at evaluating the effectiveness of synthetic block materials for bone augmentation in preclinical in vivo studies. An electronic search was performed on Pubmed, Scopus, EMBASE. Articles selected underwent risk-of-bias assessment. The outcomes were: new bone formation and residual graft with histomorphometry, radiographic bone density, soft tissue parameters, complications. Meta-analysis was performed to compare new bone formation in test (synthetic blocks) vs. control group (autogenous blocks or spontaneous healing). The search yielded 214 articles. After screening, 39 studies were included, all performed on animal models: rabbits (n = 18 studies), dogs (n = 4), rats (n = 7), minipigs (n = 4), goats (n = 4), and sheep (n = 2). The meta-analysis on rabbit studies showed significantly higher new bone formation for synthetic blocks with respect to autogenous blocks both at four-week (mean difference (MD): 5.91%, 95% confidence intervals (CI): 1.04, 10.79%, p = 0.02) and at eight-week healing (MD: 4.44%, 95% CI: 0.71, 8.17%, p = 0.02). Other animal models evidenced a trend for better outcomes with synthetic blocks, though only based on qualitative analysis. Synthetic blocks may represent a viable resource in bone regenerative surgery for achieving new bone formation. Differences in the animal models, the design of included studies, and the bone defects treated should be considered when generalizing the results. Clinical studies are needed to confirm the effectiveness of synthetic blocks in bone augmentation procedures.

The use of vancomycin-loaded poly-l-lactic acid and poly-ethylene oxide microspheres for bone repair: an in vivo study

OBJECTIVE

The aim of this study was to investigate bone repair after the implantation of vancomycin-loaded poly-L-lactic acid/poly-ethylene oxide microspheres compared with vancomycin-unloaded poly-L-lactic acid/poly-ethylene oxide microspheres.

METHODS

Poly-L-lactic acid/poly-ethylene oxide microspheres were implanted in rat tibiae and evaluated for periods of 2, 4, 8, and 12 days and 4, 8, 16, and 32 weeks. The groups implanted with vancomycin-loaded and vancomycin-unloaded microspheres were compared. Histopathologic (semi-quantitative) and histomorphometric analyses were performed to evaluate the bone formation process.

RESULTS

During the first period (second day), fibrin and hemorrhaging areas were observed to be replaced by granulation tissue around the microspheres. Woven bone formation with progressive maturation was observed. All of the histopathological findings, evaluated by a semi-quantitative assay and a quantitative analysis (percentage of bone formation), were similar between the two groups.

CONCLUSION

Vancomycin-loaded poly-L-lactic acid/poly-ethylene oxide microspheres are a good bone substitute candidate for bone repair. Local antibiotic therapy using vancomycin-loaded poly-L-lactic acid/poly-ethylene oxide microspheres should be considered after the microbiological evaluation of its efficacy.

A degradable soybean-based biomaterial used effectively as a bone filler in vivo in a rabbit

The 'gold standard' for bone filling is currently the bone autograft, but its use is limited by material availability and by the possible risks of infection or other donor site morbidity. Materials proposed so far as bone fillers do not show all the characteristics which are desirable. These are (a) osteoconductivity, (b) controlled biodegradation and (c) ease of adaptation to the implantation site. Recently, a new class of biodegradable material based on soybeans has been presented which shows good mechanical properties and an intrinsic bioactivity on inflammatory and tissue cells in vitro. The authors investigated the morphology in vivo of bone response in repairing a surgical lesion in the presence of granules of a novel soybean-based biomaterial (SB), comparing it with a sham-operated contralateral lesion of critical size (non-healing model); 26 operations were performed in New Zealand White rabbits, with back scattered electron microscopy as the analysis technique of choice. Implantation of SB granules over 8 weeks produced bone repair with features distinct from those obtained by healing in a non-treated defect. New and progressively maturing trabeculae appeared in the animal group where SB granules were implanted, while sham operation produced only a rim of pseudo-cortical bone still featuring a large defect. The trabeculae forming in the presence of SB granules had features typical of reticular bone. These findings suggest that the bone regeneration potential of SB granules and their intrinsic bioactivity, combined with their relatively easy and cost-effective preparation procedures, make them suitable candidates as a bone filler in clinical applications.