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Ninarello D, Ballardini A, Morozzi G, La Barbera L. A comprehensive systematic review of marketed bone grafts for load-bearing critical-sized bone defects. J Mech Behav Biomed Mater 2024; 160:106782. [PMID: 39488890 DOI: 10.1016/j.jmbbm.2024.106782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 10/04/2024] [Accepted: 10/14/2024] [Indexed: 11/05/2024]
Abstract
Treatment of critical-sized bone defects typically involves implantation of a bone graft. Various types of bone grafts are nowadays marketed, categorized by their origin as allografts, xenografts, or synthetic grafts. Despite their widespread use, a comprehensive understanding of their morphology and mechanical response remains elusive. Controlling these characteristics for promoting bone growth and ensuring mechanical resistance remains challenging, especially in load-bearing districts. This study aims to systematically review existing literature to delineate the principal morpho-mechanical characteristics of marketed bone grafts designed for load-bearing applications. Furthermore, the obtained data are organized and deeply discussed to find out the relationship between different graft characteristics. Among 196 documents identified through PRISMA guidelines, encompassing scientific papers and 510(k) documents, it was observed that a majority of marketed bone grafts exhibited porosity akin to bone (>60%) and mechanical properties resembling those of low-bone volume fraction trabecular bone. The present review underscores the dearth of information regarding the morpho-mechanical characteristics of bone grafts and the incomparability of data derived from different studies, due to the absence of suitable standards and guidelines. The need for new standards and complete and transparent morpho-mechanical characterization of marketed bone grafts is finally emphasized. Such an approach would enhance the comparability of data, aiding surgeons in selecting the optimal device to meet patient's needs.
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Affiliation(s)
- Davide Ninarello
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy.
| | | | | | - Luigi La Barbera
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy; IRCCS Galeazzi-Sant'Ambrogio Hospital, Milan, Italy.
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2
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Øvrebø Ø, Orlando L, Rubenis K, Ciriello L, Ma Q, Giorgi Z, Tognoni S, Loca D, Villa T, Nogueira LP, Rossi F, Haugen HJ, Perale G. The role of collagen and crystallinity in the physicochemical properties of naturally derived bone grafts. Regen Biomater 2024; 11:rbae093. [PMID: 39224130 PMCID: PMC11368411 DOI: 10.1093/rb/rbae093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 07/21/2024] [Accepted: 07/30/2024] [Indexed: 09/04/2024] Open
Abstract
Xenografts are commonly used for bone regeneration in dental and orthopaedic domains to repair bone voids and other defects. The first-generation xenografts were made through sintering, which deproteinizes them and alters their crystallinity, while later xenografts are produced using cold-temperature chemical treatments to maintain the structural collagen phase. However, the impact of collagen and the crystalline phase on physicochemical properties have not been elucidated. We hypothesized that understanding these factors could explain why the latter provides improved bone regeneration clinically. In this study, we compared two types of xenografts, one prepared through a low-temperature chemical process (Treated) and another subsequently sintered at 1100°C (Sintered) using advanced microscopy, spectroscopy, X-ray analysis and compressive testing. Our investigation showed that the Treated bone graft was free of residual blood, lipids or cell debris, mitigating the risk of pathogen transmission. Meanwhile, the sintering process removed collagen and the carbonate phase of the Sintered graft, leaving only calcium phosphate and increased mineral crystallinity. Microcomputed tomography revealed that the Treated graft exhibited an increased high porosity (81%) and pore size compared to untreated bone, whereas the Sintered graft exhibited shrinkage, which reduced the porosity (72%), pore size and strut size. Additionally, scanning electron microscopy displayed crack formation around the pores of the Sintered graft. The Treated graft displayed median mechanical properties comparable to native cancellous bone and clinically available solutions, with an apparent modulus of 166 MPa, yield stress of 5.5 MPa and yield strain of 4.9%. In contrast, the Sintered graft exhibited a lower median apparent modulus of 57 MPa. It failed in a brittle manner at a median stress of 1.7 MPa and strain level of 2.9%, demonstrating the structural importance of the collagen phase. This indicates why bone grafts prepared through cold-temperature processes are clinically favourable.
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Affiliation(s)
- Øystein Øvrebø
- Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, 20133 Milano, Italy
- Department of Biomaterials, Institute of Clinical Dentistry, University of Oslo, 0318 Oslo, Norway
- Material Biomimetic AS, 0349 Oslo, Norway
| | - Luca Orlando
- Industrie Biomediche Insubri SA, 6805 Mezzovico-Vira, Switzerland
- Orlando Engineering & Consulting Srl, 20094 Corsico, Italy
| | - Kristaps Rubenis
- Institute of Biomaterials and Bioengineering, Faculty of Natural Sciences and Technology, Riga Technical University, LV-1007 Riga, Latvia
- Baltic Biomaterials Centre of Excellence, Headquarters at Riga Technical University, Riga, Latvia
| | - Luca Ciriello
- Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, 20133 Milano, Italy
| | - Qianli Ma
- Department of Biomaterials, Institute of Clinical Dentistry, University of Oslo, 0318 Oslo, Norway
| | - Zoe Giorgi
- Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, 20133 Milano, Italy
| | - Stefano Tognoni
- Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, 20133 Milano, Italy
| | - Dagnija Loca
- Institute of Biomaterials and Bioengineering, Faculty of Natural Sciences and Technology, Riga Technical University, LV-1007 Riga, Latvia
- Baltic Biomaterials Centre of Excellence, Headquarters at Riga Technical University, Riga, Latvia
| | - Tomaso Villa
- Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, 20133 Milano, Italy
| | - Liebert P Nogueira
- Department of Biomaterials, Institute of Clinical Dentistry, University of Oslo, 0318 Oslo, Norway
- Oral Research Laboratory, Institute of Clinical Dentistry, University of Oslo, 0318 Oslo, Norway
| | - Filippo Rossi
- Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, 20133 Milano, Italy
| | - Håvard J Haugen
- Department of Biomaterials, Institute of Clinical Dentistry, University of Oslo, 0318 Oslo, Norway
- Material Biomimetic AS, 0349 Oslo, Norway
| | - Giuseppe Perale
- Industrie Biomediche Insubri SA, 6805 Mezzovico-Vira, Switzerland
- Faculty of Biomedical Sciences, University of Southern Switzerland, 6900 Lugano, Switzerland
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, 1200 Vienna, Austria
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Zhao X, Zhang Y, Wang P, Guan J, Zhang D. Construction of multileveled and oriented micro/nano channels in Mg doped hydroxyapitite bioceramics and their effect on mimicking mechanical property of cortical bone and biological performance of cancellous bone. BIOMATERIALS ADVANCES 2024; 161:213871. [PMID: 38692181 DOI: 10.1016/j.bioadv.2024.213871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 04/13/2024] [Accepted: 04/24/2024] [Indexed: 05/03/2024]
Abstract
Drawing on the structure and components of natural bone, this study developed Mg-doped hydroxyapatite (Mg-HA) bioceramics, characterized by multileveled and oriented micro/nano channels. These channels play a critical role in ensuring both mechanical and biological properties, making bioceramics suitable for various bone defects, particularly those bearing loads. Bioceramics feature uniformly distributed nanogrooves along the microchannels. The compressive strength or fracture toughness of the Mg-HA bioceramics with micro/nano channels formed by single carbon nanotube/carbon fiber (CNT/CF) (Mg-HA(05-CNT/CF)) are comparable to those of cortical bone, attributed to a combination of strengthened compact walls and microchannels, along with a toughening mechanism involving crack pinning and deflection at nanogroove intersections. The introduction of uniform nanogrooves also enhanced the porosity by 35.4 %, while maintaining high permeability owing to the capillary action in the oriented channels. This leads to superior degradation properties, protein adsorption, and in vivo osteogenesis compared with bioceramics with only microchannels. Mg-HA(05-CNT/CF) exhibited not only high strength and toughness comparable to cortical bone, but also permeability similar to cancellous bone, enhanced cell activity, and excellent osteogenic properties. This study presents a novel approach to address the global challenge of applying HA-based bioceramics to load-bearing bone defects, potentially revolutionizing their application in tissue engineering.
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Affiliation(s)
- Xueni Zhao
- College of Mechanical and Electrical Engineering, Shaanxi University of Science and Technology, Xi'an, Shaanxi 710021, PR China.
| | - Yu Zhang
- College of Mechanical and Electrical Engineering, Shaanxi University of Science and Technology, Xi'an, Shaanxi 710021, PR China
| | - Pengfei Wang
- College of Mechanical and Electrical Engineering, Shaanxi University of Science and Technology, Xi'an, Shaanxi 710021, PR China
| | - Jinxin Guan
- College of Mechanical and Electrical Engineering, Shaanxi University of Science and Technology, Xi'an, Shaanxi 710021, PR China
| | - Dexin Zhang
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, Shaanxi 710004, PR China.
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Strangis G, Labardi M, Gallone G, Milazzo M, Capaccioli S, Forli F, Cinelli P, Berrettini S, Seggiani M, Danti S, Parchi P. 3D Printed Piezoelectric BaTiO 3/Polyhydroxybutyrate Nanocomposite Scaffolds for Bone Tissue Engineering. Bioengineering (Basel) 2024; 11:193. [PMID: 38391679 PMCID: PMC10886384 DOI: 10.3390/bioengineering11020193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/03/2024] [Accepted: 02/12/2024] [Indexed: 02/24/2024] Open
Abstract
Bone defects are a significant health problem worldwide. Novel treatment approaches in the tissue engineering field rely on the use of biomaterial scaffolds to stimulate and guide the regeneration of damaged tissue that cannot repair or regrow spontaneously. This work aimed at developing and characterizing new piezoelectric scaffolds to provide electric bio-signals naturally present in bone and vascular tissues. Mixing and extrusion were used to obtain nanocomposites made of polyhydroxybutyrate (PHB) as a matrix and barium titanate (BaTiO3) nanoparticles as a filler, at BaTiO3/PHB compositions of 5/95, 10/90, 15/85 and 20/80 (w/w%). The morphological, thermal, mechanical and piezoelectric properties of the nanocomposites were studied. Scanning electron microscopy analysis showed good nanoparticle dispersion within the polymer matrix. Considerable increases in the Young's modulus, compressive strength and the piezoelectric coefficient d31 were observed with increasing BaTiO3 content, with d31 = 37 pm/V in 20/80 (w/w%) BaTiO3/PHB. 3D printing was used to produce porous cubic-shaped scaffolds using a 90° lay-down pattern, with pore size ranging in 0.60-0.77 mm and good mechanical stability. Biodegradation tests conducted for 8 weeks in saline solution at 37 °C showed low mass loss (∼4%) for 3D printed scaffolds. The results obtained in terms of piezoelectric, mechanical and chemical properties of the nanocomposite provide a new promising strategy for vascularized bone tissue engineering.
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Affiliation(s)
- Giovanna Strangis
- Department of Civil and Industrial Engineering, University of Pisa, Largo L. Lazzarino 2, 56122 Pisa, Italy
| | - Massimiliano Labardi
- Institute for Chemical and Physical Processes (IPCF), National Research Council (CNR), Pisa Research Area, Via Moruzzi 1, 56124 Pisa, Italy
| | - Giuseppe Gallone
- Department of Civil and Industrial Engineering, University of Pisa, Largo L. Lazzarino 2, 56122 Pisa, Italy
| | - Mario Milazzo
- Department of Civil and Industrial Engineering, University of Pisa, Largo L. Lazzarino 2, 56122 Pisa, Italy
| | - Simone Capaccioli
- Institute for Chemical and Physical Processes (IPCF), National Research Council (CNR), Pisa Research Area, Via Moruzzi 1, 56124 Pisa, Italy
- Department of Physics "Enrico Fermi", University of Pisa, Largo Pontecorvo 3, 56127 Pisa, Italy
| | - Francesca Forli
- Department of Surgical, Medical, Molecular Pathology and Emergency Medicine, University of Pisa, 56126 Pisa, Italy
| | - Patrizia Cinelli
- Department of Civil and Industrial Engineering, University of Pisa, Largo L. Lazzarino 2, 56122 Pisa, Italy
- Institute for Chemical and Physical Processes (IPCF), National Research Council (CNR), Pisa Research Area, Via Moruzzi 1, 56124 Pisa, Italy
| | - Stefano Berrettini
- Department of Surgical, Medical, Molecular Pathology and Emergency Medicine, University of Pisa, 56126 Pisa, Italy
| | - Maurizia Seggiani
- Department of Civil and Industrial Engineering, University of Pisa, Largo L. Lazzarino 2, 56122 Pisa, Italy
| | - Serena Danti
- Department of Civil and Industrial Engineering, University of Pisa, Largo L. Lazzarino 2, 56122 Pisa, Italy
- Institute for Chemical and Physical Processes (IPCF), National Research Council (CNR), Pisa Research Area, Via Moruzzi 1, 56124 Pisa, Italy
| | - Paolo Parchi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
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Götschi T, Hodel S, Kühne N, Bachmann E, Li X, Zimmermann SM, Snedeker JG, Fucentese SF. Osteoconductive Scaffold Placed at the Femoral Tunnel Aperture in Hamstring Tendon ACL Reconstruction: A Randomized Controlled Trial. Orthop J Sports Med 2023; 11:23259671231174478. [PMID: 37347015 PMCID: PMC10280525 DOI: 10.1177/23259671231174478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/22/2023] [Indexed: 06/23/2023] Open
Abstract
Background Bone tunnel enlargement after single-bundle anterior cruciate ligament reconstruction remains an unsolved problem that complicates revision surgery. Hypothesis Positioning of an osteoconductive scaffold at the femoral tunnel aperture improves graft-to-bone incorporation and thereby decreases bone tunnel widening. Study Design Randomized controlled trial; Level of evidence, 1. Methods In a 1:1 ratio, 56 patients undergoing primary anterior cruciate ligament reconstruction were randomized to receive femoral fixation with cortical suspension fixation and secondary press-fit fixation at the tunnel aperture of the tendon graft only (control) or with augmentation by an osteoconductive scaffold (intervention). Adverse events, patient-reported outcomes, and passive knee stability were recorded over 2 years after the index surgery. Three-dimensional bone tunnel widening was assessed using computed tomography at the time of surgery and 4.5 months and 1 year postoperatively. Results The intervention group exhibited a similar number of adverse events as the control group (8 vs 10; P = .775) including 2 partial reruptures in both groups. The approach was feasible, although 1 case was encountered where the osteoconductive scaffold was malpositioned without adversely affecting the patient's recovery. There was no difference between the intervention and control groups in femoral bone tunnel enlargement, as expressed by the relative change in tunnel volume from surgery to 4.5 months (mean ± SD, 36% ± 25% vs 40% ± 25%; P = .644) and 1 year (19% ± 20% vs 17% ± 25%; P =.698). Conclusion Press-fit graft fixation with an osteoconductive scaffold positioned at the femoral tunnel aperture is safe but does not decrease femoral bone tunnel enlargement at postoperative 1 year. Registration NCT03462823 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Tobias Götschi
- Department of Orthopaedics, Balgrist
University Hospital, University of Zurich, Zurich, Switzerland
- Institute for Biomechanics, ETH Zurich,
Zurich, Switzerland
| | - Sandro Hodel
- Department of Orthopaedics, Balgrist
University Hospital, University of Zurich, Zurich, Switzerland
| | - Nathalie Kühne
- Department of Orthopaedics, Balgrist
University Hospital, University of Zurich, Zurich, Switzerland
| | | | - Xiang Li
- ZuriMED Technologies AG, Zurich,
Switzerland
| | - Stefan M. Zimmermann
- Department of Orthopaedics, Balgrist
University Hospital, University of Zurich, Zurich, Switzerland
| | - Jess G. Snedeker
- Department of Orthopaedics, Balgrist
University Hospital, University of Zurich, Zurich, Switzerland
- Institute for Biomechanics, ETH Zurich,
Zurich, Switzerland
| | - Sandro F. Fucentese
- Department of Orthopaedics, Balgrist
University Hospital, University of Zurich, Zurich, Switzerland
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Zhou G, Wang F, Lin G, Tang B, Li X, Ding X, Wang W, Zhang J, Shi Y. Novel coatings for the continuous repair of human bone defects. Colloids Surf B Biointerfaces 2023; 222:113127. [PMID: 36610365 DOI: 10.1016/j.colsurfb.2023.113127] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/29/2022] [Accepted: 01/02/2023] [Indexed: 01/06/2023]
Abstract
Bone defects are the second most common tissue grafts after blood. However, bone grafts face several problems, such as bone scaffolds, which have low bioactivity and are prone to corrosion. Much of the current research on bone scaffolds is focused on the mechanical aspects such as structure and strength. Surface modification of the bone scaffold is carried out in terms of the mechanical structure or structural design of the bone scaffold with reference to a bionic structure. However, with the development of mechanical designs, materials science, and medicine, many studies have reported that promoting bone growth by modifying the structure of the scaffold or coating is not possible. Therefore, the application of a bioactive coating to the surface of the bone scaffold is particularly important to generate a synergistic effect between the structure and active coating. In this article, we present several perspectives to improve the bioactivity of bone scaffolds, including corrosion resistance, loading of bioactive coatings or drugs on bone scaffolds, improved adhesion to the surface of the bone scaffolds, immune response modulation, and drawing on bionic structures during manufacturing.
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Affiliation(s)
- Guangzhen Zhou
- School of Mechanical Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, China; Shandong Institute of Mechanical Design and Research, Jinan 250031, China.
| | - Fei Wang
- School of Mechanical Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, China; Shandong Institute of Mechanical Design and Research, Jinan 250031, China.
| | - Guimei Lin
- School of Pharmaceutical Science, Shandong University, Jinan 250012, China.
| | - Bingtao Tang
- School of Mechanical Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, China; Shandong Institute of Mechanical Design and Research, Jinan 250031, China.
| | - Xuelin Li
- School of Arts and Design, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, China.
| | - Xinbing Ding
- School of Mechanical Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, China; Shandong Institute of Mechanical Design and Research, Jinan 250031, China.
| | - Wenguang Wang
- School of Mechanical Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, China; Shandong Institute of Mechanical Design and Research, Jinan 250031, China.
| | - Jing Zhang
- Key Laboratory of Modern Preparation of TCM, Jiangxi University of Chinese Medicine, Nanchang 330004, China.
| | - Yanbin Shi
- School of Mechanical Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, China; Shandong Institute of Mechanical Design and Research, Jinan 250031, China; School of Arts and Design, Qilu University of Technology (Shandong Academy of Sciences), Jinan 250353, China.
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7
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A composite, off-the-shelf osteoinductive material for large, vascularized bone flap prefabrication. Acta Biomater 2022; 154:641-649. [PMID: 36261107 DOI: 10.1016/j.actbio.2022.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 12/14/2022]
Abstract
We previously described an immortalized, genetically-engineered human Mesenchymal stromal cell line to generate BMP2-enriched Chondrogenic Matrices (MB-CM), which after devitalization and storage could efficiently induce ectopic bone tissue by endochondral ossification. In order to increase the efficiency of MB-CM utilization towards engineering scaled-up bone structures, here we hypothesized that MB-CM can retain osteoinductive properties when combined with an osteoconductive material. We first tested different volumetric ratios of MB-CM:SmartBone® (as clinically used, osteoconductive reference material) and assessed the bone formation capacity of the resulting composites following ectopic mouse implantation. After 8 weeks, as little as 25% of MB-CM was sufficient to induce bone formation and fusion across SmartBone® granules, generating large interconnected bony structures. The same composite percentage was then further assessed in a scaled-up model, namely within an axially-vascularized, confined, ectopically prefabricated flap (0.8 cm3) in rats. The material efficiently induced the formation of new bone (31% of the cross-sectional area after 8 weeks), including bone marrow and vascular elements, throughout the flap volume. Our findings outline a strategy for efficient use of MB-CM as part of a composite material, thereby reducing the amount required to fill large spaces and enabling utilization in critically sized grafts, to address challenging clinical scenarios in bone reconstruction. STATEMENT OF SIGNIFICANCE: Most bone repair strategies rely either on osteconductive properties of ceramics and devitalized bone, or osteoinductive properties of growth factors and extracellular matrices (ECM). Here we designed a composite material made of a clinically accepted osteoconductive material and an off-the-shelf tissue engineered human cartilage ECM with strong osteoinductive properties. We showed that low amount of osteoinductive ECM potentiated host cells recruitment to form large vascularized bone structures in two different animal models, one being a challenging prefabricated bone-flap model targeting challenging clinical bone repair. Overall, this study highlights the use of a promising human off-the-shelf material for accelerated healing towards clinical applications.
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Ansari MAA, Golebiowska AA, Dash M, Kumar P, Jain PK, Nukavarapu SP, Ramakrishna S, Nanda HS. Engineering biomaterials to 3D-print scaffolds for bone regeneration: practical and theoretical consideration. Biomater Sci 2022; 10:2789-2816. [PMID: 35510605 DOI: 10.1039/d2bm00035k] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
There are more than 2 million bone grafting procedures performed annually in the US alone. Despite significant efforts, the repair of large segmental bone defects is a substantial clinical challenge which requires bone substitute materials or a bone graft. The available biomaterials lack the adequate mechanical strength to withstand the static and dynamic loads while maintaining sufficient porosity to facilitate cell in-growth and vascularization during bone tissue regeneration. A wide range of advanced biomaterials are being currently designed to mimic the physical as well as the chemical composition of a bone by forming polymer blends, polymer-ceramic and polymer-degradable metal composites. Transforming these novel biomaterials into porous and load-bearing structures via three-dimensional printing (3DP) has emerged as a popular manufacturing technique to develop engineered bone grafts. 3DP has been adopted as a versatile tool to design and develop bone grafts that satisfy porosity and mechanical requirements while having the ability to form grafts of varied shapes and sizes to meet the physiological requirements. In addition to providing surfaces for cell attachment and eventual bone formation, these bone grafts also have to provide physical support during the repair process. Hence, the mechanical competence of the 3D-printed scaffold plays a key role in the success of the implant. In this review, we present various recent strategies that have been utilized to design and develop robust biomaterials that can be deployed for 3D-printing bone substitutes. The article also reviews some of the practical, theoretical and biological considerations adopted in the 3D-structure design and development for bone tissue engineering.
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Affiliation(s)
- Mohammad Aftab Alam Ansari
- Biomedical Engineering and Technology Lab, Mechanical engineering discipline, PDPM Indian Institute of Information Technology, Design & Manufacturing Jabalpur, India.
- FFF Laboratory, Mechanical engineering discipline, PDPM Indian Institute of Information Technology, Design & Manufacturing Jabalpur, India.
- International Centre for Sustainable and Net Zero Technologies, PDPM-Indian Institute of Information Technology Design and Manufacturing (IIITDM) Jabalpur, Dumna Airport Road, Jabalpur-482005, MP, India
| | - Aleksandra A Golebiowska
- Biomedical Engineering, Materials Science & Engineering, and Orthopaedic Surgery, University of Connecticut, 260 Glenbrook Road, Unit 3247 Storrs, CT, 06269, USA
| | - Madhusmita Dash
- School of Minerals, Metallurgical and Materials Engineering, Indian Institute of Technology Bhubaneswar, Arugul, Khurdha 752050, Odisha, India
- International Centre for Sustainable and Net Zero Technologies, PDPM-Indian Institute of Information Technology Design and Manufacturing (IIITDM) Jabalpur, Dumna Airport Road, Jabalpur-482005, MP, India
| | - Prasoon Kumar
- Biodesign and Medical device laboratory, Department of Biotechnology and Medical Engineering, National Institute of Technology, Rourkela, 769008, Odisha, India.
| | - Prashant Kumar Jain
- FFF Laboratory, Mechanical engineering discipline, PDPM Indian Institute of Information Technology, Design & Manufacturing Jabalpur, India.
| | - Syam P Nukavarapu
- Biomedical Engineering, Materials Science & Engineering, and Orthopaedic Surgery, University of Connecticut, 260 Glenbrook Road, Unit 3247 Storrs, CT, 06269, USA
| | - Seeram Ramakrishna
- Centre for Nanofibers and Nanotechnology, Department of Mechanical Engineering, National University of Singapore, Engineering Drive 3, Singapore 117587, Singapore
| | - Himansu Sekhar Nanda
- Biomedical Engineering and Technology Lab, Mechanical engineering discipline, PDPM Indian Institute of Information Technology, Design & Manufacturing Jabalpur, India.
- International Centre for Sustainable and Net Zero Technologies, PDPM-Indian Institute of Information Technology Design and Manufacturing (IIITDM) Jabalpur, Dumna Airport Road, Jabalpur-482005, MP, India
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9
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Lei T, Qian H, Nan J, Hu Y, Lei P. The optimization of pepsin processing time to balance the mechanical and biological properties of xenogeneic bone. J Biomed Mater Res B Appl Biomater 2021; 110:403-411. [PMID: 34309189 DOI: 10.1002/jbm.b.34916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 11/07/2022]
Abstract
Xenogeneic bone showed great prospects to treat large bone defects due to its bionic composition and structure, but the immunogenicity limited its wide applications. Previously, we developed a pepsin treating method to eliminate the immunogenicity of xenogeneic bone. In this study, we further investigated the effect of pepsin processing time on the biological and mechanical properties. The results indicated that increased pepsin treating time impaired the mechanical properties of xenogeneic bone. And MC3T3-E1 cells showed enhanced adhesion ability, as well as increased production of alkaline phosphatase and calcium nodulus production on the xenogeneic bone processed by pepsin for 24 hr (P24), as compared with xenogeneic bone processed by pepsin for 30 hr (P30) and 36 hr (P36). In addition, we found no significant inflammatory responses after implanting different xenogeneic bone into the intermuscular site of rats. These results suggested that xenogeneic bone processed by pepsin for 24 hr may be a preferable choice when using the xenogeneic bone as biomaterials for further researches.
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Affiliation(s)
- Ting Lei
- Department of Orthopeadic Surgery, Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, Xiangya Hospital Central South University
| | - Hu Qian
- Department of Orthopeadic Surgery, Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, Xiangya Hospital Central South University
| | - Jiangyu Nan
- Department of Orthopeadic Surgery, Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, Xiangya Hospital Central South University
| | - Yihe Hu
- Department of Orthopeadic Surgery, Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, Xiangya Hospital Central South University.,Department of Sports Medicine, Xiangya Hospital Central South University
| | - Pengfei Lei
- Department of Orthopeadic Surgery, Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, Xiangya Hospital Central South University
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10
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Commercial Bone Grafts Claimed as an Alternative to Autografts: Current Trends for Clinical Applications in Orthopaedics. MATERIALS 2021; 14:ma14123290. [PMID: 34198691 PMCID: PMC8232314 DOI: 10.3390/ma14123290] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 02/08/2023]
Abstract
In the last twenty years, due to an increasing medical and market demand for orthopaedic implants, several grafting options have been developed. However, when alternative bone augmentation materials mimicking autografts are searched on the market, commercially available products may be grouped into three main categories: cellular bone matrices, growth factor enhanced bone grafts, and peptide enhanced xeno-hybrid bone grafts. Firstly, to obtain data for this review, the search engines Google and Bing were employed to acquire information from reports or website portfolios of important competitors in the global bone graft market. Secondly, bibliographic databases such as Medline/PubMed, Web of Science, and Scopus were also employed to analyse data from preclinical/clinical studies performed to evaluate the safety and efficacy of each product released on the market. Here, we discuss several products in terms of osteogenic/osteoinductive/osteoconductive properties, safety, efficacy, and side effects, as well as regulatory issues and costs. Although both positive and negative results were reported in clinical applications for each class of products, to date, peptide enhanced xeno-hybrid bone grafts may represent the best choice in terms of risk/benefit ratio. Nevertheless, more prospective and controlled studies are needed before approval for routine clinical use.
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11
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Zhao R, Yang R, Cooper PR, Khurshid Z, Shavandi A, Ratnayake J. Bone Grafts and Substitutes in Dentistry: A Review of Current Trends and Developments. Molecules 2021; 26:3007. [PMID: 34070157 PMCID: PMC8158510 DOI: 10.3390/molecules26103007] [Citation(s) in RCA: 216] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/29/2021] [Accepted: 05/13/2021] [Indexed: 02/07/2023] Open
Abstract
After tooth loss, bone resorption is irreversible, leaving the area without adequate bone volume for successful implant treatment. Bone grafting is the only solution to reverse dental bone loss and is a well-accepted procedure required in one in every four dental implants. Research and development in materials, design and fabrication technologies have expanded over the years to achieve successful and long-lasting dental implants for tooth substitution. This review will critically present the various dental bone graft and substitute materials that have been used to achieve a successful dental implant. The article also reviews the properties of dental bone grafts and various dental bone substitutes that have been studied or are currently available commercially. The various classifications of bone grafts and substitutes, including natural and synthetic materials, are critically presented, and available commercial products in each category are discussed. Different bone substitute materials, including metals, ceramics, polymers, or their combinations, and their chemical, physical, and biocompatibility properties are explored. Limitations of the available materials are presented, and areas which require further research and development are highlighted. Tissue engineering hybrid constructions with enhanced bone regeneration ability, such as cell-based or growth factor-based bone substitutes, are discussed as an emerging area of development.
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Affiliation(s)
- Rusin Zhao
- Department of Oral Science, Faculty of Dentistry, University of Otago, 310 Great King Street, Dunedin 9016, New Zealand; (R.Z.); (R.Y.); (P.R.C.)
| | - Ruijia Yang
- Department of Oral Science, Faculty of Dentistry, University of Otago, 310 Great King Street, Dunedin 9016, New Zealand; (R.Z.); (R.Y.); (P.R.C.)
| | - Paul R. Cooper
- Department of Oral Science, Faculty of Dentistry, University of Otago, 310 Great King Street, Dunedin 9016, New Zealand; (R.Z.); (R.Y.); (P.R.C.)
| | - Zohaib Khurshid
- Department of Prosthodontics and Dental Implantology, College of Dentistry, King Faisal University, Al-Ahsa 31982, Saudi Arabia;
| | - Amin Shavandi
- BioMatter Unit—École Polytechnique de Bruxelles, Université Libre de Bruxelles (ULB), Avenue F.D. Roosevelt, 50—CP 165/61, 1050 Brussels, Belgium;
| | - Jithendra Ratnayake
- Department of Oral Science, Faculty of Dentistry, University of Otago, 310 Great King Street, Dunedin 9016, New Zealand; (R.Z.); (R.Y.); (P.R.C.)
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12
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Poly(vinyl alcohol)/Gelatin Scaffolds Allow Regeneration of Nasal Tissues. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11083651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Need for regeneration and repair of nasal tissues occurs as a consequence of several pathologies affecting the nose, including, but not limited to infective diseases, traumas and tumor resections. A platform for nasal tissue regeneration was set up using poly(vinyl alcohol)/gelatin sponges with 20%–30% (w/w) gelatin content to be used as scaffolds, for their intrinsic hydrophilic, cell adhesive and shape recovery properties. We propose mesodermal progenitor cells (MPCs) isolated from the bone marrow as a unique stem cell source for obtaining different connective tissues of the nose, including vascular tissue. Finally, epithelial cell immune response to these scaffolds was assessed in vitro in an environment containing inflammatory molecules. The results showed that mesenchymal stromal cells (MSCs) deriving from MPCs could be used to differentiate into cartilage and fibrous tissue; whereas, in combination with endothelial cells still deriving from MPCs, into pre-vascularized bone. Finally, the scaffold did not significantly alter the epithelial cell response to inflammatory insults derived from interaction with bacterial molecules.
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Bari E, Roato I, Perale G, Rossi F, Genova T, Mussano F, Ferracini R, Sorlini M, Torre ML, Perteghella S. Biohybrid Bovine Bone Matrix for Controlled Release of Mesenchymal Stem/Stromal Cell Lyosecretome: A Device for Bone Regeneration. Int J Mol Sci 2021; 22:4064. [PMID: 33920046 PMCID: PMC8071018 DOI: 10.3390/ijms22084064] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/08/2021] [Accepted: 04/13/2021] [Indexed: 02/06/2023] Open
Abstract
SmartBone® (SB) is a biohybrid bone substitute advantageously proposed as a class III medical device for bone regeneration in reconstructive surgeries (oral, maxillofacial, orthopedic, and oncology). In the present study, a new strategy to improve SB osteoinductivity was developed. SB scaffolds were loaded with lyosecretome, a freeze-dried formulation of mesenchymal stem cell (MSC)-secretome, containing proteins and extracellular vesicles (EVs). Lyosecretome-loaded SB scaffolds (SBlyo) were prepared using an absorption method. A burst release of proteins and EVs (38% and 50% after 30 min, respectively) was observed, and then proteins were released more slowly with respect to EVs, most likely because they more strongly adsorbed onto the SB surface. In vitro tests were conducted using adipose tissue-derived stromal vascular fraction (SVF) plated on SB or SBlyo. After 14 days, significant cell proliferation improvement was observed on SBlyo with respect to SB, where cells filled the cavities between the native trabeculae. On SB, on the other hand, the process was still present, but tissue formation was less organized at 60 days. On both scaffolds, cells differentiated into osteoblasts and were able to mineralize after 60 days. Nonetheless, SBlyo showed a higher expression of osteoblast markers and a higher quantity of newly formed trabeculae than SB alone. The quantification analysis of the newly formed mineralized tissue and the immunohistochemical studies demonstrated that SBlyo induces bone formation more effectively. This osteoinductive effect is likely due to the osteogenic factors present in the lyosecretome, such as fibronectin, alpha-2-macroglobulin, apolipoprotein A, and TGF-β.
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Affiliation(s)
- Elia Bari
- Department of Drug Sciences, University of Pavia, Viale Taramelli 12, I-27100 Pavia, Italy; (E.B.); (S.P.)
| | - Ilaria Roato
- Department of Surgical Sciences, CIR-Dental School, University of Torino, Via Nizza 230, I-10126 Torino, Italy; (I.R.); (F.M.)
| | - Giuseppe Perale
- Industrie Biomediche Insubri SA, Via Cantonale 67, CH-6805 Mezzovico-Vira, Switzerland;
- Faculty of Biomedical Sciences, University of Southern Switzerland (USI), Via G. Buffi 13, CH-6900 Lugano, Switzerland
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstrasse 13, A-1200 Vienna, Austria
| | - Filippo Rossi
- Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Via Mancinelli 7, I-20131 Milano, Italy;
| | - Tullio Genova
- Department of Life Sciences and Systems Biology, University of Torino, Via Accademia Albertina 13, I-10123 Torino, Italy;
| | - Federico Mussano
- Department of Surgical Sciences, CIR-Dental School, University of Torino, Via Nizza 230, I-10126 Torino, Italy; (I.R.); (F.M.)
| | - Riccardo Ferracini
- Department of Surgical Sciences and Integrated Diagnostics, University of Genova, Viale Benedetto XV 6, I-16132 Genova, Italy;
| | - Marzio Sorlini
- SUPSI—Department of Innovative Technologies, Lugano University Centre, Campus Est, Via la Santa 1, CH-6962 Viganello, Switzerland;
- PharmaExceed Srl, Piazza Castello 19, I-27100 Pavia, Italy
| | - Maria Luisa Torre
- Department of Drug Sciences, University of Pavia, Viale Taramelli 12, I-27100 Pavia, Italy; (E.B.); (S.P.)
- PharmaExceed Srl, Piazza Castello 19, I-27100 Pavia, Italy
| | - Sara Perteghella
- Department of Drug Sciences, University of Pavia, Viale Taramelli 12, I-27100 Pavia, Italy; (E.B.); (S.P.)
- PharmaExceed Srl, Piazza Castello 19, I-27100 Pavia, Italy
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14
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Zhu H, Blahnová VH, Perale G, Xiao J, Betge F, Boniolo F, Filová E, Lyngstadaas SP, Haugen HJ. Xeno-Hybrid Bone Graft Releasing Biomimetic Proteins Promotes Osteogenic Differentiation of hMSCs. Front Cell Dev Biol 2020; 8:619111. [PMID: 33415112 PMCID: PMC7784409 DOI: 10.3389/fcell.2020.619111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/30/2020] [Indexed: 01/04/2023] Open
Abstract
Bone defect is a noteworthy health problem and is the second most transplanted tissue after blood. Numerous bone grafts are designed and applied in clinics. Limitations, however, from different aspects still exist, including limited supply, mechanical strength, and bioactivity. In this study, two biomimetic peptides (P2 and P6) are incorporated into a composite bioactive xeno hybrid bone graft named SmartBonePep®, with the aim to increase the bioactivity of the bone graft. The results, which include cytotoxicity, proliferation rate, confocal microscopy, gene expression, and protein qualification, successfully prove that the SmartBonePep® has multi-modal biological effects on human mesenchymal stem cells from bone marrow. The effective physical entrapment of P6 into a composite xeno-hybrid bone graft, withstanding manufacturing processes including exposure to strong organic solvents and ethylene oxide sterilization, increases the osteogenic potential of the stem cells as well as cell attachment and proliferation. P2 and P6 both show a strong biological potential and may be future candidates for enhancing the clinical performance of bone grafts.
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Affiliation(s)
- Hao Zhu
- Department of Orthopedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Veronika Hefka Blahnová
- Department of Tissue Engineering, Institute of Experimental Medicine of the Czech Academy of Sciences, Prague, Czechia
- Department of Biophysics, Second Faculty of Medicine, Charles University, Prague, Czechia
| | - Giuseppe Perale
- Industrie Biomediche Insubri S.A., Mezzovico-Vira, Switzerland
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
- Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland
| | - Jun Xiao
- Department of Orthopedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Felice Betge
- Industrie Biomediche Insubri S.A., Mezzovico-Vira, Switzerland
| | - Fabio Boniolo
- Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH), Neuherberg, Germany
| | - Eva Filová
- Department of Tissue Engineering, Institute of Experimental Medicine of the Czech Academy of Sciences, Prague, Czechia
- Department of Biophysics, Second Faculty of Medicine, Charles University, Prague, Czechia
| | - Ståle Petter Lyngstadaas
- Corticalis AS, Oslo, Norway
- Department of Biomaterials, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Håvard Jostein Haugen
- Corticalis AS, Oslo, Norway
- Department of Biomaterials, Faculty of Dentistry, University of Oslo, Oslo, Norway
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15
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Ferracini R, Bistolfi A, Guidotti C, Artiaco S, Battista A, Battiston B, Perale G. Bone Loss in Distal Radial Fractures Treated with A Composite Xenohybrid Bone Substitute: A Two Years Follow-Up Retrospective Study. MATERIALS (BASEL, SWITZERLAND) 2020; 13:E4040. [PMID: 32933036 PMCID: PMC7558122 DOI: 10.3390/ma13184040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/28/2020] [Accepted: 09/04/2020] [Indexed: 11/30/2022]
Abstract
(1) Background: Recently, surgical treatment of distal radius fractures has increased exponentially. Many locking plates' fixation systems have been developed allowing a more stable reduction and early mobilization. Sometimes, open reduction and fixation of distal radius fractures may leave a residual bone loss requiring grafting. This retrospective study reports clinical and radiologic outcomes of distal radius fractures treated with xenohybrid bone grafting in order to assess (i) the safety of the investigated bone graft; (ii) its radiological integration and biomechanical performances, and (iii) clinical outcomes of the patients; (2) Methods: We performed a retrospective study on a cohort of 19 patients. Preoperative X-ray and CT scan were performed. The mean clinical and radiographical follow-up was two years. Safety of the xenohybrid bone graft was constantly evaluated. Clinical results were assessed through the DASH score and Mayo wrist score; (3) Results: No adverse reactions, infections, and local or general complication were related to the use of xenohybrid bone graft. The radiolucency of the xenografts suggested progressive osteointegration. No evidence of bone graft resorption was detected. All the patients reached consolidation with good to excellent clinical results; and (4) Conclusions: Clinical and radiological data demonstrated that xenohybrid bone grafting promotes new bone formation and healing in osteopenic areas caused by fracture reduction.
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Affiliation(s)
- Riccardo Ferracini
- Department of Surgical Sciences and Integrated Diagnostics, University of Genova, Viale Benedetto XV n6, 16132 Genova, Italy
| | - Alessandro Bistolfi
- Department of Traumatology and Rehabilitation, C.T.O. Hospital-A.O.U. Città della Salute e della Scienza, Via Zuretti 29, 10126 Turin, Italy; (A.B.); (S.A.); (B.B.)
| | - Claudio Guidotti
- Medical School, University of Turin, 10100 Turin, Italy; (C.G.); (A.B.)
| | - Stefano Artiaco
- Department of Traumatology and Rehabilitation, C.T.O. Hospital-A.O.U. Città della Salute e della Scienza, Via Zuretti 29, 10126 Turin, Italy; (A.B.); (S.A.); (B.B.)
| | - Agnese Battista
- Medical School, University of Turin, 10100 Turin, Italy; (C.G.); (A.B.)
| | - Bruno Battiston
- Department of Traumatology and Rehabilitation, C.T.O. Hospital-A.O.U. Città della Salute e della Scienza, Via Zuretti 29, 10126 Turin, Italy; (A.B.); (S.A.); (B.B.)
| | - Giuseppe Perale
- Industrie Biomediche Insubri S.A., Via Cantonale 67, 6805 Mezzovico-Vira, Switzerland;
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3D printing of silk microparticle reinforced polycaprolactone scaffolds for tissue engineering applications. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 118:111433. [PMID: 33255027 DOI: 10.1016/j.msec.2020.111433] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 12/13/2022]
Abstract
Polycaprolactone (PCL) scaffolds have been widely investigated for tissue engineering applications, however, they exhibit poor cell adhesion and mechanical properties. Subsequently, PCL composites have been produced to improve the material properties. This study utilises a natural material, Bombyx mori silk microparticles (SMP) prepared by milling silk fibre, to produce a composite to enhance the scaffolds properties. Silk is biocompatible and biodegradable with excellent mechanical properties. However, there are no studies using SMPs as a reinforcing agent in a 3D printed thermoplastic polymer scaffold. PCL/SMP (10, 20, 30 wt%) composites were prepared by melt blending. Rheological analysis showed that SMP loading increased the shear thinning and storage modulus of the material. Scaffolds were fabricated using a screw-assisted extrusion-based additive manufacturing system. Scanning electron microscopy and X-ray microtomography was used to determine scaffold morphology. The scaffolds had high interconnectivity with regular printed fibres and pore morphologies within the designed parameters. Compressive mechanical testing showed that the addition of SMP significantly improved the compressive Young's modulus of the scaffolds. The scaffolds were more hydrophobic with the inclusion of SMP which was linked to a decrease in total protein adsorption. Cell behaviour was assessed using human adipose derived mesenchymal stem cells. A cytotoxic effect was observed at higher particle loading (30 wt%) after 7 days of culture. By day 21, 10 wt% loading showed significantly higher cell metabolic activity and proliferation, high cell viability, and cell migration throughout the scaffold. Calcium mineral deposition was observed on the scaffolds during cell culture. Large calcium mineral deposits were observed at 30 wt% and smaller calcium deposits were observed at 10 wt%. This study demonstrates that SMPs incorporated into a PCL scaffold provided effective mechanical reinforcement, improved the rate of degradation, and increased cell proliferation, demonstrating potential suitability for bone tissue engineering applications.
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Boffano M, Ratto N, Conti A, Pellegrino P, Rossi L, Perale G, Piana R. A Preliminary Study on the Mechanical Reliability and Regeneration Capability of Artificial Bone Grafts in Oncologic Cases, With and Without Osteosynthesis. J Clin Med 2020; 9:jcm9051388. [PMID: 32397222 PMCID: PMC7291150 DOI: 10.3390/jcm9051388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/01/2020] [Accepted: 05/05/2020] [Indexed: 12/25/2022] Open
Abstract
Several bone grafts are available for clinical use, each with their own peculiar biological and mechanical properties. A new bone graft was obtained by combining mineral structures from natural bovine bones with bioresorbable polymers and cellular nutrients. The study aims to evaluate the clinical, biological and structural properties of this bone graft and its reliability in orthopedic oncology. 23 adult patients (age range 18–85 years) were treated between October 2016 and December 2018; the oncologicdiagnoses were heterogeneous. After surgical curettage and bone grafting, a clinical-radiological follow up was conducted. Radiographs were used to evaluate graft integration according to the usual bone healing and oncologic follow up. Local complications (infection, local recurrence, wound dehiscence, fracture or early reabsorption) were evaluated. The mean followup was of 18.34 ± 4.83 months. No fracture or infection occurred. One case of patellar Giant Cell Tumor (GCT) and one of proximal tibia low-grade chondrosarcoma recurred after about one year. Two wound dehiscences occurred (one required a local flap). Follow-up X-rays showed good to excellent graft integration in most patients (20 out of 21). The investigated graft has a mechanical and structural function that can allow early weight-bearing and avoid a preventive bone fixation (only needed in four patients in this series). The graft blocks are different for shapes and dimensions, but they can be customized by the producer or sawcut by the surgeon in the operating theatre to fit the residual bone cavity. The complication rate was low, and a rapid integration was observed with no inflammatory reaction in the surrounding tissues. Further studies are mandatory to confirm these promising results.
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Affiliation(s)
- Michele Boffano
- Oncologic Orthopaedic Division, Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Center, Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (M.B.); (N.R.); (P.P.); (R.P.)
| | - Nicola Ratto
- Oncologic Orthopaedic Division, Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Center, Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (M.B.); (N.R.); (P.P.); (R.P.)
| | - Andrea Conti
- Oncologic Orthopaedic Division, Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Center, Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (M.B.); (N.R.); (P.P.); (R.P.)
- Department of Orthopaedic and Traumatology, University of Turin, 10126 Turin, Italy
- Correspondence: ; Tel.: +39-0116933229; Fax: +39-0116933270
| | - Pietro Pellegrino
- Oncologic Orthopaedic Division, Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Center, Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (M.B.); (N.R.); (P.P.); (R.P.)
| | - Laura Rossi
- Clinical Research Coordinator, Fondazione per la ricerca sui tumori dell’apparato muscoloscheletrico e rari Onlus, 10143, Turin, Italy;
| | - Giuseppe Perale
- Industrie Biomediche Insubri SA, via Cantonale 67, 6805 Mezzovico-Vira, Switzerland;
- Faculty of Biomedical Sciences, University of Southern Switzerland (USI), Via G. Buffi 13, 6900 Lugano, Switzerland
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstrasse 13, 1200 Vienna, Austria
| | - Raimondo Piana
- Oncologic Orthopaedic Division, Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Center, Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy; (M.B.); (N.R.); (P.P.); (R.P.)
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Jeong HJ, Gwak SJ, Seo KD, Lee S, Yun JH, Cho YS, Lee SJ. Fabrication of Three-Dimensional Composite Scaffold for Simultaneous Alveolar Bone Regeneration in Dental Implant Installation. Int J Mol Sci 2020; 21:E1863. [PMID: 32182824 PMCID: PMC7084329 DOI: 10.3390/ijms21051863] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 02/03/2023] Open
Abstract
Dental implant surgeries involve the insertion of implant fixtures into alveolar bones to replace missing teeth. When the availability of alveolar bone at the surgical site is insufficient, bone graft particles are filled in the insertion site for successful bone reconstruction. Bone graft particles induce bone regeneration over several months at the insertion site. Subsequently, implant fixtures can be inserted at the recipient site. Thus, conventional dental implant surgery is performed in several steps, which in turn increases the treatment period and cost involved. Therefore, to reduce surgical time and minimize treatment costs, a novel hybrid scaffold filled with bone graft particles that could be combined with implant fixtures is proposed. This scaffold is composed of a three-dimensionally (3D) printed polycaprolactone (PCL) frame and osteoconductive ceramic materials such as hydroxyapatite (HA) and β-tricalcium phosphate (β-TCP). Herein, we analyzed the porosity, internal microstructure, and hydrophilicity of the hybrid scaffold. Additionally, Saos-2 cells were used to assess cell viability and proliferation. Two types of control scaffolds were used (a 3D printed PCL frame and a hybrid scaffold without HA/β-TCP particles) for comparison, and the fabricated hybrid scaffold was verified to retain osteoconductive ceramic particles without losses. Moreover, the fabricated hybrid scaffold had high porosity and excellent microstructural interconnectivity. The in vitro Saos-2 cell experiments revealed superior cell proliferation and alkaline phosphatase assay results for the hybrid scaffold than the control scaffold. Hence, the proposed hybrid scaffold is a promising candidate for minimizing cost and duration of dental implant surgery.
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Affiliation(s)
- Hun-Jin Jeong
- Department of Mechanical Engineering, Wonkwang University, Iksan 54538, Korea; (H.-J.J.); (K.D.S.)
| | - So-Jung Gwak
- Department of Chemical Engineering, Wonkwang University, Iksan 54538, Korea;
| | - Kyoung Duck Seo
- Department of Mechanical Engineering, Wonkwang University, Iksan 54538, Korea; (H.-J.J.); (K.D.S.)
| | - SaYa Lee
- Department of Periodontology, College of Dentistry and Institute of Oral Bioscience, Jeonbuk National University, Jeonju 54896, Korea; (S.L.); (J.-H.Y.)
| | - Jeong-Ho Yun
- Department of Periodontology, College of Dentistry and Institute of Oral Bioscience, Jeonbuk National University, Jeonju 54896, Korea; (S.L.); (J.-H.Y.)
| | - Young-Sam Cho
- Department of Mechanical Engineering, Wonkwang University, Iksan 54538, Korea; (H.-J.J.); (K.D.S.)
- Department of Mechanical and Design Engineering, Wonkwang University, Iksan 54538, Korea
| | - Seung-Jae Lee
- Department of Mechanical Engineering, Wonkwang University, Iksan 54538, Korea; (H.-J.J.); (K.D.S.)
- Department of Mechanical and Design Engineering, Wonkwang University, Iksan 54538, Korea
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Zhu H, Gomez M, Xiao J, Perale G, Betge F, Lyngstadaas SP, Haugen HJ. Xenohybrid Bone Graft Containing Intrinsically Disordered Proteins Shows Enhanced In Vitro Bone Formation. ACS APPLIED BIO MATERIALS 2020; 3:2263-2274. [DOI: 10.1021/acsabm.0c00064] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Hao Zhu
- Department of Orthopedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, 430030 Wuhan, China
- Corticalis AS, Oslo Sciencepark, Gaustadallén 21, NO-0349 Oslo, Norway
| | - Manuel Gomez
- Corticalis AS, Oslo Sciencepark, Gaustadallén 21, NO-0349 Oslo, Norway
| | - Jun Xiao
- Department of Orthopedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, 430030 Wuhan, China
| | - Giuseppe Perale
- Industrie Biomediche Insubri SA, Via Cantonale 67, 6805 Mezzovico-Vira, Switzerland
- Faculty of Biomedical Sciences, University of Southern Switzerland, Via G. Buffi 13, 6900 Lugano, Switzerland
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstrasse 13, 1200 Vienna, Austria
| | - Felice Betge
- Industrie Biomediche Insubri SA, Via Cantonale 67, 6805 Mezzovico-Vira, Switzerland
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Haim Zada M, Kumar A, Elmalak O, Mechrez G, Domb AJ. Effect of Ethylene Oxide and Gamma (γ-) Sterilization on the Properties of a PLCL Polymer Material in Balloon Implants. ACS OMEGA 2019; 4:21319-21326. [PMID: 31867526 PMCID: PMC6921626 DOI: 10.1021/acsomega.9b02889] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 11/19/2019] [Indexed: 06/10/2023]
Abstract
Poly-l-lactide-co-ε-caprolactone (PLCL) is a unique polymer containing both polylactic acid and poly-ε-caprolactone (PCL) chain units, and thus it has better flexible and biodegradable properties. Based on these unique properties of PLCL, we have developed balloons that are now widely used in treating major medical problems [Biomaterials 2016, 105, 109-116]. One of the most important considerations needed for balloons is to ensure that the material properties remain similar after undergoing ethylene oxide (EtO) or gamma (γ-) sterilization treatments. From the biotechnological point of view, we focused on analyzing the vital molecular properties of the PLCL material after sterilization, such as changes in crystallinity, molecular weight distributions (M w, M n, and polydispersity index), and inherent viscosity (η). Analysis of the data reveals that EtO sterilization does not engender any change in crystallinity, melting temperature (T m), molecular weights, and η of the polymer. On the contrary, γ-radiations induce chain scission and consequential decrease of ∼33 and ∼15% in molecular weights and η values, respectively. Based on our observations, we recommend EtO sterilization instead of γ-radiation for PLCL. This ensures prolonged stability of the polymer against degradation in a biological environment, long-shelf life, and absolute assurance that balloon failures do not occur after implantation.
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Affiliation(s)
- Moran Haim Zada
- Institute
of Drug Research, Alex Grass Center for Drug Design and Novel Therapeutics,
School of Pharmacy-Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Awanish Kumar
- Institute
of Drug Research, Alex Grass Center for Drug Design and Novel Therapeutics,
School of Pharmacy-Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Omar Elmalak
- Institute
of Drug Research, Alex Grass Center for Drug Design and Novel Therapeutics,
School of Pharmacy-Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Guy Mechrez
- Department
of Food Quality and Safety, Institute for Postharvest and Food Sciences,
Volcani Center, ARO, 68 HaMaccabim Road, Rishon
LeZion 7505101, Israel
| | - Abraham J. Domb
- Institute
of Drug Research, Alex Grass Center for Drug Design and Novel Therapeutics,
School of Pharmacy-Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91120, Israel
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21
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Perale G, Monjo M, Ramis JM, Øvrebø Ø, Betge F, Lyngstadaas P, Haugen HJ. Biomimetic Biomolecules in Next Generation Xeno-Hybrid Bone Graft Material Show Enhanced In Vitro Bone Cells Response. J Clin Med 2019; 8:jcm8122159. [PMID: 31817744 PMCID: PMC6947180 DOI: 10.3390/jcm8122159] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 11/27/2019] [Accepted: 12/04/2019] [Indexed: 12/18/2022] Open
Abstract
Bone defects resulting from trauma, disease, surgery or congenital malformations are a significant health problem worldwide. Consequently, bone is the second most transplanted tissue just after blood. Although bone grafts (BGs) have been used for decades to improve bone repairs, none of the currently available BGs possesses all the desirable characteristics. One way to overcome such limitations is to introduce the feature of controlled release of active bone-promoting biomolecules: however, the administration of, e.g., recombinant Bone morphogenetic proteins (BMPs) have been used in concentrations overshooting physiologically occurring concentrations and has thus raised concerns as documented side effects were recorded. Secondly, most such biomolecules are very sensitive to organic solvents and this hinders their use. Here, we present a novel xeno-hybrid bone graft, SmartBonePep®, with a new type of biomolecule (i.e., intrinsically disordered proteins, IDPs) that is both resistant to processing with organic solvent and both triggers bone cells proliferation and differentiation. SmartBonePep® is an advanced and improved modification of SmartBone®, which is a bone substitute produced by combining naturally-derived mineral bone structures with resorbable polymers and collagen fragments. Not only have we demonstrated that Intrinsically Disordered Proteins (IDPs) can be successfully and safely loaded onto a SmartBonePep®, withstanding the hefty manufacturing processes, but also made them bioavailable in a tuneable manner and proved that these biomolecules are a robust and resilient biomolecule family, being a better candidate with respect to other biomolecules for effectively producing the next generation bone grafts. Most other biomolecules which enhances bone formation, e.g., BMP, would not have tolerated the organic solvent used to produce SmartBonePep®.
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Affiliation(s)
- Giuseppe Perale
- Industrie Biomediche Insubri SA, Via Cantonale 67, 6805 Mezzovico-Vira, Switzerland; (Ø.Ø.); (F.B.)
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstrasse 13, 1200 Vienna, Austria
- Correspondence:
| | - Marta Monjo
- Cell Therapy and Tissue Engineering Group, Research Institute on Health Sciences (IUNICS), University of the Balearic Islands. Ctra. Valldemossa km 7.5, 07122 Palma de Mallorca, Spain; (M.M.); (J.M.R.)
- Balearic Islands Health Research Institute (IdISBa), 07010 Palma de Mallorca, Spain
| | - Joana M. Ramis
- Cell Therapy and Tissue Engineering Group, Research Institute on Health Sciences (IUNICS), University of the Balearic Islands. Ctra. Valldemossa km 7.5, 07122 Palma de Mallorca, Spain; (M.M.); (J.M.R.)
- Balearic Islands Health Research Institute (IdISBa), 07010 Palma de Mallorca, Spain
| | - Øystein Øvrebø
- Industrie Biomediche Insubri SA, Via Cantonale 67, 6805 Mezzovico-Vira, Switzerland; (Ø.Ø.); (F.B.)
- Corticalis AS, Oslo Sciencepark, Gaustadallen 21, 0349 Oslo, Norway; (P.L.); (H.J.H.)
| | - Felice Betge
- Industrie Biomediche Insubri SA, Via Cantonale 67, 6805 Mezzovico-Vira, Switzerland; (Ø.Ø.); (F.B.)
| | - Petter Lyngstadaas
- Corticalis AS, Oslo Sciencepark, Gaustadallen 21, 0349 Oslo, Norway; (P.L.); (H.J.H.)
| | - Håvard J. Haugen
- Corticalis AS, Oslo Sciencepark, Gaustadallen 21, 0349 Oslo, Norway; (P.L.); (H.J.H.)
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22
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Grottoli CF, Cingolani A, Zambon F, Ferracini R, Villa T, Perale G. Simulated Performance of a Xenohybrid Bone Graft (SmartBone ®) in the Treatment of Acetabular Prosthetic Reconstruction. J Funct Biomater 2019; 10:E53. [PMID: 31766685 PMCID: PMC6963854 DOI: 10.3390/jfb10040053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 11/15/2019] [Accepted: 11/20/2019] [Indexed: 02/06/2023] Open
Abstract
Total hip arthroplasty (THA) is a surgical procedure for the replacement of hip joints with artificial prostheses. Several approaches are currently employed in the treatment of this kind of defect. Overall, the most common method involves using a quite invasive metallic support (a Burch-Schneider ring). Moreover, valid alternatives and less invasive techniques still need to be supported by novel material development. In this work, we evaluated the performance of SmartBone®, a xenohybrid bone graft composed of a bovine bone matrix reinforced with biodegradable polymers and collagen, as an effective support in acetabular prosthesis reconstruction. Specifically, the material's mechanical properties were experimentally determined (E = ~1.25 GPa, Ef = ~0.34 GPa, and Et = ~0.49 GPa) and used for simulation of the hip joint system with a SmartBone® insert. Moreover, a comparison with a similar case treated with a Burch-Schneider ring was also conducted. It was found that it is possible to perform THA revision surgeries without the insertion of an invasive metal support and it can be nicely combined with SmartBone®'s osteointegration characteristics. The material can withstand the loads independently (σmax = ~12 MPa) or be supported by a thinner titanium plate in contact with the bone in the worst cases. This way, improved bone regeneration can be achieved.
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Affiliation(s)
| | - Alberto Cingolani
- Industrie Biomediche Insubri SA, 6805 Mezzovico-Vira, Switzerland; (C.F.G.); (A.C.)
| | - Fabio Zambon
- Politecnico di Milano, Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “G. Natta”, 20133 Milan, Italy; (F.Z.); (T.V.)
| | - Riccardo Ferracini
- Department of Surgical Sciences and Integrated Diagnostics, University of Genova, Largo R. Benzi 10, 16132 Genova, Italy;
- IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132 Genova, Italy
| | - Tomaso Villa
- Politecnico di Milano, Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “G. Natta”, 20133 Milan, Italy; (F.Z.); (T.V.)
| | - Giuseppe Perale
- Industrie Biomediche Insubri SA, 6805 Mezzovico-Vira, Switzerland; (C.F.G.); (A.C.)
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstrasse 13, 1200 Vienna, Austria
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23
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Hydroxyapatite Block Produced by Sponge Replica Method: Mechanical, Clinical and Histologic Observations. MATERIALS 2019; 12:ma12193079. [PMID: 31546617 PMCID: PMC6804165 DOI: 10.3390/ma12193079] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/10/2019] [Accepted: 09/19/2019] [Indexed: 12/14/2022]
Abstract
Purpose: The grafting procedure for the anthropic ridges of jaws represents a surgical technique for increasing the bone volume to permit the placement of dental implants for oral rehabilitations. The aim of this study was to evaluate a hydroxyapatite (HA) porous scaffold produced via a sponge replica method for the treatment of maxillary bone defects in a human model. Methods: A total of thirteen patients were treated for sinus lifting in the posterior maxilla for a total of 16 defects treated with cylindrical HA Block. The experimental sites were evaluated by a 3D Cone Beam Computer Tomography scan (CBCT), and the histological analysis was performed after 3 months of healing. Results: After the 3 months healing period, the histological outcome of the investigation showed a high level of biological osteoconduction of the HA. Microscopical evidence of new bone formation was also observed in the central portion of the graft block. The samples were composed of different tissues: 39 ± 1% new bone, 42 ± 3% marrow space, 17 ± 3% residual HA Block and 4.02 ± 2% osteoid tissue were present. The new bone formation in the block was 8 ± 3%. Conclusions: The study findings support that HA porous scaffolds produced by sponge replica were effective for the treatment of maxillary bone defects in humans.
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Facciuto E, Grottoli CF, Mattarocci M, Illiano F, Compagno M, Ferracini R, Perale G. Three-Dimensional Craniofacial Bone Reconstruction With SmartBone on Demand. J Craniofac Surg 2019; 30:739-741. [PMID: 30807480 DOI: 10.1097/scs.0000000000005277] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This is a report of a 34-year-old male lacking of bone development in the frontal and orbital part of the skull due to a surgical removal of a right orbital-front osteoma at the age of 5. The integrity of the craniofacial district was important for the young patient also for social acceptance and self-esteem.Based on computed tomography patient images, a skull model was reconstructed, both digitally and on 3-dimensional real model, to best design the needed bone graft. Defect wide extension and surface curvature called for the use of the puzzle technique, where the whole graft is composed by several elements, mechanically slotting into each other. The realization was made possible thanks to the use of a composite xenohybrid bone substitute specifically developed for reconstructive surgery (SmartBone, by Industrie Biomediche Insubri SA). SmartBone technology allowed the realization of custom-made grafts which perfectly joined each other and fitted the bone defect thanks to mechanical strength, also at low thicknesses and wide extensions.The postoperative course was uneventful and computed tomography scans showed new bone formation and complete calvaria continuity already 10 months after surgery, with no signs of inflammation over the entire follow-up.This case study represents a proof of concept that SmartBone on Demand custom-made bone grafts, together with puzzle technique, are effective, easy to handle and provide final excellent functional and aesthetic results.
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Affiliation(s)
- Enzo Facciuto
- AORN Antonio Caldarelli Napoli UOSC of Maxillo-Facial Surgery
| | | | | | - Fausto Illiano
- AORN Antonio Caldarelli Napoli UOSC of Maxillo-Facial Surgery
| | - Mara Compagno
- Center for Research and Medical Studies, AOU Città della Salute e della Scienza, Turin
| | - Riccardo Ferracini
- Department of Surgical Sciences (DISC), Orthopaedic Clinic, IRCCS AOU San Martino, Genoa, Italy
| | - Giuseppe Perale
- Industrie Biomediche Insubri SA, Mazzovico-Vira, Switzerland.,University of Applied Sciences and Arts of Southern Switzerland (SUPSI), Manno, Switzerland
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Composite Xenohybrid Bovine Bone-Derived Scaffold as Bone Substitute for the Treatment of Tibial Plateau Fractures. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9132675] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: Tibial plateau fractures represent a common challenge for orthopaedic surgeons, sometimes representing complex cases to manage, where augmentation using bone grafts is required for stabilisation. Autologous iliac bone graft (AIBG) is the current gold standard for bone grafting. In order to overcome limitations related to the procedure, alternative strategies, like allogenic and xenogeneic bone substitutes have been investigated. Here, within the framework of an observational clinical study, we report clinical and radiological outcomes of patients treated for tibial plateau fractures with a composite xenohybrid bone graft, aiming at assessing clinical and radiological outcomes. Materials and Methods: We performed a cohort retrospective study of patients treated for tibial plateau fractures from May 2017 to January 2018. Thirty-four patients, i.e. 100% of those having received the bone graft under investigation for tibial plateaux fracture treatment, met the inclusion criteria and were enrolled in the study. Patients were assessed at 2 weeks, and then at a 1-, 3-, and 6-months, and 1-year follow-up. At each evaluation patients filled a visual analogue scale (VAS) for the level of pain during the day life activities and underwent physical exam and anteroposterior and lateral projection radiographs of the knee. At 1 year the Tegner Lysholm Scoring Scale, International Knee Document Committee 2000 (IKDC 2000), and Short Form (36) Health Survey (SF-36) were administered. Results: At 1-year, mean VAS decreased from 6.33 ± 1.40 to 1 ± 0.79 (P < 0.0001); Tegner Lysholm Scoring Scale was 89 ± 4.10 and mean IKDC 2000 was 78.67 ± 3.31. No infections, neurovascular complications or adverse effects related to implants were reported during the clinical exams at follow-up. Mean ROM was 124 ± 6°. Radiographs did not show defects of consolidation or progressive post-surgical subsidence and demonstrated a good grade of integration of the implant. Conclusions: Clinical and radiological outcomes, and scores of questionnaires, were good. The xenograft has demonstrated to be a safe biomaterial, with satisfactory mechanical and biological performances in the mid-term period. It also showed a high grade of osteointegration and remodelling.
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26
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Haugen HJ, Lyngstadaas SP, Rossi F, Perale G. Bone grafts: which is the ideal biomaterial? J Clin Periodontol 2019; 46 Suppl 21:92-102. [DOI: 10.1111/jcpe.13058] [Citation(s) in RCA: 171] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 12/13/2018] [Accepted: 12/15/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Håvard Jostein Haugen
- Department of Biomaterials; Institute of Clinical Dentistry; Faculty of Dentistry; University of Oslo; Oslo Norway
| | - Ståle Petter Lyngstadaas
- Department of Biomaterials; Institute of Clinical Dentistry; Faculty of Dentistry; University of Oslo; Oslo Norway
- Corticalis AS; Oslo Science Park Oslo Norway
| | - Filippo Rossi
- Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”; Politecnico di Milano; Milano Italy
| | - Giuseppe Perale
- Industrie Biomediche Insubri SA; Mezzovico-Vira Switzerland
- Biomaterials Laboratory; Institute for Mechanical Engineering and Materials Technology; University of Applied Sciences and Arts of Southern Switzerland; Manno Switzerland
- Department of Surgical Sciences; Faculty of Medical Sciences; Orthopaedic Clinic-IRCCS A.O.U. San Martino; Genova Italy
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27
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Sheftel Y, Ruddiman F, Schmidlin P, Duncan W. Biphasic calcium phosphate and polymer-coated bovine bone matrix for sinus grafting in an animal model. J Biomed Mater Res B Appl Biomater 2019; 108:750-759. [PMID: 31199055 DOI: 10.1002/jbm.b.34429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 04/25/2019] [Accepted: 05/17/2019] [Indexed: 11/09/2022]
Abstract
Autogenous bone grafting requires a donor site and may lose substantial volume during remodeling. Several bone replacement materials (BRMs) are under development to overcome these limitations, especially for indications for minimally intervention surgeries. The objective of our study was to assess the potential of an equine collagen cone reinforced with biphasic calcium phosphate (CC-BCP) particles and deproteinized bovine bone matrix (BBM) coated with polylactic acid, and poly-ε-caprolactone copolymer (BBM-PCC) and then to compare the outcomes with a deproteinized BBM and an equine CC without a filler in a sheep sinus grafting model in the Elleven female sheep were selected. Two experimental sites on each side of the animals were prepared using an extraoral approach for maxillary sinus wall. The four treatments were performed in each animal through a standardized 10-mm access window. While the BBM access was covered with a collagen membrane, all other sites were closed with an equine collagen membrane. All animals were euthanized after 16 weeks. New bone (NB), residual graft particles, and connective tissue were measured in undemineralized resin-embedded sections. As a result, one sheep did not survive the surgery. All sites in the remaining 10 sheep healed uneventfully. All CC and BBM-PCC grafts resorbed and failed to augment the sinuses. BBM and CC-BCP, in contrast, showed some histologic evidence of NB and surgical site augmentation. The NB fraction in the latter two groups accounted for 10 ± 9 and 4 ± 5%, respectively (p > 0.05). In conclusion, BBM-PCC and collagen cone performed poorly for sinus floor augmentation, while deproteinised BBM and reinforced collagen cone demonstrated comparable outcomes.
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Affiliation(s)
- Yevgeny Sheftel
- Division of Periodontology, Department of Oral Sciences, University of Otago, Dunedin, New Zealand
| | - Frances Ruddiman
- Division of Periodontology, Department of Oral Sciences, University of Otago, Dunedin, New Zealand
| | - Patrick Schmidlin
- Division of Periodontology and Peri-implant Diseases, Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Warwick Duncan
- Division of Periodontology, Department of Oral Sciences, University of Otago, Dunedin, New Zealand
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28
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A Radiological Approach to Evaluate Bone Graft Integration in Reconstructive Surgeries. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9071469] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
(1) Background: Bone tissue engineering is a promising tool to develop new smart solutions for regeneration of complex bone districts, from orthopedic to oral and maxillo-facial fields. In this respect, a crucial characteristic for biomaterials is the ability to fully integrate within the patient body. In this work, we developed a novel radiological approach, in substitution to invasive histology, for evaluating the level of osteointegration and osteogenesis, in both qualitative and quantitative manners. (2) SmartBone®, a composite xeno-hybrid bone graft, was selected as the base material because of its remarkable effectiveness in clinical practice. Using pre- and post-surgery computed tomography (CT), we built 3D models that faithfully represented the patient’s anatomy, with special attention to the bone defects. (3) Results: This way, it was possible to assess whether the new bone formation respected the natural geometry of the healthy bone. In all cases of the study (four dental, one maxillo-facial, and one orthopedic) we evaluated the presence of new bone formation and volumetric increase. (4) Conclusion: The newly established radiological protocol allowed the tracking of SmartBone® effective integration and bone regeneration. Moreover, the patient’s anatomy was completely restored in the defect area and functionality completely rehabilitated without foreign body reaction or inflammation.
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29
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Ferracini R, Martínez Herreros I, Russo A, Casalini T, Rossi F, Perale G. Scaffolds as Structural Tools for Bone-Targeted Drug Delivery. Pharmaceutics 2018; 10:pharmaceutics10030122. [PMID: 30096765 PMCID: PMC6161191 DOI: 10.3390/pharmaceutics10030122] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 12/19/2022] Open
Abstract
Although bone has a high potential to regenerate itself after damage and injury, the efficacious repair of large bone defects resulting from resection, trauma or non-union fractures still requires the implantation of bone grafts. Materials science, in conjunction with biotechnology, can satisfy these needs by developing artificial bones, synthetic substitutes and organ implants. In particular, recent advances in materials science have provided several innovations, underlying the increasing importance of biomaterials in this field. To address the increasing need for improved bone substitutes, tissue engineering seeks to create synthetic, three-dimensional scaffolds made from organic or inorganic materials, incorporating drugs and growth factors, to induce new bone tissue formation. This review emphasizes recent progress in materials science that allows reliable scaffolds to be synthesized for targeted drug delivery in bone regeneration, also with respect to past directions no longer considered promising. A general overview concerning modeling approaches suitable for the discussed systems is also provided.
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Affiliation(s)
- Riccardo Ferracini
- Department of Surgical Sciences, Orthopaedic Clinic-IRCCS A.O.U. San Martino, 16132 Genova, Italy.
| | - Isabel Martínez Herreros
- Department of Surgical Sciences, Orthopaedic Clinic-IRCCS A.O.U. San Martino, 16132 Genova, Italy.
| | - Antonio Russo
- Department of Surgical Sciences, Orthopaedic Clinic-IRCCS A.O.U. San Martino, 16132 Genova, Italy.
| | - Tommaso Casalini
- Department of Chemistry and Applied Biosciences, Institute for Chemical and Bioengineering, ETH Zurich, Vladimir-Prelog-Weg 1, 8093 Zurich, Switzerland.
- Biomaterials Laboratory, Institute for Mechanical Engineering and Materials Technology, University of Applied Sciences and Arts of Southern Switzerland, Via Cantonale 2C, Galleria, 26928 Manno, Switzerland.
| | - Filippo Rossi
- Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, via Mancinelli 7, 20131 Milano, Italy.
| | - Giuseppe Perale
- Department of Surgical Sciences, Orthopaedic Clinic-IRCCS A.O.U. San Martino, 16132 Genova, Italy.
- Biomaterials Laboratory, Institute for Mechanical Engineering and Materials Technology, University of Applied Sciences and Arts of Southern Switzerland, Via Cantonale 2C, Galleria, 26928 Manno, Switzerland.
- Industrie Biomediche Insubri SA, Via Cantonale 67, 6805 Mezzovico-Vira, Switzerland.
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30
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Cingolani A, Casalini T, Caimi S, Klaue A, Sponchioni M, Rossi F, Perale G. A Methodologic Approach for the Selection of Bio-Resorbable Polymers in the Development of Medical Devices: The Case of Poly(l-lactide- co-ε-caprolactone). Polymers (Basel) 2018; 10:E851. [PMID: 30960776 PMCID: PMC6403915 DOI: 10.3390/polym10080851] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 07/23/2018] [Accepted: 07/31/2018] [Indexed: 11/16/2022] Open
Abstract
In the last decades bioresorbable and biodegradable polymers have gained a very good reputation both in research and in industry thanks to their unique characteristics. They are able to ensure high performance and biocompatibility, at the same time avoiding post-healing surgical interventions for device removal. In the medical device industry, it is widely known that product formulation and manufacturing need to follow specific procedures in order to ensure both the proper mechanical properties and desired degradation profile. Moreover, the sterilization method is crucial and its impact on physical properties is generally underestimated. In this work we focused our attention on the effect of different terminal sterilization methods on two commercially available poly(l-lactide-co-ε-caprolactone) with equivalent chemical composition (70% PLA and 30% PCL) and relatively similar initial molecular weights, but different chain arrangements and crystallinity. Results obtained show that crystallinity plays a key role in helping preserve the narrow distribution of chains and, as a consequence, defined physical properties. These statements can be used as guidelines for a better choice of the most adequate biodegradable polymers in the production of resorbable medical devices.
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Affiliation(s)
- Alberto Cingolani
- Institute for Chemical and Bioengineering, Department of Chemistry and Applied Bioscience ETH Zurich, Vladimir-Prelog-Weg 1-5/10, 8093 Zürich, Switzerland.
- Industrie Biomediche Insubri SA (IBI), Via Cantonale 67, 6805 Mezzovico-Vira, Switzerland.
| | - Tommaso Casalini
- Institute for Chemical and Bioengineering, Department of Chemistry and Applied Bioscience ETH Zurich, Vladimir-Prelog-Weg 1-5/10, 8093 Zürich, Switzerland.
- Biomaterials Laboratory, Institute for Mechanical Engineering and Materials Technology, SUPSI-University of Applied Sciences and Arts of Southern Switzerland, Via Cantonale 2C, Galleria 2, 6928 Manno, Switzerland.
| | - Stefano Caimi
- Institute for Chemical and Bioengineering, Department of Chemistry and Applied Bioscience ETH Zurich, Vladimir-Prelog-Weg 1-5/10, 8093 Zürich, Switzerland.
| | - Antoine Klaue
- Institute for Chemical and Bioengineering, Department of Chemistry and Applied Bioscience ETH Zurich, Vladimir-Prelog-Weg 1-5/10, 8093 Zürich, Switzerland.
| | - Mattia Sponchioni
- Department of Chemistry, Materials and Chemical Engineering "G. Natta", Politecnico di Milano, 20100 Milan, Italy.
| | - Filippo Rossi
- Department of Chemistry, Materials and Chemical Engineering "G. Natta", Politecnico di Milano, 20100 Milan, Italy.
| | - Giuseppe Perale
- Industrie Biomediche Insubri SA (IBI), Via Cantonale 67, 6805 Mezzovico-Vira, Switzerland.
- Biomaterials Laboratory, Institute for Mechanical Engineering and Materials Technology, SUPSI-University of Applied Sciences and Arts of Southern Switzerland, Via Cantonale 2C, Galleria 2, 6928 Manno, Switzerland.
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Adipose-Derived Stromal Vascular Fraction/Xenohybrid Bone Scaffold: An Alternative Source for Bone Regeneration. Stem Cells Int 2018; 2018:4126379. [PMID: 29853912 PMCID: PMC5949175 DOI: 10.1155/2018/4126379] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 02/25/2018] [Indexed: 01/21/2023] Open
Abstract
Adipose tissue-derived stem cells (ASCs) are a promising tool for the treatment of bone diseases or skeletal lesions, thanks to their ability to potentially repair damaged tissue. One of the major limitations of ASCs is represented by the necessity to be isolated and expanded through in vitro culture; thus, a strong interest was generated by the adipose stromal vascular fraction (SVF), the noncultured fraction of ASCs. SVF is a heterogeneous cell population, directly obtained after collagenase treatment of adipose tissue. In order to investigate and compare the bone-regenerative potential of SVF and ASCs, they were plated on SmartBone®, a xenohybrid bone scaffold, already used in clinical practice with successful results. We showed that SVF plated on SmartBone, in the presence of osteogenic factors, had better osteoinductive capabilities than ASCs, in terms of differentiation into bone cells, mineralization, and secretion of soluble factors stimulating osteoblasts. Indeed, we observed an increasing area of new tissue over time, with and without OM. These data strongly support an innovative idea for the use of adipose SVF and bone scaffolds to promote tissue regeneration and repair, also thanks to an easier cell management preparation that allows a potentially larger use in clinical applications.
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Secondo F, Grottoli CF, Zollino I, Perale G, Lauritano D. Positioning of a contextual implant along with a sinus lift anchored with a block of heterologous bone. ACTA ACUST UNITED AC 2017; 10:457-467. [PMID: 29682263 DOI: 10.11138/orl/2017.10.4.457] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
During a sinus lift procedure the main requirement in order to position an implant is to have a maxillary sinus floor cortical bone thick enough to guarantee a primary stability in the implant inserted. In this way, the healing process is facilitated and osseointegration of the titanium surface may occur simultaneously, thus reducing the waiting time for the engraftment of the implant into the body. Unfortunately, these conditions are not always present. Hence, the need of developing an alternative approach that could simultaneously allow to perform sinus floor elevation along with an implant placement. Here we present the case of a 62-year-old patient that requires implant-prosthetic rehabilitation from 1.2 to 1.6 at diagnosis. In this study, we reported a novel application derived from the use of a heterologous bone scaffold (SmartBone@) in a sinus lift procedure. We showed the successful implant along with sinus lift with SmartBone@, both at the time of the surgery and after follow-up of the patient at 10 months from the implant. The possibility to perform simultaneously the contextual implant along with sinus lift dramatically reduced the waiting time for the patient of minimum 5-6 months required for osseointegration of the grafted biomaterials, before performing the implant procedure. This surgery represents an advance both in terms of medical technique and as life-benefit for the patient.
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Affiliation(s)
| | - C F Grottoli
- Industrie Biomediche Insubri SA, Mezzovico-Vira, Switzerland
| | - I Zollino
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - G Perale
- Industrie Biomediche Insubri SA, Mezzovico-Vira, Switzerland.,Department of Innovative Technologies, University for Applied Science and Art of Southern Switzerland, Manno, Switzerland
| | - D Lauritano
- Department of Medicine and Surgery, University of Milano "Bicocca", Monza, Italy
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