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An update to the advances in understanding distraction histogenesis: From biological mechanisms to novel clinical applications. J Orthop Translat 2020. [DOI: 10.1016/j.jot.2020.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Gurler G, Gursoy B. Investigation of effects of low level laser therapy in distraction osteogenesis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 119:469-476. [PMID: 29885471 DOI: 10.1016/j.jormas.2018.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/29/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE The purpose of the study was to investigate the histopathological effects of low level laser therapy (LLLT) application in distraction osteogenesis (DO). MATERIALS AND METHODS Twenty adult female New Zealand white rabbits were included in the study. Under general anesthesia unilateral mandibular corpus osteotomy was performed. Custom made external distractors were placed to right mandibles of rabbits. After five days of latency period, distractors were activated once a day for 5 days with 1mm/day frequency. Animals in the study group were exposed to LLLT from six different points transcutanously after each distractor activation. Control group was not exposed to laser irradiation. Animals were sacrificed after 15 and 30 days of consolidation periods and mandibles were processed for histopathological investigation under light microscope. Bone healing was analyzed with a semi-quantitative 4 point scale. RESULTS Osteoblastic activity and vascularization were found higher in the study group than control group after 15 days consolidation. Chondroblastic activity of the control group was significantly higher than the study group in both 15 and 30 days of consolidation groups. Osteoblastic activity and trabecular bone formation were found significantly higher in the study group than the control group after 15 days consolidation. CONCLUSIONS The use of LLLT in activation period of distraction osteogenesis stimulates bone repair in the early stages of distraction osteogenesis by inducing intramembranous healing and less cartilage tissue formation in the bone callus.
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Affiliation(s)
- G Gurler
- Istanbul Medipol University, School of Dentistry, Department of Oral and Maxillofacial Surgery, Ataturk Bulvari No 27, 34083 Unkapani-Fatih Istanbul, Turkey.
| | - B Gursoy
- University of Kyrenia, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, University of Kyrenia, Şehit Yahya Bakır Sokak, Karakum Kyrenia, TRNC.
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Comparison of the Effects of Local and Systemic Zoledronic Acid Application on Mandibular Distraction Osteogenesis. J Craniofac Surg 2017; 28:e621-e625. [DOI: 10.1097/scs.0000000000003629] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Effects of Intermittent Low-Dose Parathyroid Hormone Treatment on Rapid Mandibular Distraction Osteogenesis in Rabbits. J Oral Maxillofac Surg 2017; 75:1722-1731. [DOI: 10.1016/j.joms.2017.04.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/07/2017] [Accepted: 04/10/2017] [Indexed: 12/31/2022]
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The effect of human amniotic fluid on mandibular distraction osteogenesis. Int J Oral Maxillofac Surg 2015; 44:404-11. [DOI: 10.1016/j.ijom.2014.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 08/05/2014] [Accepted: 10/03/2014] [Indexed: 12/19/2022]
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Küçük D, Ay S, Kara MI, Avunduk MC, Gümus C. Comparison of local and systemic alendronate on distraction osteogenesis. Int J Oral Maxillofac Surg 2011; 40:1395-400. [PMID: 21945486 DOI: 10.1016/j.ijom.2011.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Revised: 08/19/2011] [Accepted: 08/31/2011] [Indexed: 11/25/2022]
Abstract
This study compared the effect of systemic and local administration of alendronate on distraction osteogenesis in rabbit mandibles. Thirty New Zealand white rabbits were allocated to 3 groups: 10 rabbits for systemic alendronate; 9 for local alendronate; and 11 as controls. After a 5 day latency period, distraction was performed at a rate of 0.8mm/day for 9 days via a custom-made distractor. Animals were killed at the end of the consolidation period of 28 days. The distracted mandibles were harvested and evaluated by plain radiography, computed tomography (CT), dual energy X-ray absorptiometry (DEXA), and histomorphometry. Histologically, comparing the systemic and local alendronate groups, there were no statistically significant differences in the bone healing parameters, but each group showed a statistically superior effect over the control group (p<0.05). Quantitative CT evaluation showed a significant difference mean in the density of the regeneration between experimental and control groups. There was a significant increase in mean bone mineral density in the experimental groups compared with the control group. Histologic, CT, and DEXA analysis demonstrated that using systemic and local alendronate may be effective in accelerating new bone formation in the distraction gap in rabbit mandibles.
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Affiliation(s)
- Dervişhan Küçük
- Dept. of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gaziantep University, Gaziantep, Turkey
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Emara KM, Ghafar KAA, Kersh MAA. Methods to shorten the duration of an external fixator in the management of tibial infections. World J Orthop 2011; 2:85-92. [PMID: 22474640 PMCID: PMC3302046 DOI: 10.5312/wjo.v2.i9.85] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 08/25/2011] [Accepted: 08/31/2011] [Indexed: 02/06/2023] Open
Abstract
Massive segmental bone loss due to chronic osteomyelitis represents a considerable challenge to orthopedic surgeons and is a limb threatening condition. The only option available in such a clinical situation is segment transport using the Ilizarov technique of distraction osteogenesis; yet the most common problem in cases of bone transport with the Ilizarov technique in massive bone loss, is the long duration of the fixator. In addition to autologous bone grafting, several mechanical, biologic, and external physical treatment modalities may be employed to promote bone formation and maturation during segment transport in osteomyelitis patients. Mechanical approaches include compressive loading of the distraction regenerate, increased frequency of small increments of distraction, and compression-distraction. Intramedullary nailing and hemicorticotomy can reduce the time in external fixation; however, these techniques are associated with technical difficulties and complications. Exogenous application of low-intensity pulsed ultrasound or pulsed electromagnetic fields may shorten the duration of external fixation. Other promising modalities include diphosphonates, physician-directed use (off-label use) of bone morphogenetic proteins, and local injection of bone marrow aspirate and platelet gel at the osteotomy site. Well-designed clinical studies are needed to establish safe and effective guidelines for various modalities to enhance new bone formation during distraction osteogenesis after segment transfer.
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Abstract
Delayed bone healing during distraction osteogenesis negatively affects clinical outcome. In addition to autologous bone grafting, several mechanical, chemical, biologic, and external treatment modalities may be employed to promote bone growth during distraction osteogenesis in the pediatric patient. Mechanical approaches include compressive loading of the distraction regenerate, increased frequency of small increments of distraction, and compression-distraction. Intramedullary nailing and submuscular plating can reduce the time in external fixation; however, these techniques are associated with technical difficulties and complications. Exogenous application of low-intensity pulsed ultrasound or pulsed electromagnetic fields may shorten the duration of external fixation. Other promising modalities include diphosphonates, physician-directed use (off-label use) of bone morphogenetic proteins, and local injection of bone marrow aspirate and platelet gel at the osteotomy site. Well-designed clinical studies are needed to establish safe and effective guidelines for various modalities to enhance new bone formation during distraction osteogenesis in children.
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Kokoroghiannis C, Charopoulos I, Lyritis G, Raptou P, Karachalios T, Papaioannou N. Correlation of pQCT bone strength index with mechanical testing in distraction osteogenesis. Bone 2009; 45:512-6. [PMID: 19497394 DOI: 10.1016/j.bone.2009.05.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2009] [Revised: 05/20/2009] [Accepted: 05/20/2009] [Indexed: 10/20/2022]
Abstract
Distraction osteogenesis is an established method of treatment of non-unions and limb length discrepancies. Despite improvements in surgical techniques and fixation devices there is still a considerable possibility of failure of the regenerate bone after frame removal. The hypothesis of the present experimental study was that a noninvasive bone strength marker, the strength-strain index (SSI) measured by peripheral quantitative computerized tomography (pQCT), could be significantly correlated with a biomechanical bone strength index, the maximum load at bone failure (F(max)), assessed in a three-point bending test. The right tibias of fifteen male New Zealand White rabbits were subjected to gradual lengthening using an external fixator. At the end of the consolidation phase (55th day) the animals were sacrificed and the lengthened tibiae were collected free of soft tissue, after removal of the lengthener, for immediate scanning and mechanical testing. The values of cortical bone mineral density, cortical bone area, and the corresponding SSIy, as measured by pQCT, were assessed for statistically significant correlation relative to the values of the F(max) and stiffness as evaluated by the three-point bending test were assessed. SSIy showed a statistically significant positive correlation with the maximum load (F(max)) with a correlation value R=0.846 (p<0.001), and it was a good predictor of F(max) since it was able to describe the 71.6% of variability of F(max)(R2=0.716). Furthermore, cortical bone area appeared to be highly correlated with F(max) (p<0.005), but it was a less efficient predictor of F(max) (R2=0.471). There was, also, a statistically significant correlation between SSIy and bone stiffness as assessed in the 3-point bending test (p<0.005). In conclusion, the present study reveals that the SSI can be used as a sensitive index of adequate consolidation of the regenerate bone, possibly able to reduce mechanical failure due to premature frame removal. In clinical relevance, the aforementioned hypothesis should be applied in studies of human populations and possible confirmation of its validity would establish pQCT as a valuable diagnostic tool not only in distraction osteogenesis but also in other techniques of bone healing.
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Wang Y, Ni M, Tang PF, Li G. Novel application of HA-TCP biomaterials in distraction osteogenesis shortened the lengthening time and promoted bone consolidation. J Orthop Res 2009; 27:477-82. [PMID: 18973240 DOI: 10.1002/jor.20782] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This study tested the hypothesis that use of biomaterials in distraction osteogenesis (DO) would reduce the treatment time and enhance bone formation quality. A 1.0-cm tibial shaft was removed in the left tibia of 36 rabbits. Rabbits were randomly divided into three groups: group A, the defect gap was reduced with the tibia shortened for 1.0-cm; group B, the defect gap was filled with 1.0-cm restorable porous hydroxyapatite and Tri-calcium phosphates cylindrical block (HA/TCP block, diameter is 0.5-cm); group C, The 1.0-cm defect gap was reduced 0.5 cm and the remaining 0.5-cm defect gap was filled with the 0.5-cm HA/TCP block. The tibia was then fixed with unilateral lengthener; for groups A and C; lengthening started 7 days after surgery at a rate of 1.0 mm/day, in two steps. Group A received lengthening for 10 days and group C for 5 days, there was no lengthening for group B. All animals were terminated at day 37 following surgery. The excised bone specimens were subject to microcomputed tomography (micro-CT), mechanical testing, and histological examinations. Bone mineral density and content and tissue mineral density and content, as well as the mechanical properties of the regenerates were significantly higher in group C compared to groups A and B. Micro-CT and histological examinations also confirmed that the regenerates in Group C had most advanced bone formation, consolidation, and remodeling compared to other groups. In conclusion, the combined use of biomaterials and DO technique can reduce the treatment time and enhance bone consolidation in bone defect management.
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Affiliation(s)
- Yan Wang
- Department of Orthopaedic Surgery, General Hospital of Chinese People's Liberation Army, Beijing, People's Republic of China
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Chang F, Mishima H, Ishii T, Yanai T, Akaogi H, Sakai S, Yoshioka T, Ochiai N. Stimulation of EP4 receptor enhanced bone consolidation during distraction osteogenesis. J Orthop Res 2007; 25:221-9. [PMID: 17106877 DOI: 10.1002/jor.20327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The objective of this study was to confirm whether an agonist of prostaglandin E receptor subtype EP4 can enhance bone consolidation in distraction osteogenesis. A rat distraction osteogenesis model was generated. A unilateral external fixator was fixed to the left femur of the rats of this model after osteotomy. Seven days later, 0.25 mm/12 h or 0.5 mm/12 h elongation was performed for 2 weeks. A systemic administration of an EP4 receptor agonist (ONO 4819 . CD, 3, 10, 30 microg/kg) or normal saline by subcutaneous injection was also performed for 2 weeks. The animals were sacrificed 10, 14, 17, 21, and 42 days after the operation. Radiographic examination, histological examination, and measurements of bone mineral density (BMD) and distraction-callus hardness were performed to qualitatively and quantitatively evaluate new bone formation. Twenty-one days after the operation, the experimental group had a higher BMD and a higher distraction-callus hardness than that of the control group. Forty-two days after the operation, BMD was similar among all of the groups. But the hardness of the experimental groups increased more than that of the control group, so the statistical differences in distraction-callus hardness became more distinct between the two groups, indicating an improved remodeling of the distraction callus. These findings are also supported by histological examination. Subcutaneous injection of an EP4 receptor agonist can promote bone formation and remodeling during distraction osteogenesis. ONO 4819 * CD might be a potential candidate for shortening the treatment time of distraction osteogenesis.
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Affiliation(s)
- Fei Chang
- Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575 Japan
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Yonezawa H, Harada K, Ikebe T, Shinohara M, Enomoto S. Effect of recombinant human bone morphogenetic protein-2 (rhBMP-2) on bone consolidation on distraction osteogenesis: a preliminary study in rabbit mandibles. J Craniomaxillofac Surg 2006; 34:270-6. [PMID: 16790354 DOI: 10.1016/j.jcms.2006.02.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2004] [Accepted: 02/15/2006] [Indexed: 11/16/2022] Open
Abstract
AIM To examine the effectiveness of administering recombinant human bone morphogenetic protein-2 (rhBMP-2) in distraction osteogenesis. MATERIAL AND METHODS Twenty-one mature male Japanese white rabbits underwent unilateral mandibular osteotomy. After 5 days, the osteotomized mandibles were distracted 1mm/day for 10 days. On the first day (groups A-1 [n=4] and A-2 [n=4]) or on the last day (group B [n=5]) of distraction, rhBMP-2 mixed with collagen gel was injected into the distraction zone. In control groups (groups C-1 [n=4] and C-2 [n=4]), the mandibles were distracted without rhBMP-2 injection. At the end of the distraction period (groups A-1 and C-1) and after 2 weeks of consolidation (groups A-2, B, and C-2), the distracted mandibles were harvested and examined with soft radiographs, peripheral quantitative computed tomography (pQCT), and microscopy. RESULTS Radioopacity was more marked in the distraction zone of the groups with rhBMP-2 than in control groups. The mineral density of the cortical bone (BMD) was higher in groups B and A-2 than in group C-2. Histologically, bone formation was more advanced in groups A-2 and B than in group C-2. The cortical BMD was higher in group A-1 than in group C-1. Histologically, bone formation was more advanced in groups A-2 and B than in group C-2. CONCLUSION These results suggest that rhBMP-2 promotes bone formation in distraction osteogenesis.
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Affiliation(s)
- Hisanobu Yonezawa
- Department of Oral and Maxillofacial Surgery, Sensory and Motor Organ Sciences, Graduate School of Medicine and Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan.
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Sen C, Gunes T, Erdem M, Koseoglu RD, Filiz NO. Effects of calcitonin and alendronate on distraction osteogenesis. INTERNATIONAL ORTHOPAEDICS 2006; 30:272-7. [PMID: 16523336 PMCID: PMC2532132 DOI: 10.1007/s00264-005-0048-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2005] [Accepted: 11/15/2005] [Indexed: 11/30/2022]
Abstract
In this experimental animal study the effects of calcitonin and alendronate on distraction osteogenesis are investigated. Forty-five mature female New Zealand type rabbits were used. Rabbits were randomized into three groups, each consisting of 15 animals. Under optimal operating conditions a pre-reconstructed circular external fixator was applied to the right tibia of rabbits, and osteotomy was performed with a Gigli saw just below the tibial tuberosity. During the ten days of distraction, a placebo was administered for group I (control group), group II received 10 U of calcitonin, and group III was treated with alendronate (0.5 mg/kg/day) gavages. Rabbits were examined histologically (at the third and eighth weeks, according to Huddlestone et al.), radiologically (at the third, sixth, and eighth weeks, according to Lane and Sandhu), and mechanically (at the eighth week, as torsional loading). During the first three weeks, the groups did not differ much with regard to radiological parameters. However, in the calcitonin and alendronate groups improved histological scores were detected compared with the control group. Radiological images obtained at the end of six weeks demonstrated improved consolidation in the calcitonin and alendronate groups compared with the control group. At the end of eight weeks postoperatively, radiological and histological parameters did not differ among the groups, while torsional failure load was found to be much improved in the calcitonin group (p=0.006). During the distraction osteogenesis period, calcitonin and alendronate affected the quality of regenerate favourably. This effect is sustained until the end of the consolidation period. However, this finding needs to be supported by experimental and human studies.
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Affiliation(s)
- Cengiz Sen
- Orthopaedics and Traumatology, Gaziosmanpasa University, Tokat, Turkey
| | - Taner Gunes
- Orthopaedics and Traumatology, Gaziosmanpasa University, Tokat, Turkey
| | - Mehmet Erdem
- Orthopaedics and Traumatology, Gaziosmanpasa University, Tokat, Turkey
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