1
|
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: 174] [Impact Index Per Article: 58.0] [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.
Collapse
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.)
| |
Collapse
|
2
|
Miar S, Pearson J, Montelongo S, Zamilpa R, Betancourt AM, Ram B, Navara C, Appleford MR, Ong JL, Griffey S, Guda T. Regeneration enhanced in critical-sized bone defects using bone-specific extracellular matrix protein. J Biomed Mater Res B Appl Biomater 2021; 109:538-547. [PMID: 32915522 PMCID: PMC8740960 DOI: 10.1002/jbm.b.34722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 12/19/2022]
Abstract
Extracellular matrix (ECM) products have the potential to improve cellular attachment and promote tissue-specific development by mimicking the native cellular niche. In this study, the therapeutic efficacy of an ECM substratum produced by bone marrow stem cells (BM-MSCs) to promote bone regeneration in vitro and in vivo were evaluated. Fluorescence-activated cell sorting analysis and phenotypic expression were employed to characterize the in vitro BM-MSC response to bone marrow specific ECM (BM-ECM). BM-ECM encouraged cell proliferation and stemness maintenance. The efficacy of BM-ECM as an adjuvant in promoting bone regeneration was evaluated in an orthotopic, segmental critical-sized bone defect in the rat femur over 8 weeks. The groups evaluated were either untreated (negative control); packed with calcium phosphate granules or granules+BM-ECM free protein and stabilized by collagenous membrane. Bone regeneration in vivo was analyzed using microcomputed tomography and histology. in vivo results demonstrated improvements in mineralization, osteogenesis, and tissue infiltration (114 ± 15% increase) in the BM-ECM complex group from 4 to 8 weeks compared to mineral granules only (45 ± 21% increase). Histological observations suggested direct apposition of early bone after 4 weeks and mineral consolidation after 8 weeks implantation for the group supplemented with BM-ECM. Significant osteoid formation and greater functional bone formation (polar moment of inertia was 71 ± 0.2 mm4 with BM-ECM supplementation compared to 48 ± 0.2 mm4 in untreated defects) validated in vivo indicated support of osteoconductivity and increased defect site cellularity. In conclusion, these results suggest that BM-ECM free protein is potentially a therapeutic supplement for stemness maintenance and sustaining osteogenesis.
Collapse
Affiliation(s)
- Solaleh Miar
- Department of Biomedical Engineering and Chemical Engineering, University of Texas at San Antonio, San Antonio, Texas
| | - Joseph Pearson
- Department of Biomedical Engineering and Chemical Engineering, University of Texas at San Antonio, San Antonio, Texas
| | - Sergio Montelongo
- Department of Biomedical Engineering and Chemical Engineering, University of Texas at San Antonio, San Antonio, Texas
| | - Rogelio Zamilpa
- StemBioSys Inc., San Antonio, Texas
- GenCure Inc., San Antonio, Texas
| | - Alejandro M. Betancourt
- Department of Biomedical Engineering and Chemical Engineering, University of Texas at San Antonio, San Antonio, Texas
| | - Bharath Ram
- Department of Biomedical Engineering and Chemical Engineering, University of Texas at San Antonio, San Antonio, Texas
- Department of Biology, University of Texas at San Antonio, San Antonio, Texas
| | - Christopher Navara
- Department of Biology, University of Texas at San Antonio, San Antonio, Texas
| | - Mark R. Appleford
- Department of Biomedical Engineering and Chemical Engineering, University of Texas at San Antonio, San Antonio, Texas
| | - Joo L. Ong
- Department of Biomedical Engineering and Chemical Engineering, University of Texas at San Antonio, San Antonio, Texas
| | | | - Teja Guda
- Department of Biomedical Engineering and Chemical Engineering, University of Texas at San Antonio, San Antonio, Texas
| |
Collapse
|
3
|
Boller LA, Jones AA, Cochran DL, Guelcher SA. Compression-Resistant Polymer/Ceramic Composite Scaffolds Augmented with rhBMP-2 Promote New Bone Formation in a Nonhuman Primate Mandibular Ridge Augmentation Model. Int J Oral Maxillofac Implants 2020; 35:616-624. [PMID: 32406661 DOI: 10.11607/jomi.7877] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
PURPOSE This study was designed to test the hypothesis that compression-resistant (CR) scaffolds augmented with recombinant human bone morphogenetic protein-2 (rhBMP-2) at clinically relevant doses in a nonhuman primate lateral ridge augmentation model enhances bone formation in a dose-responsive manner without additional protective membranes. MATERIALS AND METHODS Defects (15 mm long × 8 mm wide × 5 mm deep) were created bilaterally in the mandibles of nine hamadryas baboons. The defect sites were implanted with poly(ester urethane) (PEUR)/ceramic CR scaffolds augmented with 0 mg/mL rhBMP-2 (CR control), 0.75 mg/mL rhBMP-2 (CR-L), or 1.5 mg/mL rhBMP-2 (CR-H). The primary outcome of ridge width and secondary outcomes of new bone formation, cellular infiltration, and integration with host bone were evaluated using histology, histomorphometry, and microcomputed tomography (micro-CT) at 16 weeks following implantation. RESULTS New bone formation in the mandible was observed in a dose-responsive manner. CR-H promoted significantly greater new bone formation compared with the CR control group. In all groups, ridge width was maintained without an additional protective membrane. CONCLUSION CR scaffolds augmented with a clinically relevant dose of rhBMP-2 (1.5 mg/mL) promoted significant new bone formation. These results suggest that a CR PEUR/ceramic composite scaffold without a protective membrane may be a potential new rhBMP-2 carrier for clinical use.
Collapse
|
4
|
Vital Bone Formation After Grafting of Autogenous Bone and Biphasic Calcium Phosphate Bioceramic in Extraction Sockets of Rats. IMPLANT DENT 2018; 27:615-622. [DOI: 10.1097/id.0000000000000815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
5
|
Clinical and Histological Evaluation of Ceramic Matrix in a Collagen Carrier for Socket Preservation in Humans. IMPLANT DENT 2017; 25:149-54. [PMID: 26655328 DOI: 10.1097/id.0000000000000362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION A case series was used to evaluate the efficacy and predictability of a ceramic matrix in a putty-like collagen carrier in immediate extraction sockets. METHODS A single failing tooth was atraumatically extracted from each of 10 subjects. The sockets were debrided and grafted with ceramic matrix in a putty-like collagen carrier (15% hydroxyapatite, 85% β-tricalcium phosphate complex). A bovine pericardium membrane was draped over the graft site and a tension-free primary closure was obtained. After 6 months of healing, a trephine biopsy was taken from the center of each graft and a dental implant was placed. Two subjects were withdrawn from the study and were considered treatment failures. One of them moved to another state and the second exhibited delayed healing that required debridement of the grafting material from the socket. RESULTS After 6 months follow-up, there was a mean reduction of ridge width of 1.667 mm and mean reduction of ridge height of 0.483 mm after graft healing and integration. Over a 24-month follow-up, mean new bone fill was 40.25% and implant osseointegration was 100%. CONCLUSION Ceramic matrix in a putty-like collagen carrier maintained ridge dimensions and, despite ongoing bone turnover, produced adequate mineralized tissue that enabled implant placement at 6 months.
Collapse
|
6
|
Bone integration behavior of hydroxyapatite/β-tricalcium phosphate graft implanted in dental alveoli: a histomorphometric and scanning electron microscopy study. IMPLANT DENT 2016; 23:710-5. [PMID: 25343320 DOI: 10.1097/id.0000000000000172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study investigated the bone integration ability of a biphasic calcium phosphate bioceramic implanted in dental alveolus of rats. MATERIALS AND METHODS A total of 21 male rats were submitted to upper right incisor extraction and implanted with a synthetic bioceramic (Straumann Bone Ceramic). The animals were killed on 7th, 21st, and 42nd day after surgery for light and scanning electron microscopy (SEM) analysis of bone, bioceramic, and soft tissue volume as well as the quality of graft in its interface. RESULTS Light histology results showed no persistent inflammatory and foreign body reactions, a newly formed bone adhered on the ceramic surface without interposition of soft tissue, which was confirmed by SEM analysis. Histometrically, reduction/resorption, between 7 and 42 days, in the percentage of bioceramic implanted (α = 1%) left gaps for a gradual increase in vital bone formation (α = 1%) around the particles. CONCLUSIONS The bioceramic in question is biocompatible, has good bone integration, being gradually resorbed and replaced by it, featuring a viable bone substitute for grafting procedures.
Collapse
|
7
|
Abstract
BACKGROUND Infectious complications of musculoskeletal trauma are an important factor contributing to patient morbidity. Biofilm-dispersive bone grafts augmented with D-amino acids (D-AAs) prevent biofilm formation in vitro and in vivo, but the effects of D-AAs on osteocompatibility and new bone formation have not been investigated. QUESTIONS/PURPOSES We asked: (1) Do D-AAs hinder osteoblast and osteoclast differentiation in vitro? (2) Does local delivery of D-AAs from low-viscosity bone grafts inhibit new bone formation in a large-animal model? METHODS Methicillin-sensitive Staphylococcus aureus and methicillin-resistant S aureus clinical isolates, mouse bone marrow stromal cells, and osteoclast precursor cells were treated with an equal mass (1:1:1) mixture of D-Pro:D-Met:D-Phe. The effects of the D-AA dose on biofilm inhibition (n = 4), biofilm dispersion (n = 4), and bone marrow stromal cell proliferation (n = 3) were quantitatively measured by crystal violet staining. Osteoblast differentiation was quantitatively assessed by alkaline phosphatase staining, von Kossa staining, and quantitative reverse transcription for the osteogenic factors a1Col1 and Ocn (n = 3). Osteoclast differentiation was quantitatively measured by tartrate-resistant acid phosphatase staining (n = 3). Bone grafts augmented with 0 or 200 mmol/L D-AAs were injected in ovine femoral condyle defects in four sheep. New bone formation was evaluated by μCT and histology 4 months later. An a priori power analysis indicated that a sample size of four would detect a 7.5% difference of bone volume/total volume between groups assuming a mean and SD of 30% and 5%, respectively, with a power of 80% and an alpha level of 0.05 using a two-tailed t-test between the means of two independent samples. RESULTS Bone marrow stromal cell proliferation, osteoblast differentiation, and osteoclast differentiation were inhibited at D-AAs concentrations of 27 mmol/L or greater in a dose-responsive manner in vitro (p < 0.05). In methicillin-sensitive and methicillin-resistant S aureus clinical isolates, D-AAs inhibited biofilm formation at concentrations of 13.5 mmol/L or greater in vitro (p < 0.05). Local delivery of D-AAs from low-viscosity grafts did not inhibit new bone formation in a large-animal model pilot study (0 mmol/L D-AAs: bone volume/total volume = 26.9% ± 4.1%; 200 mmol/L D-AAs: bone volume/total volume = 28.3% ± 15.4%; mean difference with 95% CI = -1.4; p = 0.13). CONCLUSIONS D-AAs inhibit biofilm formation, bone marrow stromal cell proliferation, osteoblast differentiation, and osteoclast differentiation in vitro in a dose-responsive manner. Local delivery of D-AAs from bone grafts did not inhibit new bone formation in vivo at clinically relevant doses. CLINICAL RELEVANCE Local delivery of D-AAs is an effective antibiofilm strategy that does not appear to inhibit bone repair. Longitudinal studies investigating bacterial burden, bone formation, and bone remodeling in contaminated defects as a function of D-AA dose are required to further support the use of D-AAs in the clinical management of infected open fractures.
Collapse
|
8
|
Tatara AM, Kretlow JD, Spicer PP, Lu S, Lam J, Liu W, Cao Y, Liu G, Jackson JD, Yoo JJ, Atala A, van den Beucken JJJP, Jansen JA, Kasper FK, Ho T, Demian N, Miller MJ, Wong ME, Mikos AG. Autologously generated tissue-engineered bone flaps for reconstruction of large mandibular defects in an ovine model. Tissue Eng Part A 2015; 21:1520-8. [PMID: 25603924 DOI: 10.1089/ten.tea.2014.0426] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The reconstruction of large craniofacial defects remains a significant clinical challenge. The complex geometry of facial bone and the lack of suitable donor tissue often hinders successful repair. One strategy to address both of these difficulties is the development of an in vivo bioreactor, where a tissue flap of suitable geometry can be orthotopically grown within the same patient requiring reconstruction. Our group has previously designed such an approach using tissue chambers filled with morcellized bone autograft as a scaffold to autologously generate tissue with a predefined geometry. However, this approach still required donor tissue for filling the tissue chamber. With the recent advances in biodegradable synthetic bone graft materials, it may be possible to minimize this donor tissue by replacing it with synthetic ceramic particles. In addition, these flaps have not previously been transferred to a mandibular defect. In this study, we demonstrate the feasibility of transferring an autologously generated tissue-engineered vascularized bone flap to a mandibular defect in an ovine model, using either morcellized autograft or synthetic bone graft as scaffold material.
Collapse
|
9
|
Lyons FG, Gleeson JP, Partap S, Coghlan K, O’Brien FJ. Novel microhydroxyapatite particles in a collagen scaffold: a bioactive bone void filler? Clin Orthop Relat Res 2014; 472:1318-28. [PMID: 24385037 PMCID: PMC3940764 DOI: 10.1007/s11999-013-3438-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 12/16/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Treatment of segmental bone loss remains a major challenge in orthopaedic surgery. Traditional techniques (eg, autograft) and newer techniques (eg, recombinant human bone morphogenetic protein-2 [rhBMP-2]) have well-established performance limitations and safety concerns respectively. Consequently there is an unmet need for osteoinductive bone graft substitutes that may eliminate or reduce the use of rhBMP-2. QUESTIONS/PURPOSES Using an established rabbit radius osteotomy defect model with positive (autogenous bone graft) and negative (empty sham) control groups, we asked: (1) whether a collagen-glycosaminoglycan scaffold alone can heal the defect, (2) whether the addition of hydroxyapatite particles to the collagen scaffold promote faster healing, and (3) whether the collagen-glycosaminoglycan and collagen-hydroxyapatite scaffolds are able to promote faster healing (by carrying a low dose rhBMP-2). METHODS A 15-mm transosseous radius defect in 4-month-old skeletally mature New Zealand White rabbits were treated with either collagen-hydroxyapatite or collagen-glycosaminoglycan scaffolds with and without rhBMP-2. Autogenous bone graft served as a positive control. Time-series radiographs at four intervals and postmortem micro-CT and histological analysis at 16 weeks were performed. Qualitative histological analysis of postmortem explants, and qualitative and volumetric 3-D analysis of standard radiographs and micro-CT scans enabled direct comparison of healing between test groups. RESULTS Six weeks after implantation the collagen-glycosaminoglycan group had callus occupying greater than ½ the defect, whereas the sham (empty) control defect was still empty and the autogenous bone graft defect was completely filled with unremodeled bone. At 6 weeks, the collagen-hydroxyapatite scaffold groups showed greater defect filling with dense callus compared with the collagen-glycosaminoglycan controls. At 16 weeks, the autogenous bone graft groups showed evidence of early-stage medullary canal formation beginning at the proximal and distal defect borders. The collagen-glycosaminoglycan and collagen-glycosaminoglycan-rhBMP-2 groups had nearly complete medullary canal formation and anatomic healing at 16 weeks. However, collagen-hydroxyapatite-rhBMP-2 scaffolds showed the best levels of healing, exhibiting a dense callus which completely filled the defect. CONCLUSIONS The collagen-hydroxyapatite scaffold showed comparable healing to the current gold standard of autogenous bone graft. It also performed comparably to collagen-glycosaminoglycan-rhBMP-2, a representative commercial device in current clinical use, but without the cost and safety concerns. CLINICAL RELEVANCE The collagen-glycosaminoglycan scaffold may be suitable for a low load-bearing defect. The collagen-hydroxyapatite scaffold may be suitable for a load-bearing defect. The rhBMP-2 containing collagen-glycosaminoglycan and collagen-hydroxyapatite scaffolds may be suitable for established nonunion defects.
Collapse
Affiliation(s)
- Frank G. Lyons
- />Tissue Engineering Research Group, Department of Anatomy, Royal College of Surgeons in Ireland, 123 St. Stephen’s Green, Dublin 2, Ireland
- />Trinity Centre for Bioengineering, Trinity College Dublin, Dublin 2, Ireland
- />Cappagh National Orthopaedic Hospital, Dublin, Ireland
- />Mater Misericordiae University Hospital, Dublin, Ireland
| | - John P. Gleeson
- />Tissue Engineering Research Group, Department of Anatomy, Royal College of Surgeons in Ireland, 123 St. Stephen’s Green, Dublin 2, Ireland
- />Trinity Centre for Bioengineering, Trinity College Dublin, Dublin 2, Ireland
| | - Sonia Partap
- />Tissue Engineering Research Group, Department of Anatomy, Royal College of Surgeons in Ireland, 123 St. Stephen’s Green, Dublin 2, Ireland
- />Trinity Centre for Bioengineering, Trinity College Dublin, Dublin 2, Ireland
| | - Karen Coghlan
- />Tissue Engineering Research Group, Department of Anatomy, Royal College of Surgeons in Ireland, 123 St. Stephen’s Green, Dublin 2, Ireland
- />Trinity Centre for Bioengineering, Trinity College Dublin, Dublin 2, Ireland
- />Advanced Materials and Bioengineering Research (AMBER) Centre, Royal College of Surgeons in Ireland, Trinity College Dublin, Dublin, Ireland
| | - Fergal J. O’Brien
- />Tissue Engineering Research Group, Department of Anatomy, Royal College of Surgeons in Ireland, 123 St. Stephen’s Green, Dublin 2, Ireland
- />Trinity Centre for Bioengineering, Trinity College Dublin, Dublin 2, Ireland
- />Advanced Materials and Bioengineering Research (AMBER) Centre, Royal College of Surgeons in Ireland, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
10
|
Characteristics of Newly Formed Bone in Sockets Augmented With Cancellous Porous Bovine Bone and a Resorbable Membrane. IMPLANT DENT 2013; 22:380-7. [DOI: 10.1097/id.0b013e31829afa44] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
11
|
Antunes AA, Oliveira Neto P, de Santis E, Caneva M, Botticelli D, Salata LA. Comparisons between Bio-Oss®and Straumann®Bone Ceramic in immediate and staged implant placement in dogs mandible bone defects. Clin Oral Implants Res 2011; 24:135-42. [DOI: 10.1111/j.1600-0501.2011.02385.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2011] [Indexed: 11/29/2022]
Affiliation(s)
- Antonio A. Antunes
- Oral and Maxillofacial Surgery; University of São Paulo; São Paulo; Brazil
| | | | - Enzo de Santis
- Faculty of Dentistry of Aracatuba; University of the State of São Paulo; São Paulo; Brazil
| | - Marco Caneva
- Faculty of Dentistry of Aracatuba; University of the State of São Paulo; São Paulo; Brazil
| | | | - Luiz A. Salata
- Oral and Maxillofacial Surgery and Periodontics; University of Sao Paulo; São Paulo; Brazil
| |
Collapse
|