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Sadeghian Dehkord E, De Carvalho B, Ernst M, Albert A, Lambert F, Geris L. Influence of physicochemical characteristics of calcium phosphate-based biomaterials in cranio-maxillofacial bone regeneration. A systematic literature review and meta-analysis of preclinical models. Mater Today Bio 2024; 26:101100. [PMID: 38854953 PMCID: PMC11157282 DOI: 10.1016/j.mtbio.2024.101100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/11/2024] Open
Abstract
Objectives Calcium phosphate-based biomaterials (CaP) are the most widely used biomaterials to enhance bone regeneration in the treatment of alveolar bone deficiencies, cranio-maxillofacial and periodontal infrabony defects, with positive preclinical and clinical results reported. This systematic review aimed to assess the influence of the physicochemical properties of CaP biomaterials on the performance of bone regeneration in preclinical animal models. Methods The PubMed, EMBASE and Web of Science databases were searched to retrieve the preclinical studies investigating physicochemical characteristics of CaP biomaterials. The studies were screened for inclusion based on intervention (physicochemical characterization and in vivo evaluation) and reported measurable outcomes. Results A total of 1532 articles were retrieved and 58 studies were ultimately included in the systematic review. A wide range of physicochemical characteristics of CaP biomaterials was found to be assessed in the included studies. Despite a high degree of heterogeneity, the meta-analysis was performed on 39 studies and evidenced significant effects of biomaterial characteristics on their bone regeneration outcomes. The study specifically showed that macropore size, Ca/P ratio, and compressive strength exerted significant influence on the formation of newly regenerated bone. Moreover, factors such as particle size, Ca/P ratio, and surface area were found to impact bone-to-material contact during the regeneration process. In terms of biodegradability, the amount of residual graft was determined by macropore size, particle size, and compressive strength. Conclusion The systematic review showed that the physicochemical characteristics of CaP biomaterials are highly determining for scaffold's performance, emphasizing its usefulness in designing the next generation of bone scaffolds to target higher rates of regeneration.
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Affiliation(s)
- Ehsan Sadeghian Dehkord
- GIGA In Silico Medicine, Biomechanics Research Unit (Biomech), University of Liège, Belgium
- Prometheus, The R&D Division for Skeletal Tissue Engineering, KU Leuven, Belgium
| | - Bruno De Carvalho
- Department of Periodontology, Oral-Dental and Implant Surgery, CHU of Liège, Belgium
- Dental Biomaterials Research Unit (d-BRU), University of Liège, Belgium
| | - Marie Ernst
- Biostatistics and Research Method Center (B-STAT), CHU of Liège and University of Liège, Belgium
| | - Adelin Albert
- Biostatistics and Research Method Center (B-STAT), CHU of Liège and University of Liège, Belgium
- Department of Public Health Sciences, University of Liège, Belgium
| | - France Lambert
- Department of Periodontology, Oral-Dental and Implant Surgery, CHU of Liège, Belgium
- Dental Biomaterials Research Unit (d-BRU), University of Liège, Belgium
| | - Liesbet Geris
- GIGA In Silico Medicine, Biomechanics Research Unit (Biomech), University of Liège, Belgium
- Prometheus, The R&D Division for Skeletal Tissue Engineering, KU Leuven, Belgium
- Department of Mechanical Engineering, Biomechanics Section (BMe), KU Leuven, Belgium
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Neto JVC, Teixeira ABV, Cândido Dos Reis A. Hydroxyapatite coatings versus osseointegration in dental implants: A systematic review. J Prosthet Dent 2023:S0022-3913(23)00631-5. [PMID: 37845113 DOI: 10.1016/j.prosdent.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/18/2023]
Abstract
STATEMENT OF PROBLEM Knowledge of the effectiveness of hydroxyapatite coatings on the surface of titanium dental implants is lacking because of difficulties in standardizing their thickness, roughness, and effect on osseointegration. The selection of articles describing this coating in osseointegration will be of great relevance to implant dentistry. PURPOSE This systematic review aimed to answer the question, "How effective is hydroxyapatite on titanium surfaces for osseointegration?" MATERIAL AND METHODS The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines were followed, and the protocol was registered on the international prospective register of systematic reviews (PROSPERO) database (CRD42023422601). The PubMed, Scopus, Web of Science, and Embase databases were searched, and articles were selected manually in 2 steps by 2 blinded investigators according to the previously selected eligibility criteria. The risk of bias was assessed using the systematic review center for laboratory animal experimentation (SYRCLE) tool. RESULTS Initially, 671 results were found. After analysis of eligibility criteria and full reading, 15 articles were included in the present review. Of these, 12 reported favorable osseointegration results for hydroxyapatite-coated surfaces, and 3 found no significant long-term difference between the coated and uncoated groups. CONCLUSIONS Hydroxyapatite surface treatment is effective in the osseointegration of titanium dental implants because it favors the absorption of proteins, adhesion, and proliferation of bone cells when obtained by methods that ensure proper adhesion. (J Prosthet Dent xxxx;xxx:xxx-xxx).
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Affiliation(s)
- João Vicente Calazans Neto
- Graduate student, Department of Dental Materials and Prosthesis, Ribeirão Preto School of Dentistry, University of São Paulo (USP), Ribeirão Preto, Brazil
| | - Ana Beatriz Vilela Teixeira
- Postdoctoral Fellow, Department of Dental Materials and Prosthesis, Ribeirão Preto School of Dentistry, University of São Paulo (USP), Ribeirão Preto, Brazil
| | - Andréa Cândido Dos Reis
- Associate Professor, Department of Dental Materials and Prosthesis, Ribeirão Preto School of Dentistry, University of São Paulo (USP), Ribeirão Preto, Brazil..
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Dorozhkin SV. Calcium Orthophosphate (CaPO4)-Based Bioceramics: Preparation, Properties, and Applications. COATINGS 2022; 12:1380. [DOI: 10.3390/coatings12101380] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Various types of materials have been traditionally used to restore damaged bones. In the late 1960s, a strong interest was raised in studying ceramics as potential bone grafts due to their biomechanical properties. A short time later, such synthetic biomaterials were called bioceramics. Bioceramics can be prepared from diverse inorganic substances, but this review is limited to calcium orthophosphate (CaPO4)-based formulations only, due to its chemical similarity to mammalian bones and teeth. During the past 50 years, there have been a number of important achievements in this field. Namely, after the initial development of bioceramics that was just tolerated in the physiological environment, an emphasis was shifted towards the formulations able to form direct chemical bonds with the adjacent bones. Afterwards, by the structural and compositional controls, it became possible to choose whether the CaPO4-based implants would remain biologically stable once incorporated into the skeletal structure or whether they would be resorbed over time. At the turn of the millennium, a new concept of regenerative bioceramics was developed, and such formulations became an integrated part of the tissue engineering approach. Now, CaPO4-based scaffolds are designed to induce bone formation and vascularization. These scaffolds are usually porous and harbor various biomolecules and/or cells. Therefore, current biomedical applications of CaPO4-based bioceramics include artificial bone grafts, bone augmentations, maxillofacial reconstruction, spinal fusion, and periodontal disease repairs, as well as bone fillers after tumor surgery. Prospective future applications comprise drug delivery and tissue engineering purposes because CaPO4 appear to be promising carriers of growth factors, bioactive peptides, and various types of cells.
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Nanohydroxyapatite Electrodeposition onto Electrospun Nanofibers: Technique Overview and Tissue Engineering Applications. Bioengineering (Basel) 2021; 8:bioengineering8110151. [PMID: 34821717 PMCID: PMC8615206 DOI: 10.3390/bioengineering8110151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/15/2021] [Accepted: 10/15/2021] [Indexed: 11/17/2022] Open
Abstract
Nanocomposite scaffolds based on the combination of polymeric nanofibers with nanohydroxyapatite are a promising approach within tissue engineering. With this strategy, it is possible to synthesize nanobiomaterials that combine the well-known benefits and advantages of polymer-based nanofibers with the osteointegrative, osteoinductive, and osteoconductive properties of nanohydroxyapatite, generating scaffolds with great potential for applications in regenerative medicine, especially as support for bone growth and regeneration. However, as efficiently incorporating nanohydroxyapatite into polymeric nanofibers is still a challenge, new methodologies have emerged for this purpose, such as electrodeposition, a fast, low-cost, adjustable, and reproducible technique capable of depositing coatings of nanohydroxyapatite on the outside of fibers, to improve scaffold bioactivity and cell–biomaterial interactions. In this short review paper, we provide an overview of the electrodeposition method, as well as a detailed discussion about the process of electrodepositing nanohydroxyapatite on the surface of polymer electrospun nanofibers. In addition, we present the main findings of the recent applications of polymeric micro/nanofibrous scaffolds coated with electrodeposited nanohydroxyapatite in tissue engineering. In conclusion, comments are provided about the future direction of nanohydroxyapatite electrodeposition onto polymeric nanofibers.
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Guo X, Li M, Qi W, Bai H, Nie Z, Hu Z, Xiao Y, de Bruijn JD, Bao C, Yuan H. Serial cellular events in bone formation initiated by calcium phosphate ceramics. Acta Biomater 2021; 134:730-743. [PMID: 34303865 DOI: 10.1016/j.actbio.2021.07.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 02/05/2023]
Abstract
To better understand the biological mechanisms triggered by osteoinductive materials in vivo, we evaluated the timeline of cellular responses to osteoinductive materials subcutaneously implanted in FVB mice. More F4/80-positive macrophages were present in osteoinductive tri-CaP ceramic (TCP) with submicron surface topography (TCPs) than non-osteoinductive TCP with micron surface topography (TCPb) at week 1. Moreover, TCPs (but not TCPb) significantly enhanced osteoclastogenesis, and induced macrophages to polarize from M1 to M2 in the first week. The time sequence and relevance of macrophages and osteoclasts responses involved in bone formation was then evaluated through peri-implant injection of specific chemicals in mice implanted with osteoinductive TCPs. Day-1 injection of clodronate liposomes (LipClod) depleted macrophages, inhibited macrophage polarization to M2, blocked osteoclastogenesis and bone formation, while the day-6 injection was less effective. Anti-RANKL antibody (aRANKL) did not affect macrophage colonization but inhibited osteoclastogenesis. Injection of aRANKL before week 2 aborted bone formation in TCPs, while injection at week 4 partially inhibited bone formation. The overall data show that following ectopic implantation, osteoinductive materials allow macrophage colonization in hours to days, macrophage polarization to M2 in days (within 7 days), osteoclastogenesis in weeks (e.g. in 2 weeks) and bone formation thereafter (after 4 weeks). The serial cellular events verified herein bring a new insight on material-induced bone formation and pave the way to further explore the mechanisms triggered by osteoinductive materials. STATEMENT OF SIGNIFICANCE: A series of key cellular events triggered by osteoinductive calcium phosphate ceramic was revealed: macrophages colonized within hours to days, polarization of M2 macrophages occurred within 7 days, osteoclastogenesis mainly occurred in weeks (e.g. in 2 weeks) and bone formation finally arose thereafter (after 4 weeks). Moreover, such time sequence of cellular events was confirmed with specific chemicals (clodronate liposomes and anti-RANKL antibody). The findings verified herein bring a new insight on material-induced bone formation and pave the way to further explore the mechanisms triggered by osteoinductive materials.
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Affiliation(s)
- Xiaodong Guo
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Ren Min Nan Rd, Chengdu, Sichuan 610041, China
| | - Mingzheng Li
- Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 400015, China
| | - Wenting Qi
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Ren Min Nan Rd, Chengdu, Sichuan 610041, China
| | - Hetian Bai
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Ren Min Nan Rd, Chengdu, Sichuan 610041, China
| | - Zhangling Nie
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Ren Min Nan Rd, Chengdu, Sichuan 610041, China
| | - Zhiqiao Hu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Ren Min Nan Rd, Chengdu, Sichuan 610041, China
| | - Yu Xiao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Ren Min Nan Rd, Chengdu, Sichuan 610041, China
| | - Joost D de Bruijn
- Kuros Biosciences BV, Prof. Bronkhorstlaan 10, MB Bilthoven 3723, the Netherlands; School of Engineering and Materials Science, Queen Mary University of London, UK
| | - Chongyun Bao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Ren Min Nan Rd, Chengdu, Sichuan 610041, China.
| | - Huipin Yuan
- Kuros Biosciences BV, Prof. Bronkhorstlaan 10, MB Bilthoven 3723, the Netherlands; Huipin Yuan's Lab, Sichuan, China.
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Mangano C, Giuliani A, De Tullio I, Raspanti M, Piattelli A, Iezzi G. Case Report: Histological and Histomorphometrical Results of a 3-D Printed Biphasic Calcium Phosphate Ceramic 7 Years After Insertion in a Human Maxillary Alveolar Ridge. Front Bioeng Biotechnol 2021; 9:614325. [PMID: 33937211 PMCID: PMC8082101 DOI: 10.3389/fbioe.2021.614325] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/08/2021] [Indexed: 02/04/2023] Open
Abstract
Introduction: Dental implant placement can be challenging when insufficient bone volume is present and bone augmentation procedures are indicated. The purpose was to assess clinically and histologically a specimen of 30%HA-60%β-TCP BCP 3D-printed scaffold, after 7-years. Case Description: The patient underwent bone regeneration of maxillary buccal plate with 3D-printed biphasic-HA block in 2013. After 7-years, a specimen of the regenerated bone was harvested and processed to perform microCT and histomorphometrical analyses. Results: The microarchitecture study performed by microCT in the test-biopsy showed that biomaterial volume decreased more than 23% and that newly-formed bone volume represented more than 57% of the overall mineralized tissue. Comparing with unloaded controls or peri-dental bone, Test-sample appeared much more mineralized and bulky. Histological evaluation showed complete integration of the scaffold and signs of particles degradation. The percentage of bone, biomaterials and soft tissues was, respectively, 59.2, 25.6, and 15.2%. Under polarized light microscopy, the biomaterial was surrounded by lamellar bone. These results indicate that, while unloaded jaws mimicked the typical osteoporotic microarchitecture after 1-year without loading, the BCP helped to preserve a correct microarchitecture after 7-years. Conclusions: BCP 3D-printed scaffolds represent a suitable solution for bone regeneration: they can lead to straightforward and less time-consuming surgery, and to bone preservation.
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Affiliation(s)
| | - Alessandra Giuliani
- Department of Clinical Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Ilaria De Tullio
- Department of Medical, Oral and Biotechnological Sciences, University "G. D'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Mario Raspanti
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Adriano Piattelli
- Department of Medical, Oral and Biotechnological Sciences, University "G. D'Annunzio" of Chieti-Pescara, Chieti, Italy.,Chair of Biomaterials Engineering, Catholic University of San Antonio de Murcia (UCAM), Murcia, Spain.,Fondazione Villaserena per la Ricerca, Città Sant'Angelo, Italy
| | - Giovanna Iezzi
- Department of Medical, Oral and Biotechnological Sciences, University "G. D'Annunzio" of Chieti-Pescara, Chieti, Italy
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Klimecs V, Grishulonoks A, Salma I, Neimane L, Locs J, Saurina E, Skagers A. Bone Loss around Dental Implants 5 Years after Implantation of Biphasic Calcium Phosphate (HAp/ βTCP) Granules. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:4804902. [PMID: 30631412 PMCID: PMC6304842 DOI: 10.1155/2018/4804902] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/09/2018] [Accepted: 09/25/2018] [Indexed: 11/18/2022]
Abstract
Biphasic calcium phosphate ceramic granules (0.5-1.0 mm) with a hydroxyapatite and β-tricalcium phosphate ratio of 90/10 were used. Biphasic calcium phosphate ceramic granules produced in the Riga Technical University, Riga Rudolph Cimdins Biomaterials Innovation and Development Centre, were used for filling the bone loss on 18 patients with peri-implantitis. After 5 years at the minimum, clinical and 3D cone-beam computed tomography control was done. Clinical situation confirmed good stability of implants without any signs of inflammation around. Radiodensity of the previous gap and alveolar bone horizontally from middle point of dental implants showed similar radiodensity as in normal alveolar bone. This trial is registered with ISRCTN13514478.
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Affiliation(s)
- Vadims Klimecs
- Department of Doctoral Studies, Riga Stradins University, Riga, Latvia
| | | | - Ilze Salma
- Department of Oral and Maxillofacial Surgery, Riga Stradins University, Riga, Latvia
| | - Laura Neimane
- Department of Diagnostic Radiology, Riga Stradins University, Riga, Latvia
| | - Janis Locs
- Rudolfs Cimdins Centre of Development and Innovations of Biomaterials, Riga Technical University, Riga, Latvia
| | - Eva Saurina
- Department of Statistic, Riga Stradins University, Riga, Latvia
| | - Andrejs Skagers
- Department of Oral and Maxillofacial Surgery, Riga Stradins University, Riga, Latvia
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Suruagy AAPDS, Alves ATNN, Sartoretto SC, Calasans-Maia JDA, Granjeiro JM, Calasans-Maia MD. Physico-chemical and Histomorphometric Evaluation of Zinc-containing Hydroxyapatite in Rabbits Calvaria. Braz Dent J 2017; 27:717-726. [PMID: 27982185 DOI: 10.1590/0103-6440201601028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 10/17/2016] [Indexed: 01/18/2023] Open
Abstract
The aim of this study was to characterize the physico-chemical properties and bone repair after implantation of zinc-containing nanostructured porous hydroxyapatite scaffold (nZnHA) in rabbits' calvaria. nZnHA powder containing 2% wt/wt zinc and stoichiometric nanostructured porous hydroxyapatite (nHA - control group) were shaped into disc (8 mm) and calcined at 550 °C. Two surgical defects were created in the calvaria of six rabbits (nZnHA and nHA). After 12 weeks, the animals were euthanized and the grafted area was removed, fixed in 10% formalin with 0.1 M phosphate buffered saline and embedded in paraffin (n=10) for histomorphometric evaluation. In addition, one sample from each group (n=2) was embedded in methylmethacrylate for the SEM and EDS analyses. The thermal treatment transformed the nZnHA disc into a biphasic implant composed of Zn-containing HA and Zn-containing β-tricalcium phosphate (ZnHA/βZnTCP). The XRD patterns for the nHA disc were highly crystalline compared to the ZnHA disc. Histological analysis revealed that both materials were biologically compatible and promoted osteoconduction. X-ray fluorescence and MEV-EDS of nZnHA confirmed zinc in the samples. Histomorphometric evaluation revealed the presence of new bone formation in both frameworks but without statistically significant differences (p>0.05), based on the Wilcoxon test. The current study confirmed that both biomaterials improve bone repair, are biocompatible and osteoconductive, and that zinc (2wt%) did not increase the bone repair. Additional in vivo studies are required to investigate the effect of doping hydroxyapatite with a higher Zn concentration.
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Affiliation(s)
| | | | | | | | - José Mauro Granjeiro
- Clinical Unit Research, Dental School, UFF - Universidade Federal Fluminense, Niterói, RJ, Brazil
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9
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Computer simulations on the mechanical behaviors of biphasic calcium phosphates. J Mol Model 2017; 23:156. [DOI: 10.1007/s00894-017-3316-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 03/13/2017] [Indexed: 10/19/2022]
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10
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Figliuzzi MM, Giudice A, Pileggi S, Scordamaglia F, Marrelli M, Tatullo M, Fortunato L. Biomimetic hydroxyapatite used in the treatment of periodontal intrabony pockets: clinical and radiological analysis. ANNALI DI STOMATOLOGIA 2016; 7:16-23. [PMID: 27486507 DOI: 10.11138/ads/2016.7.1.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
AIM Hydroxyapatite (PA) has a chemical composition and physical structure very similar to natural bone and therefore it has been considered to be the ideal biomaterial able to ensure a biomimetic scaffold to use in bone tissue engineering. The aim of this study is to clinically test hydroxyapatite used as osteoconductive biomaterial in the treatment of periodontal bone defects. Clinical and radiological evaluations were conducted at 6, 12 and 18 months after the surgery. MATERIALS AND METHODS Forty patients with 2- and 3-wall intrabony pockets were enrolled in this study. PPD, CAL, radiographic depth (RD) and angular defects were preoperatively measured. After surgery, patients were re-evaluated every 6 months for 18 months. Statistical analyses were also performed to investigate any differences between preoperative and postoperative measurements. RESULTS Paired t-test samples conducted on the data obtained at baseline and 18 months after, showed significant (p<0.01) differences in each measurement performed. The role of preoperative RD was demonstrated to be a significant key factor (p<0.01). A relevant correlation between preoperative PPD and CAL gain was also found. CONCLUSIONS Within the limitations of this study, the absence of anatomical variables, except the morphology of the bone defect, emphasizes the importance of the proper surgical approach and the graft material used.
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Affiliation(s)
| | - Amerigo Giudice
- Department of Periodontics and Oral Sciences, University "Magna Graecia" Catanzaro, Italy
| | - Settimia Pileggi
- Department of Periodontics and Oral Sciences, University "Magna Graecia" Catanzaro, Italy
| | - Francesco Scordamaglia
- Department of Periodontics and Oral Sciences, University "Magna Graecia" Catanzaro, Italy
| | | | - Marco Tatullo
- Maxillofacial Unit, Calabrodental Clinic, Crotone, Italy
| | - Leonzio Fortunato
- Department of Periodontics and Oral Sciences, University "Magna Graecia" Catanzaro, Italy
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Canullo L, Pellegrini G, Canciani E, Heinemann F, Galliera E, Dellavia C. Alveolar socket preservation technique: Effect of biomaterial on bone regenerative pattern. Ann Anat 2016; 206:73-9. [DOI: 10.1016/j.aanat.2015.05.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 05/07/2015] [Accepted: 05/26/2015] [Indexed: 10/23/2022]
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Zizzari VL, Zara S, Tetè G, Vinci R, Gherlone E, Cataldi A. Biologic and clinical aspects of integration of different bone substitutes in oral surgery: a literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 122:392-402. [PMID: 27496576 DOI: 10.1016/j.oooo.2016.04.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 04/12/2016] [Indexed: 12/21/2022]
Abstract
Many bone substitutes have been proposed for bone regeneration, and researchers have focused on the interactions occurring between grafts and host tissue, as the biologic response of host tissue is related to the origin of the biomaterial. Bone substitutes used in oral and maxillofacial surgery could be categorized according to their biologic origin and source as autologous bone graft when obtained from the same individual receiving the graft; homologous bone graft, or allograft, when harvested from an individual other than the one receiving the graft; animal-derived heterologous bone graft, or xenograft, when derived from a species other than human; and alloplastic graft, made of bone substitute of synthetic origin. The aim of this review is to describe the most commonly used bone substitutes, according to their origin, and to focus on the biologic events that ultimately lead to the integration of a biomaterial with the host tissue.
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Affiliation(s)
| | - Susi Zara
- Department of Pharmacy, University "G. d'Annunzio", Chieti, Italy
| | - Giulia Tetè
- Dental School, Vita-Salute University and Department of Dentistry, IRCCS San Raffaele Hospital, Milan, Italy
| | - Raffaele Vinci
- Dental School, Vita-Salute University and Department of Dentistry, IRCCS San Raffaele Hospital, Milan, Italy
| | - Enrico Gherlone
- Dental School, Vita-Salute University and Department of Dentistry, IRCCS San Raffaele Hospital, Milan, Italy
| | - Amelia Cataldi
- Department of Pharmacy, University "G. d'Annunzio", Chieti, Italy
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Dorozhkin SV. Multiphasic calcium orthophosphate (CaPO 4 ) bioceramics and their biomedical applications. CERAMICS INTERNATIONAL 2016; 42:6529-6554. [DOI: 10.1016/j.ceramint.2016.01.062] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
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Groen N, Guvendiren M, Rabitz H, Welsh WJ, Kohn J, de Boer J. Stepping into the omics era: Opportunities and challenges for biomaterials science and engineering. Acta Biomater 2016; 34:133-142. [PMID: 26876875 DOI: 10.1016/j.actbio.2016.02.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 01/22/2016] [Accepted: 02/10/2016] [Indexed: 12/11/2022]
Abstract
The research paradigm in biomaterials science and engineering is evolving from using low-throughput and iterative experimental designs towards high-throughput experimental designs for materials optimization and the evaluation of materials properties. Computational science plays an important role in this transition. With the emergence of the omics approach in the biomaterials field, referred to as materiomics, high-throughput approaches hold the promise of tackling the complexity of materials and understanding correlations between material properties and their effects on complex biological systems. The intrinsic complexity of biological systems is an important factor that is often oversimplified when characterizing biological responses to materials and establishing property-activity relationships. Indeed, in vitro tests designed to predict in vivo performance of a given biomaterial are largely lacking as we are not able to capture the biological complexity of whole tissues in an in vitro model. In this opinion paper, we explain how we reached our opinion that converging genomics and materiomics into a new field would enable a significant acceleration of the development of new and improved medical devices. The use of computational modeling to correlate high-throughput gene expression profiling with high throughput combinatorial material design strategies would add power to the analysis of biological effects induced by material properties. We believe that this extra layer of complexity on top of high-throughput material experimentation is necessary to tackle the biological complexity and further advance the biomaterials field. STATEMENT OF SIGNIFICANCE In this opinion paper, we postulate that converging genomics and materiomics into a new field would enable a significant acceleration of the development of new and improved medical devices. The use of computational modeling to correlate high-throughput gene expression profiling with high throughput combinatorial material design strategies would add power to the analysis of biological effects induced by material properties. We believe that this extra layer of complexity on top of high-throughput material experimentation is necessary to tackle the biological complexity and further advance the biomaterials field.
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Affiliation(s)
- Nathalie Groen
- Department of Tissue Regeneration, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Murat Guvendiren
- New Jersey Center for Biomaterials, Rutgers University, Piscataway, NJ, USA
| | - Herschel Rabitz
- Department of Chemistry, Princeton University, Princeton, NJ, USA
| | - William J Welsh
- Department of Pharmacology, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, USA
| | - Joachim Kohn
- New Jersey Center for Biomaterials, Rutgers University, Piscataway, NJ, USA
- Department of Chemistry and Chemical Biology, New Jersey Center for Biomaterials, Rutgers University, Piscataway, NJ, USA
| | - Jan de Boer
- Department of Tissue Regeneration, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
- cBITE Lab, Merln Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, The Netherlands
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Ripamonti U, Klar RM, Parak R, Dickens C, Dix-Peek T, Duarte R. Tissue segregation restores the induction of bone formation by the mammalian transforming growth factor-β(3) in calvarial defects of the non-human primate Papio ursinus. Biomaterials 2016; 86:21-32. [PMID: 26874889 DOI: 10.1016/j.biomaterials.2016.01.071] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 01/31/2016] [Indexed: 12/12/2022]
Abstract
A diffusion molecular hypothesis from the dura and/or the leptomeninges below that would control the induction of calvarial membranous bone formation by the recombinant human transforming growth factor-β3 (hTGF-β3) was investigated. Coral-derived calcium carbonate-based macroporous constructs (25 mm diameter; 3.5/4 mm thickness) with limited hydrothermal conversion to hydroxyapatite (7% HA/CC) were inserted into forty calvarial defects created in 10 adult Chacma baboons Papio ursinus. In 20 defects, an impermeable nylon foil membrane (SupraFOIL(®)) was inserted between the cut endocranial bone and the underlying dura mater. Twenty of the macroporous constructs were preloaded with hTGF-β3 (125 μg in 1000 μl 20 mM sodium succinate, 4% mannitol pH4.0), 10 of which were implanted into defects segregated by the SupraFOIL(®) membrane, and 10 into non-segregated defects. Tissues were harvested on day 90, processed for decalcified and undecalcified histology and quantitative real-time polymerase chain reaction (qRT-PCR). Segregated untreated macroporous specimens showed a reduction of bone formation across the macroporous spaces compared to non-segregated constructs. qRT-PCR of segregated untreated specimens showed down regulation of osteogenic protein-1 (OP-1), osteocalcin (OC), bone morphogenetic protein-2 (BMP-2), RUNX-2 and inhibitor of DNA binding-2 and -3 (ID2,ID3) and up regulation of TGF-β3, a molecular signalling pathway inhibiting the induction of membranous bone formation. Non-segregated hTGF-β3/treated constructs also showed non-osteogenic expression profiles when compared to non-segregated untreated specimens. Segregated hTGF-β3/treated 7% HA/CC constructs showed significantly greater induction of bone formation across the macroporous spaces and, compared to non-segregated hTGF-β3/treated constructs, showed up regulation of OP-1, OC, BMP-2, RUNX-2, ID2 and ID3. Similar up-regulated expression profiles were seen for untreated non-segregated constructs. TGF-β signalling via ID genes creates permissive or refractory micro-environments that regulate the induction of calvarial bone formation which is controlled by the exogenous hTGF-β3 upon segregation of the calvarial defects. The dura is the common regulator of the induction of calvarial bone formation modulated by the presence or absence of the SupraFOIL(®) membrane with or without hTGF-β3.
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Affiliation(s)
- U Ripamonti
- Bone Research Laboratory, School of Oral Health Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Roland Manfred Klar
- Bone Research Laboratory, School of Oral Health Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Molecular and Cellular Biology Laboratories, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ruqayya Parak
- Bone Research Laboratory, School of Oral Health Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Oral Biological Sciences, School of Oral Health Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Caroline Dickens
- Molecular and Cellular Biology Laboratories, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Therese Dix-Peek
- Molecular and Cellular Biology Laboratories, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Raquel Duarte
- Molecular and Cellular Biology Laboratories, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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17
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García-Gareta E, Coathup MJ, Blunn GW. Osteoinduction of bone grafting materials for bone repair and regeneration. Bone 2015; 81:112-121. [PMID: 26163110 DOI: 10.1016/j.bone.2015.07.007] [Citation(s) in RCA: 361] [Impact Index Per Article: 40.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 07/03/2015] [Accepted: 07/06/2015] [Indexed: 01/01/2023]
Abstract
Regeneration of bone defects caused by trauma, infection, tumours or inherent genetic disorders is a clinical challenge that usually necessitates bone grafting materials. Autologous bone or autograft is still considered the clinical "gold standard" and the most effective method for bone regeneration. However, limited bone supply and donor site morbidity are the most important disadvantages of autografting. Improved biomaterials are needed to match the performance of autograft as this is still superior to that of synthetic bone grafts. Osteoinductive materials would be the perfect candidates for achieving this task. The aim of this article is to review the different groups of bone substitutes in terms of their most recently reported osteoinductive properties. The different factors influencing osteoinductivity by biomaterials as well as the mechanisms behind this phenomenon are also presented, showing that it is very limited compared to osteoinductivity shown by bone morphogenetic proteins (BMPs). Therefore, a new term to describe osteoinductivity by biomaterials is proposed. Different strategies for adding osteoinductivity (BMPs, stem cells) to bone substitutes are also discussed. The overall objective of this paper is to gather the current knowledge on osteoinductivity of bone grafting materials for the effective development of new graft substitutes that enhance bone regeneration.
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Affiliation(s)
- Elena García-Gareta
- RAFT Institute of Plastic Surgery, Mount Vernon Hospital, Northwood HA6 2RN, UK.
| | - Melanie J Coathup
- John Scales Centre for Biomedical Engineering, Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, Royal National Orthopaedic Hospital, Stanmore HA7 4LP, UK
| | - Gordon W Blunn
- John Scales Centre for Biomedical Engineering, Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, Royal National Orthopaedic Hospital, Stanmore HA7 4LP, UK
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Ectopic osteoid and bone formation by three calcium-phosphate ceramics in rats, rabbits and dogs. PLoS One 2014; 9:e107044. [PMID: 25229501 PMCID: PMC4167699 DOI: 10.1371/journal.pone.0107044] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 08/14/2014] [Indexed: 02/05/2023] Open
Abstract
Calcium phosphate ceramics with specific physicochemical properties have been shown to induce de novo bone formation upon ectopic implantation in a number of animal models. In this study we explored the influence of physicochemical properties as well as the animal species on material-induced ectopic bone formation. Three bioceramics were used for the study: phase-pure hydroxyapatite (HA) sintered at 1200°C and two biphasic calcium phosphate (BCP) ceramics, consisting of 60 wt.% HA and 40 wt.% TCP (β-Tricalcium phosphate), sintered at either 1100°C or 1200°C. 108 samples of each ceramic were intramuscularly implanted in dogs, rabbits, and rats for 6, 12, and 24 weeks respectively. Histological and histomorphometrical analyses illustrated that ectopic bone and/or osteoid tissue formation was most pronounced in BCP sintered at 1100°C and most limited in HA, independent of the animal model. Concerning the effect of animal species, ectopic bone formation reproducibly occurred in dogs, while in rabbits and rats, new tissue formation was mainly limited to osteoid. The results of this study confirmed that the incidence and the extent of material-induced bone formation are related to both the physicochemical properties of calcium phosphate ceramics and the animal model.
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Matsuura T, Akizuki T, Hoshi S, Ikawa T, Kinoshita A, Sunaga M, Oda S, Kuboki Y, Izumi Y. Effect of a tunnel-structured β-tricalcium phosphate graft material on periodontal regeneration: a pilot study in a canine one-wall intrabony defect model. J Periodontal Res 2014; 50:347-55. [DOI: 10.1111/jre.12213] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2014] [Indexed: 12/28/2022]
Affiliation(s)
- T. Matsuura
- Department of Periodontology; Graduate School of Medical and Dental Science; Tokyo Medical and Dental University; Tokyo Japan
| | - T. Akizuki
- Department of Periodontology; Graduate School of Medical and Dental Science; Tokyo Medical and Dental University; Tokyo Japan
- Division of Periodontology; Department of Oral Science; Graduate School of Dentistry; Kanagawa Dental University; Kanagawa Japan
| | - S. Hoshi
- Department of Periodontology; Graduate School of Medical and Dental Science; Tokyo Medical and Dental University; Tokyo Japan
| | - T. Ikawa
- Department of Periodontology; Graduate School of Medical and Dental Science; Tokyo Medical and Dental University; Tokyo Japan
| | - A. Kinoshita
- Department of Educational Media Development; Institute for Library and Media Information Technology; Tokyo Medical and Dental University; Tokyo Japan
| | - M. Sunaga
- Department of Educational Media Development; Institute for Library and Media Information Technology; Tokyo Medical and Dental University; Tokyo Japan
| | - S. Oda
- Oral Diagnosis and General Dentistry; University Hospital of Dentistry; Tokyo Medical and Dental University; Tokyo Japan
| | - Y. Kuboki
- Graduate School of Dental Medicine; Hokkaido University; Sapporo Japan
| | - Y. Izumi
- Department of Periodontology; Graduate School of Medical and Dental Science; Tokyo Medical and Dental University; Tokyo Japan
- Global Center of Excellence Program; International Research Center for Molecular Science in Tooth and Bone Diseases (GCOE Program); Tokyo Japan
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20
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Figliuzzi MM, De Fazio R, Tiano R, De Franceschi S, Pacifico D, Mangano F, Fortunato L. Histological evaluation of a biomimetic material in bone regeneration after one year from graft. ANNALI DI STOMATOLOGIA 2014; 5:103-107. [PMID: 25506415 PMCID: PMC4252859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM The use of substitute materials is one of the solutions used in periodontology for the reconstruction of intrabony defects. Advances in scientific research gave rise to a new generation of biomaterials of synthetic origin stoichiometrically unstable and therefore really absorbable. Our research is directed precisely towards a biomaterial synthesis, Engipore® (Finceramica, Faenza, Italy) which is a bone substitute of the latest hydroxyapatite-based generation, that possesses chemical and morphological properties similar to those of natural bone in the treatment of infrabony periodontal defects. Aim of this study was to evaluate the efficacy of Engipore® in the treatment of intrabony periodontal defects. METHODS The study was conducted on 100 parodontopatics patients, which had gingival pockets of at least infrabonies 8/10 mm. The histological evaluation was performed with samples after one year from the graft. RESULTS The histological samples collected after one year showed an abundant new bone formation, with mature lamellar bone tissue surrounding the residual particles of Engipore® that appear completely osteointegrated. The surrounding connective tissue shows no signs of inflammation. CONCLUSIONS The results obtained in our research demonstrated that, after a proper selection of patients and lesions, and applying an adequate surgical technique, this type of biomaterial in the treatment of periodontal defects acts in an optimal manner as a filler inducing the formation of new bone as evidenced by histological examinations.
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Affiliation(s)
- Michele M. Figliuzzi
- Department of Periodontics and Oral Sciences, Magna Graecia University, Catanzaro, Italy
| | - Rossella De Fazio
- Department of Periodontics and Oral Sciences, Magna Graecia University, Catanzaro, Italy
| | - Rosamaria Tiano
- Department of Periodontics and Oral Sciences, Magna Graecia University, Catanzaro, Italy
| | - Serena De Franceschi
- Department of Periodontics and Oral Sciences, Magna Graecia University, Catanzaro, Italy
| | - Delfina Pacifico
- Department of Periodontics and Oral Sciences, Magna Graecia University, Catanzaro, Italy
| | | | - Leonzio Fortunato
- Department of Periodontics and Oral Sciences, Magna Graecia University, Catanzaro, Italy
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Liposomal clodronate inhibition of osteoclastogenesis and osteoinduction by submicrostructured beta-tricalcium phosphate. Biomaterials 2014; 35:5088-97. [PMID: 24698521 DOI: 10.1016/j.biomaterials.2014.03.013] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 03/07/2014] [Indexed: 12/27/2022]
Abstract
Bone graft substitutes such as calcium phosphates are subject to the innate inflammatory reaction, which may bear important consequences for bone regeneration. We speculate that the surface architecture of osteoinductive β-tricalcium phosphate (TCP) stimulates the differentiation of invading monocyte/macrophages into osteoclasts, and that these cells may be essential to ectopic bone formation. To test this, porous TCP cubes with either submicron-scale surface architecture known to induce ectopic bone formation (TCPs, positive control) or micron-scale, non-osteoinductive surface architecture (TCPb, negative control) were subcutaneously implanted on the backs of FVB strain mice for 12 weeks. Additional TCPs samples received local, weekly injections of liposome-encapsulated clodronate (TCPs + LipClod) to deplete invading monocyte/macrophages. TCPs induced osteoclast formation, evident by positive tartrate resistant acid phosphatase (TRAP) cytochemical staining and negative macrophage membrane marker F4/80 immunostaining. No TRAP positive cells were found in TCPb or TCPs + LipClod, only F4/80 positive macrophages and foreign body giant cells. TCPs stimulated subcutaneous bone formation in all implants, while no bone could be found in TCPb or TCPs + LipClod. In agreement, expression of bone and osteoclast gene markers was upregulated in TCPs versus both TCPb and TCPs + LipClod, which were equivalent. In summary, submicron-scale surface structure of TCP induced osteoclastogenesis and ectopic bone formation in a process that is blocked by monocyte/macrophage depletion.
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22
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Dorozhkin SV. Calcium Orthophosphate-Based Bioceramics. MATERIALS (BASEL, SWITZERLAND) 2013; 6:3840-3942. [PMID: 28788309 PMCID: PMC5452669 DOI: 10.3390/ma6093840] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 08/07/2013] [Accepted: 08/19/2013] [Indexed: 02/07/2023]
Abstract
Various types of grafts have been traditionally used to restore damaged bones. In the late 1960s, a strong interest was raised in studying ceramics as potential bone grafts due to their biomechanical properties. A bit later, such synthetic biomaterials were called bioceramics. In principle, bioceramics can be prepared from diverse materials but this review is limited to calcium orthophosphate-based formulations only, which possess the specific advantages due to the chemical similarity to mammalian bones and teeth. During the past 40 years, there have been a number of important achievements in this field. Namely, after the initial development of bioceramics that was just tolerated in the physiological environment, an emphasis was shifted towards the formulations able to form direct chemical bonds with the adjacent bones. Afterwards, by the structural and compositional controls, it became possible to choose whether the calcium orthophosphate-based implants remain biologically stable once incorporated into the skeletal structure or whether they were resorbed over time. At the turn of the millennium, a new concept of regenerative bioceramics was developed and such formulations became an integrated part of the tissue engineering approach. Now calcium orthophosphate scaffolds are designed to induce bone formation and vascularization. These scaffolds are often porous and harbor different biomolecules and/or cells. Therefore, current biomedical applications of calcium orthophosphate bioceramics include bone augmentations, artificial bone grafts, maxillofacial reconstruction, spinal fusion, periodontal disease repairs and bone fillers after tumor surgery. Perspective future applications comprise drug delivery and tissue engineering purposes because calcium orthophosphates appear to be promising carriers of growth factors, bioactive peptides and various types of cells.
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Mangano C, Sinjari B, Shibli JA, Mangano F, Hamisch S, Piattelli A, Perrotti V, Iezzi G. A Human Clinical, Histological, Histomorphometrical, and Radiographical Study on Biphasic HA-Beta-TCP 30/70 in Maxillary Sinus Augmentation. Clin Implant Dent Relat Res 2013; 17:610-8. [PMID: 24004190 DOI: 10.1111/cid.12145] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND By mixing hydroxyapatite (HA) and tricalcium phosphate (TCP), biphasic calcium phosphate ceramics can be obtained, and by varying their ratio it is possible to tailor the characteristics of the biomaterial. PURPOSE The aim of the present human study was to evaluate the histological and radiographical aspects of bone formation in maxillary sinus augmentation using a 30/70 HA-beta-TCP with a reticular structure. MATERIALS AND METHODS A total of 12 patients, undergoing two-stage sinus augmentation procedure using HA-beta-TCP at a ratio of 30/70, were included in the present study. After a 6-month healing period, during implant insertion, radiographical analysis was performed, and then the bone core biopsies were harvested and processed for histology. RESULTS At radiographic evaluation, the bone gain was on average 6.85 ± 0.60 mm. HA-beta-TCP 30/70 appeared to be lined by newly formed bone, with no gaps at the interface. The histomorphometric analysis revealed 26 ± 2% of residual grafted biomaterial, 29 ± 3% of newly formed bone, and 45 ± 2% of marrow spaces. CONCLUSIONS The present results indicate histologically the high biocompatibility and osteoconductivity of HA-beta-TCP 30/70, and clinically its successful use for sinus augmentation procedures.
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Affiliation(s)
- Carlo Mangano
- Department of Morphological and Surgical Science, University of Insubria, Varese, Italy
| | - Bruna Sinjari
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Jamil A Shibli
- Dental Research Division, Guarulhos University, SP, Guarulhos, Brazil
| | - Francesco Mangano
- Department of Morphological and Surgical Science, University of Insubria, Varese, Italy
| | | | - Adriano Piattelli
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Vittoria Perrotti
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Giovanna Iezzi
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
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Coathup MJ, Cai Q, Campion C, Buckland T, Blunn GW. The effect of particle size on the osteointegration of injectable silicate-substituted calcium phosphate bone substitute materials. J Biomed Mater Res B Appl Biomater 2013; 101:902-10. [PMID: 23362131 PMCID: PMC4166705 DOI: 10.1002/jbm.b.32895] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 11/20/2012] [Accepted: 12/20/2012] [Indexed: 12/12/2022]
Abstract
Calcium phosphate (CaP) particles as a carrier in an injectable bone filler allows less invasive treatment of bony defects. The effect of changing granule size within a poloxamer filler on the osteointegration of silicate-substituted calcium phosphate (SiCaP) bone substitute materials was investigated in an ovine critical-sized femoral condyle defect model. Treatment group (TG) 1 consisted of SiCaP granules sized 1000-2000 μm in diameter (100 vol %). TG2 investigated a granule size of 250-500 μm (75 vol %), TG3 a granule size of 90-125 μm (75 vol %) and TG4 a granule size of 90-125 μm (50 vol %). Following a 4 and 8 week in vivo period, bone area, bone-implant contact, and remaining implant area were quantified within each defect. At 4 weeks, significantly increased bone formation was measured in TG2 (13.32% ± 1.38%) when compared with all other groups (p = 0.021 in all cases). Bone in contact with the bone substitute surface was also significantly higher in TG2. At 8 weeks most new bone was associated within defects containing the smallest granule size investigated (at the lower volume) (TG4) (42.78 ± 3.36%) however this group was also associated with higher amounts of fragmented SiCaP. These smaller particles were phagocytosed by macrophages and did not appear to have a negative influence on healing. In conclusion, SiCaP granules of 250-500 μm in size may be a more suitable scaffold when used as an injectable bone filler and may be a convenient method for treating bony defects.
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Affiliation(s)
- Melanie J Coathup
- Division of Surgery and Interventional Science, John Scales Centre for Biomedical Engineering, Institute of Orthopaedics and Musculoskeletal Science, University College London, The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore Middlesex, HA7 4LP, UK.
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25
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Barboni B, Mangano C, Valbonetti L, Marruchella G, Berardinelli P, Martelli A, Muttini A, Mauro A, Bedini R, Turriani M, Pecci R, Nardinocchi D, Zizzari VL, Tetè S, Piattelli A, Mattioli M. Synthetic bone substitute engineered with amniotic epithelial cells enhances bone regeneration after maxillary sinus augmentation. PLoS One 2013; 8:e63256. [PMID: 23696804 PMCID: PMC3656960 DOI: 10.1371/journal.pone.0063256] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 04/01/2013] [Indexed: 12/13/2022] Open
Abstract
Background Evidence has been provided that a cell-based therapy combined with the use of bioactive materials may significantly improve bone regeneration prior to dental implant, although the identification of an ideal source of progenitor/stem cells remains to be determined. Aim In the present research, the bone regenerative property of an emerging source of progenitor cells, the amniotic epithelial cells (AEC), loaded on a calcium-phosphate synthetic bone substitute, made by direct rapid prototyping (rPT) technique, was evaluated in an animal study. Material And Methods Two blocks of synthetic bone substitute (∼0.14 cm3), alone or engineered with 1×106 ovine AEC (oAEC), were grafted bilaterally into maxillary sinuses of six adult sheep, an animal model chosen for its high translational value in dentistry. The sheep were then randomly divided into two groups and sacrificed at 45 and 90 days post implantation (p.i.). Tissue regeneration was evaluated in the sinus explants by micro-computer tomography (micro-CT), morphological, morphometric and biochemical analyses. Results And Conclusions The obtained data suggest that scaffold integration and bone deposition are positively influenced by allotransplantated oAEC. Sinus explants derived from sheep grafted with oAEC engineered scaffolds displayed a reduced fibrotic reaction, a limited inflammatory response and an accelerated process of angiogenesis. In addition, the presence of oAEC significantly stimulated osteogenesis either by enhancing bone deposition or making more extent the foci of bone nucleation. Besides the modulatory role played by oAEC in the crucial events successfully guiding tissue regeneration (angiogenesis, vascular endothelial growth factor expression and inflammation), data provided herein show that oAEC were also able to directly participate in the process of bone deposition, as suggested by the presence of oAEC entrapped within the newly deposited osteoid matrix and by their ability to switch-on the expression of a specific bone-related protein (osteocalcin, OCN) when transplanted into host tissues.
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Affiliation(s)
- Barbara Barboni
- Department of Comparative Biomedical Science, University of Teramo, Teramo, Italy
- Stem TeCh Group, Chieti, Italy
| | - Carlo Mangano
- Department of Surgical and Morphological Science, University of Insubria, Varese, Italy
| | - Luca Valbonetti
- Department of Comparative Biomedical Science, University of Teramo, Teramo, Italy
- Stem TeCh Group, Chieti, Italy
| | - Giuseppe Marruchella
- Department of Comparative Biomedical Science, University of Teramo, Teramo, Italy
| | - Paolo Berardinelli
- Department of Comparative Biomedical Science, University of Teramo, Teramo, Italy
| | - Alessandra Martelli
- Department of Comparative Biomedical Science, University of Teramo, Teramo, Italy
| | - Aurelio Muttini
- Department of Comparative Biomedical Science, University of Teramo, Teramo, Italy
- Stem TeCh Group, Chieti, Italy
| | - Annunziata Mauro
- Department of Comparative Biomedical Science, University of Teramo, Teramo, Italy
| | - Rossella Bedini
- Department of Technologies and Health, Istituto Superiore di Sanità, Rome, Italy
| | - Maura Turriani
- Department of Comparative Biomedical Science, University of Teramo, Teramo, Italy
| | - Raffaella Pecci
- Department of Technologies and Health, Istituto Superiore di Sanità, Rome, Italy
| | - Delia Nardinocchi
- Department of Comparative Biomedical Science, University of Teramo, Teramo, Italy
| | - Vincenzo Luca Zizzari
- Department of Medical, Oral and Biotechnological Science, University “G. d'Annunzio”, Chieti, Italy
| | - Stefano Tetè
- Department of Medical, Oral and Biotechnological Science, University “G. d'Annunzio”, Chieti, Italy
- Stem TeCh Group, Chieti, Italy
- * E-mail:
| | - Adriano Piattelli
- Department of Medical, Oral and Biotechnological Science, University “G. d'Annunzio”, Chieti, Italy
| | - Mauro Mattioli
- Department of Comparative Biomedical Science, University of Teramo, Teramo, Italy
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Swain LD, Cornet DA, Manwaring ME, Collins B, Singh VK, Beniker D, Carnes DL. Negative pressure therapy stimulates healing of critical-size calvarial defects in rabbits. BONEKEY REPORTS 2013; 2:299. [PMID: 23951542 PMCID: PMC3722738 DOI: 10.1038/bonekey.2013.33] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 01/28/2013] [Indexed: 01/27/2023]
Abstract
Negative pressure therapy (NPT) is the controlled application of subatmospheric pressure to wounds. It has been shown to stimulate healing across a broad spectrum of soft-tissue wounds, at least in part from the application of mechanical stress on cells and tissues in the wound environment. This study tests the hypothesis that application of NPT to cranial critical-size defects (CSD) in skeletally mature rabbits leads to osseous healing. NPT was delivered 1, 4, 6 or 10 days over CSD-containing calcium phosphate scaffolds placed in contact with intact dura. At 12 weeks after defect creation, NPT groups exhibited significantly greater defect bridging and bone within the scaffolds (P<0.01). Increasing duration of NPT did not result in a greater amount of bone within the scaffolds, but did increase the amount of bone distributed in the upper half of the scaffolds. Appearance of tissue within defects immediately following the removal of NPT at day 6 suggests alternating regions of dural compression and distention indicative of cell stretching. Dura and adjacent tissue were composed of multiple cell layers that extended up into the scaffolds, lining struts and populating pore spaces. An extracellular matrix densely populated with cells and capillaries, as well as larger vessels, infiltrated pores of NPT-treated scaffolds, while scattered spindle-shaped cells and sparse stroma are present within pores of control scaffolds. This rabbit model data suggest that NPT activates within mature dura a natural healing cascade that results in osseous tissue formation without the addition of exogenous factors or progenitor cells.
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Wepener I, Richter W, van Papendorp D, Joubert AM. In vitro osteoclast-like and osteoblast cells' response to electrospun calcium phosphate biphasic candidate scaffolds for bone tissue engineering. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2012; 23:3029-40. [PMID: 22965382 DOI: 10.1007/s10856-012-4751-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 08/20/2012] [Indexed: 05/23/2023]
Abstract
Successful long term bone replacement and repair remain a challenge today. Nanotechnology has made it possible to alter materials' characteristics and therefore possibly improve on the material itself. In this study, biphasic hydroxyapatite/β-tricalcium phosphate nanobioceramic scaffolds were prepared by the electrospinning technique in order to mimic the extracellular matrix. Scaffolds were characterised by scanning electron microscopy (SEM) and attenuated total reflectance-fourier transform infrared. Osteoblasts as well as monocytes that were differentiated into osteoclast-like cells, were cultured separately on the biphasic bioceramic scaffolds for up to 6 days and the proliferation, adhesion and cellular response were determined using lactate dehydrogenase cytotoxicity assay, nucleus and cytoskeleton dynamics, analysis of the cell cycle progression, measurement of the mitochondrial membrane potential and the detection of phosphatidylserine expression. SEM analysis of the biphasic bioceramic scaffolds revealed nanofibers spun in a mesh-like scaffold. Results indicate that the biphasic bioceramic electrospun scaffolds are biocompatible and have no significant negative effects on either osteoblasts or osteoclast-like cells in vitro.
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Affiliation(s)
- I Wepener
- Council for Scientific and Industrial Research, Polymers and Composites, P.O. Box 395, Pretoria, 0001, South Africa.
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Seeherman HJ, Li XJ, Smith E, Wozney JM. rhBMP-2/calcium phosphate matrix induces bone formation while limiting transient bone resorption in a nonhuman primate core defect model. J Bone Joint Surg Am 2012; 94:1765-76. [PMID: 23032587 DOI: 10.2106/jbjs.k.00523] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Transient bone resorption limits the use of recombinant human bone morphogenetic protein-2 (rhBMP-2)/absorbable collagen sponge in metaphyseal bone. The purpose of the present study was to evaluate the efficacy of rhBMP-2/calcium phosphate matrix (CPM) to induce bone formation while limiting transient bone resorption in nonhuman primate core defects. METHODS Metaphyseal core defects were created in eighteen cynomolgus monkeys. rhBMP-2 retention was evaluated in the distal part of the radius. Bone formation was evaluated at eight weeks following treatment with 1.5 or 4.5-mg/mL rhBMP-2/CPM, CPM alone, or no treatment in the distal part of the radius, the proximal part of the tibia, and the proximal part of the femur; at twenty-four weeks following treatment with 1.5-mg/mL rhBMP-2/CPM or CPM alone in the proximal part of the tibia; and at one, two, and four weeks following treatment with 1.5-mg/mL rhBMP-2/CPM or no treatment in the distal part of the radius. Bone resorption was evaluated at four weeks following treatment with 1.5, 2.0, 3.0, and 4.5-mg/mL rhBMP-2/CPM or CPM alone in the distal part of the femur. Evaluations were performed with use of scintigraphy, radiographs, histological analysis, and computed tomography. RESULTS Seventy-eight percent, 64%, 50%, 35%, and 12% of the rhBMP-2 was retained in the distal part of the radius at one, seven, fourteen, twenty-one, and forty-nine days after surgery. rhBMP-2/CPM increased bone formation within core defects and surrounding trabeculae compared with CPM alone or no treatment at all anatomic locations at eight weeks, and bone formation was ongoing in the rhBMP-2/CPM-treated proximal tibial sites at twenty-four weeks. Bone formation began in the trabeculae surrounding the core defects at one week and was observed adjacent to the resorbing CPM within the core defects and in the surrounding trabecular bone at two and four weeks in the rhBMP-2/CPM-treated distal radial sites. Bone formation was confined to the region immediately surrounding the core defects in the untreated distal radial sites at all time points. Transient bone resorption was only observed in the distal femoral sites treated with 4.5 mg/mL of rhBMP-2/CPM at two weeks. CONCLUSIONS Treatment of nonhuman primate metaphyseal core defects with 1.5 to 3.0-mg/mL rhBMP-2/CPM resulted in bone formation without transient bone resorption. CLINICAL RELEVANCE rhBMP-2/CPM may be useful to accelerate healing of metaphyseal bone defects in humans.
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Affiliation(s)
- Howard J Seeherman
- Inflammation and Tissue Repair, Pfizer Discovery Research, 200 Cambridge Park Drive, Cambridge, MA 02140, USA.
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Canullo L, Heinemann F, Gedrange T, Biffar R, Kunert-Keil C. Histological evaluation at different times after augmentation of extraction sites grafted with a magnesium-enriched hydroxyapatite: double-blinded randomized controlled trial. Clin Oral Implants Res 2012; 24:398-406. [DOI: 10.1111/clr.12035] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2012] [Indexed: 11/30/2022]
Affiliation(s)
| | - Friedhelm Heinemann
- Department of Prosthodontics, Gerostomatolgy and Biomaterials; University Medicine of Greifswald; Greifswald; Germany
| | - Tomasz Gedrange
- Deptartment of Orthodontics; Technische Universität Dresden; Dresden; Germany
| | - Reiner Biffar
- Department of Prosthodontics, Gerostomatolgy and Biomaterials; University Medicine of Greifswald; Greifswald; Germany
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Davison N, Yuan H, de Bruijn JD, Barrere-de Groot F. In vivo performance of microstructured calcium phosphate formulated in novel water-free carriers. Acta Biomater 2012; 8:2759-69. [PMID: 22487931 DOI: 10.1016/j.actbio.2012.04.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 03/27/2012] [Accepted: 04/02/2012] [Indexed: 10/28/2022]
Abstract
Osteoinductive calcium phosphate (CaP) ceramics can be combined with polymeric carriers to make shapeable bone substitutes as an alternative to autologous bone; however, carriers containing water may degrade the ceramic surface microstructure, which is crucial to bone formation. In this study five novel tricalcium phosphate (TCP) formulations were designed from water-free polymeric binders and osteoinductive TCP granules of different particle sizes (500-1000 μm for moldable putty forms, and 150-500 μm for flowable paste forms). The performance of these novel TCP formulations was studied and compared with control TCP granules alone (both 150-500 and 500-1000 μm). In vitro the five TCP formulations were characterized by their carrier dissolution times and TCP mineralization kinetic profiles in simulated body fluid. In vivo the formulations were implanted in the dorsal muscle and a unicortical femoral defect (Ø=5 mm) of dogs for 12 weeks. The TCP formulation based on a xanthan gum-glycerol carrier exhibited fast carrier dissolution (1 h) and TCP mineralization (7 days) in vitro, but induced inflammation and showed little ectopic bone formation. This carrier chemistry was thus found to disrupt the early cellular response related to osteoinduction by microstructured TCP. TCP formulations based on carboxymethyl cellulose-glycerol and Polyoxyl 15-hydroxystearate-Pluronic(®) F127 allowed the in vitro surface mineralization of TCP by day 7 and produced the highest level of orthotopic bone bridging and ectopic bone formation, which was equivalent to the control. These results demonstrate that water-free carriers can preserve the chemistry, microstructure, and performance of osteoinductive CaP ceramics.
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Dorozhkin SV. Biphasic, triphasic and multiphasic calcium orthophosphates. Acta Biomater 2012; 8:963-77. [PMID: 21945826 DOI: 10.1016/j.actbio.2011.09.003] [Citation(s) in RCA: 144] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Revised: 08/26/2011] [Accepted: 09/01/2011] [Indexed: 01/01/2023]
Abstract
Biphasic, triphasic and multiphasic (polyphasic) calcium orthophosphates have been sought as biomaterials for reconstruction of bone defects in maxillofacial, dental and orthopedic applications. In general, this concept is determined by advantageous balances of more stable (frequently hydroxyapatite) and more resorbable (typically tricalcium orthophosphates) phases of calcium orthophosphates, while the optimum ratios depend on the particular applications. Therefore, all currently known biphasic, triphasic and multiphasic formulations of calcium orthophosphate bioceramics are sparingly soluble in water and, thus, after being implanted they are gradually resorbed inside the body, releasing calcium and orthophosphate ions into the biological medium and, hence, seeding new bone formation. The available formulations have already demonstrated proven biocompatibility, osteoconductivity, safety and predictability in vitro, in vivo, as well as in clinical models. More recently, in vitro and in vivo studies have shown that some of them might possess osteoinductive properties. Hence, in the field of tissue engineering biphasic, triphasic and multiphasic calcium orthophosphates represent promising biomaterials to construct various scaffolds capable of carrying and/or modulating the behavior of cells. Furthermore, such scaffolds are also suitable for drug delivery applications. This review summarizes the available information on biphasic, triphasic and multiphasic calcium orthophosphates, including their biomedical applications. New formulations are also proposed.
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Abstract
The new strategy of tissue engineering, and regenerative medicine at large, is to construct biomimetic matrices to mimic nature's hierarchical structural assemblages and mechanisms of simplicity and elegance that are conserved throughout genera and species. There is a direct spatial and temporal relationship of morphologic and molecular events that emphasize the biomimetism of the remodeling cycles of the osteonic corticocancellous bone versus the "geometric induction of bone formation," that is, the induction of bone by "smart" concavities assembled in biomimetic matrices of macroporous calcium phosphate-based constructs. The basic multicellular unit of the corticocancellous bone excavates a trench across the bone surface, leaving in its wake a hemiosteon rather than an osteon, that is, a trench with cross-sectional geometric cues of concavities after cyclic episodes of osteoclastogenesis, eventually leading to osteogenesis. The concavities per se are geometric regulators of growth-inducing angiogenesis and osteogenesis as in the remodeling processes of the corticocancellous bone. The concavities act as a powerful geometric attractant for myoblastic/myoendothelial and/or endothelial/pericytic stem cells, which differentiate into bone-forming cells. The lacunae, pits, and concavities cut by osteoclastogenesis within the biomimetic matrices are the driving morphogenetic cues that induce bone formation in a continuum of sequential phases of resorption/dissolution and formation. To induce the cascade of bone differentiation, the soluble osteogenic molecular signals of the transforming growth factor β supergene family must be reconstituted with an insoluble signal or substratum that triggers the bone differentiation cascade. By carving a series of repetitive concavities into solid and/or macroporous biomimetic matrices of highly crystalline hydroxyapatite or biphasic hydroxyapatite/β-tricalcium phosphate, we were able to embed smart biologic functions within intelligent scaffolds for tissue engineering of bone. The concavities assembled in the bioceramic constructs biomimetize the remodeling cycle of the corticocancellous bone and are endowed with multifunctional pleiotropic self-assembly capacities, initiating angiogenesis and bone formation by induction without the exogenous applications of the osteogenic-soluble molecular signals of the transforming growth factor β supergene family. The incorporation of specific biologic activities into biomimetic matrices by manipulating the geometry of the substratum, defined as geometric induction of bone formation, is now helping to engineer therapeutic osteogenesis in clinical contexts.
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Sisti A, Canullo L, Mottola MP, Covani U, Barone A, Botticelli D. Clinical evaluation of a ridge augmentation procedure for the severely resorbed alveolar socket: multicenter randomized controlled trial, preliminary results. Clin Oral Implants Res 2011; 23:526-35. [PMID: 22150876 DOI: 10.1111/j.1600-0501.2011.02386.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To radiographically analyze extraction sites left untreated or treated using a socket preservation technique. MATERIALS AND METHODS A total of 20 patients scheduled for single extraction in the maxilla from second to second premolar were enrolled in this study. All sites showed a bone defect >5 mm at the buccal wall and no soft tissue recession. At baseline (T0), tooth extraction was performed; subsequently, sites were randomly allocated to the control (CG: left to heal without grafting) or test group (TG: grafted using hydroxyapatite). Two months later (T1), implants were inserted and eventual GBR procedure was performed. Three months later, the definitive crown was placed. Follow up was 24 months (T2). A cone-beam computed tomographic examination (CT) was performed at each time point. At each radiographic analysis, horizontal and vertical widths of the sockets were measured. Comparisons between CG and TG were performed by a Wilcoxon non-parametric test. RESULTS At the end of the study, no patient dropped out and all implants inserted (10 in each group) resulted integrated. GBR procedures were performed at T1 only in the CG. In the CG, the mean value of the horizontal width in the coronal CT slices was 0.98 mm (± 0.37), 7.70 mm (± 0.92), 7.45 mm (± 0.69) at T0, T1 (after bone regeneration) and T2, respectively. In the TG, the mean value of the horizontal width in the coronal CT slices was 0.96 mm (± 0.41), 8.97 mm (± 1.91), 9.48 mm (± 1.56); at T2, it was 9.52 mm (± 1.87) at T0 (pre- and post-socket preservation) T1 and T2, respectively. At each follow up, the mean horizontal bone width in TG was statistically significantly greater than in the control group (P < 0.05). At T0, mean value of the vertical bone defect length (BDL) was 6.93 mm for TG, 6.5 mm for CG. At T1 and T2, mean BDL value was 0 for both groups. Statistically significant difference was not found between TC and CG at any time point (P > 0.05). CONCLUSIONS This randomized controlled trial suggested that in sites with buccal bone defects >5 mm, the application of HA can minimize alveolar crest resorption following tooth extraction. Furthermore, compared with traditional regenerative procedure carried out following socket healing, this preservation technique seems to result in better horizontal regeneration of the buccal bone wall.
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Affiliation(s)
- Angelo Sisti
- Ugo Covani, Istituto Stomatologico Tirreno, Lucca, Italy
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Boyan BD, Schwartz Z. Regenerative medicine: Are calcium phosphate ceramics 'smart' biomaterials? Nat Rev Rheumatol 2011; 7:8-9. [PMID: 21206482 DOI: 10.1038/nrrheum.2010.210] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Chai YC, Roberts SJ, Schrooten J, Luyten FP. Probing the osteoinductive effect of calcium phosphate by using an in vitro biomimetic model. Tissue Eng Part A 2011; 17:1083-97. [PMID: 21091326 DOI: 10.1089/ten.tea.2010.0160] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The use of calcium phosphate (CaP)-based carriers in bone engineering is a promising approach to induce in vivo bone formation. However, the exact mechanism of osteoinduction by CaP is not known. Here, by mimicking the in vivo Ca(2+) and P(i)-enriched environment in an in vitro model, we assessed the effects of these ions on human periosteum-derived cells. We observed a significant Ca(2+) and P(i)-induced cell proliferation, which was found to be through the modulation of cell cycle progression, in a dose- and time-dependent manner. In addition, Ca(2+), P(i), and combined Ca-P upregulated osteogenic gene expression in a dose- and time-dependent manner. Encouragingly, both ions administered individually or in combination persistently and dose dependently upregulated bone morphogenetic protein-2 gene expression. This suggested a potential osteoinductive effect through an autonomous activation of the bone morphogenetic protein signaling pathway by released Ca(2+) and P(i), which may serve as an autocrine/paracrine osteoinduction loop that drives the cellularized CaP constructs toward effective bone formation in vivo. In conclusion, through an in vitro biomimetic model, we have partially probed the roles of the released Ca(2+) and P(i) on the osteoinductivity of CaP-based biomaterials.
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Affiliation(s)
- Yoke Chin Chai
- Laboratory for Skeletal Development and Joint Disorders, Katholieke Universiteit Leuven, Leuven, Belgium
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Abstract
The new strategy to initiate the induction of bone formation is to carve smart, self-inducing geometric cues assembled within biomimetic medical devices. These are endowed with the striking prerogative of differentiating myoblastic and/or pericytic stem cells into osteoblastic-like cells attached to the morphogenetic concavities; osteoblastic-like cells secrete osteogenic gene products of the TGF-beta supergene family, further differentiating invading stem cells into osteoblastic-like cells, and initiating bone formation by induction as a secondary response.
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Affiliation(s)
- Ugo Ripamonti
- Medical Research Council/University of the Witwatersrand, Johannesburg, 2193 Parktown, South Africa.
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Ripamonti U, Roden LC. Induction of bone formation by transforming growth factor-beta2 in the non-human primate Papio ursinus and its modulation by skeletal muscle responding stem cells. Cell Prolif 2010; 43:207-18. [PMID: 20546239 DOI: 10.1111/j.1365-2184.2010.00675.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Four adult non-human primates Papio ursinus were used to study induction of bone formation by recombinant human transforming growth factor-beta(2) (hTGF-beta(2)) together with muscle-derived stem cells. MATERIALS AND METHODS The hTGF-beta(2) was implanted in rectus abdominis muscles and in calvarial defects with and without addition of morcellized fragments of striated muscle, harvested from the rectus abdominis or temporalis muscles. Expression of osteogenic markers including osteogenic protein-1, bone morphogenetic protein-3 and type IV collagen mRNAs from generated specimens was examined by Northern blot analysis. RESULTS Heterotopic intramuscular implantation of 5 and 25 microg hTGF-beta(2) combined with 100 mg of insoluble collagenous bone matrix yielded large corticalized mineralized ossicles by day 30 with remodelling and induction of haematopoietic marrow by day 90. Addition of morcellized rectus abdominis muscle to calvarial implants enhanced induction of bone formation significantly by day 90. CONCLUSIONS In Papio ursinus, in marked contrast to rodents and lagomorphs, hTGF-beta(2) induced large corticalized and vascularized ossicles by day 30 after implantation into the rectus abdominis muscle. This striated muscle contains responding stem cells that enhance the bone induction cascade of hTGF-beta(2). Induction of bone formation by hTGF-beta(2) in the non-human primate Papio ursinus may occur as a result of expression of bone morphogenetic proteins on heterotopic implantation of hTGF-beta(2); the bone induction cascade initiated by mammalian TGF-beta proteins in Papio ursinus needs to be re-evaluated for novel molecular therapeutics for induction of bone formation in clinical contexts.
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Affiliation(s)
- U Ripamonti
- Bone Research Unit, Medical Research Council/University of the Witwatersrand, Johannesburg, South Africa.
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Ripamonti U, Klar RM, Renton LF, Ferretti C. Synergistic induction of bone formation by hOP-1, hTGF-beta3 and inhibition by zoledronate in macroporous coral-derived hydroxyapatites. Biomaterials 2010; 31:6400-10. [PMID: 20493522 DOI: 10.1016/j.biomaterials.2010.04.037] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Accepted: 04/21/2010] [Indexed: 01/19/2023]
Abstract
Thirty coral-derived calcium carbonate-based macroporous constructs with limited hydrothermal conversion to hydroxyapatite (7% HA/CC) were implanted in the rectus abdominis of three adult non-human primate Papio ursinus to investigate the intrinsic induction of bone formation. Macroporous constructs with 125 microg human recombinant osteogenic protein-1 (hOP-1) or 125 microg human recombinant transforming growth factor-beta(3) (hTGF-beta(3)) were also implanted. The potential synergistic interaction between morphogens was tested by implanting binary applications of hOP-1 and hTGF-beta(3) 5:1 by weight, respectively. To evaluate the role of osteoclastic activity on the implanted macroporous surfaces, coral-derived constructs were pre-loaded with 0.24 mg of bisphosphonate zoledronate (Zometa). To correlate the morphology of tissue induction with osteogenic gene expression and activation, harvested specimens on day 90 were analyzed for changes in OP-1 and TGF-beta(3) mRNA synthesis by quantitative real-time polymerase chain reaction (qRT-PCR). The induction of bone formation in 7% HA/CC solo correlated with OP-1 expression. Massive bone induction formed by binary applications of the recombinant morphogens. Single applications of hOP-1 and hTGF-beta(3) also resulted in substantial bone formation, not comparable however to synergistic binary applications. Zoledronate-treated macroporous constructs showed limited bone formation and in two specimens bone formation was altogether absent; qRT-PCR showed a prominent reduction of OP-1 gene expression whilst TGF-beta(3) expression was far greater than OP-1. The lack of bone formation by zoledronate-treated specimens indicates that osteoclastic activity on the implanted coral-derived constructs is critical for the spontaneous induction of bone formation. Indirectly, zoledronate-treated samples showing lack of OP-1 gene expression and absent or very limited bone formation by induction confirm that the spontaneous induction of bone formation by coral-derived macroporous constructs is initiated by secreted BMPs/OPs, in context the OP-1 isoform.
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Affiliation(s)
- Ugo Ripamonti
- Bone Research Unit, Medical Research Council/University of the Witwatersrand, Johannesburg, South Africa.
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Ferretti C, Ripamonti U, Tsiridis E, Kerawala CJ, Mantalaris A, Heliotis M. Osteoinduction: translating preclinical promise into clinical reality. Br J Oral Maxillofac Surg 2010; 49:507-9. [PMID: 20430492 DOI: 10.1016/j.bjoms.2010.07.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2010] [Accepted: 07/17/2010] [Indexed: 12/24/2022]
Abstract
This review, the second in a series of three editorials, focuses on the problems of translating basic scientific research on induction of bone into reliable clinical applications.
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Affiliation(s)
- Carlo Ferretti
- Division of Maxillofacial and Oral Surgery, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa.
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Ferretti C, Ripamonti U, Tsiridis E, Kerawala CJ, Mantalaris A, Heliotis M. Osteoinduction: translating preclinical promise into clinical reality. Br J Oral Maxillofac Surg 2010; 48:536-9. [PMID: 20430492 DOI: 10.1016/j.bjoms.2009.08.043] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Accepted: 08/21/2009] [Indexed: 11/29/2022]
Abstract
This review, the second in a series of three editorials, focuses on the problems of translating basic scientific research on induction of bone into reliable clinical applications.
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Affiliation(s)
- Carlo Ferretti
- Division of Maxillofacial and Oral Surgery, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa.
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He D, Genecov DG, Herbert M, Barcelo R, Elsalanty ME, Weprin BE, Opperman LA. Effect of recombinant human bone morphogenetic protein-2 on bone regeneration in large defects of the growing canine skull after dura mater replacement with a dura mater substitute. J Neurosurg 2010; 112:319-28. [PMID: 19267528 DOI: 10.3171/2009.1.jns08976] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT This study was designed to evaluate the bone regeneration potential of the dura mater and dura mater substitute (Durepair) in the presence of recombinant human bone morphogenetic protein-2 (rhBMP-2) delivered in a collagen sponge-collagen-ceramic matrix (CCM; MasterGraft Matrix) in a large skull defect in growing canines. METHODS Forty immature male beagles were used to create two 2.5 x 4-cm cranial defects on each side of the sagittal suture. The dura mater on the left side was cut to make a 1 x 3-cm defect and replaced with bovine skin collagen (Durepair). The dura mater on the right side remained intact. Different doses of rhBMP-2 (none [8 animals], 0.11 mg/ml [4 animals], 0.21 mg/ml [4 animals], and 0.43 mg/ml [8 animals]) were infused on 2 Type I bovine absorbable collagen sponge (ACS) strips. The strips were layered with the CCM (15% hydroxyapatite [HA]/85% tricalcium phosphate [TCP]) to reconstruct both cranial defects. In a fifth group (8 animals), 0.43 mg/ml rhBMP-2 was directly infused into the CCM. Demineralized canine cancellous freeze-dried demineralized bone matrix (DBM; 8 animals) was used as a control in a sixth group. All materials were fixed under 2 resorbable protective sheets (MacroPore). Skulls were resected 16 weeks after operation. Histological and histomorphometric analyses on the percentage of the defect spanned by bone, and the percentage of residual HA-TCP granules and collagen were analyzed. RESULTS Calcified seroma was the only complication observed and only occurred in the 0.43-mg/ml rhBMP-2 groups (Groups 4 and 5). Dura mater repair appeared complete at 4 months in all animals. New bone was formed sporadically throughout the skull defect in the ACS+CCM and DBM groups without rhBMP-2. In all rhBMP-2 groups, mature new bone (compact and trabecular) was uniformly formed across the defect on both the repaired and intact dura mater sides. There was significant new compact bone formation on top of the repaired dura mater, which did not appear in the ACS+CCM and DBM groups lacking rhBMP-2. Greater HA-TCP and collagen scaffold resorption was noted in rhBMP-2 groups compared with non-rhBMP-2 groups. Statistical analysis showed there was a significantly lower percentage of bone spanning the defect in the ACS+CCM group compared with groups with rhBMP-2, with more residual HA-TCP and collagen on the repaired dura mater side than the intact dura mater side (p < 0.05). In all rhBMP-2 groups, there were no significant differences in new bone formation between the repaired and intact dura mater sides (p > 0.05). CONCLUSIONS The ACS+CCM combination had an effect similar to demineralized bone-on-bone regeneration in craniofacial reconstruction. The addition of rhBMP-2 to CCM directly or with ACS induces mature new bone formation in large cranial defects both in the presence of intact dura mater and repaired dura mater.
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Affiliation(s)
- Dongmei He
- International Craniofacial Institute, Cleft Lip and Palate Treatment Center, Medical City Dallas, Dallas, Texas, USA
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Transforming growth factor-beta isoforms and the induction of bone formation: implications for reconstructive craniofacial surgery. J Craniofac Surg 2010; 20:1544-55. [PMID: 19816294 DOI: 10.1097/scs.0b013e3181b09ca6] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Craniofacial skeletal reconstruction remains a challenging problem despite major molecular and surgical developments in the understanding of bone formation by induction. The induction of bone formation has been a critical topic of research across the planet. The bone induction principle identified important cues for tissue engineering of bone, namely, osteogenic soluble molecular signals, the bone morphogenetic and osteogenic proteins, and insoluble signals or substrata including biomimetic bioactive matrices and responding stem cells. In primates, and in primates only, the osteogenic soluble molecular signals that initiate the induction of bone formation additionally include the 3 mammalian transforming growth factor-beta (TGF-beta) isoforms, members of the TGF-beta supergene family. The mammalian TGF-beta isoforms, when implanted in the rectus abdominis muscle of the nonhuman primate Papio ursinus, induce rapid and substantial endochondral bone formation resulting in large corticalized ossicles by day 30 after heterotopic implantation; in calvarial defects of the same nonhuman primates, identical or higher doses of the TGF-beta protein do not induce bone formation because of the overexpression of Smad-6 and Smad-7, gene product inhibitors of the TGF-beta signaling pathway. The addition of minced fragments of autogenous rectus abdominis muscle partially restores the osteoinductive activity of the human TGF-beta3 isoform resulting in the induction of bone formation in the treated calvarial defects. Recombinant human TGF-beta3 delivered by Matrigel matrix and implanted in class II and III furcation defects of mandibular molars of P. ursinus induce periodontal tissue regeneration. The addition of minced fragments of autogenous rectus abdominis muscle significantly enhances cementogenesis. This review highlights the induction of bone formation by the osteogenic proteins of the TGF-beta superfamily in the nonhuman primate P. ursinus and reviews combinatorial applications of myoblastic/myogenic stem cell-based therapeutics for bone induction and morphogenesis. The recruitment of myoendothelial cells is also discussed in the light of the intrinsic and spontaneous induction of bone formation by smart biomaterial matrices that induce bone differentiation in heterotopic extraskeletal sites of P. ursinus without the exogenous application of the osteogenic soluble molecular signals of the TGF-beta superfamily.
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Chen FM, Shelton RM, Jin Y, Chapple ILC. Localized delivery of growth factors for periodontal tissue regeneration: role, strategies, and perspectives. Med Res Rev 2009; 29:472-513. [PMID: 19260070 DOI: 10.1002/med.20144] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Difficulties associated with achieving predictable periodontal regeneration, means that novel techniques need to be developed in order to regenerate the extensive soft and hard tissue destruction that results from periodontitis. Localized delivery of growth factors to the periodontium is an emerging and versatile therapeutic approach, with the potential to become a powerful tool in future regenerative periodontal therapy. Optimized delivery regimes and well-defined release kinetics appear to be logical prerequisites for safe and efficacious clinical application of growth factors and to avoid unwanted side effects and toxicity. While adequate concentrations of growth factor(s) need to be appropriately localized, delivery vehicles are also expected to possess properties such as protein protection, precision in controlled release, biocompatibility and biodegradability, self-regulated therapeutic activity, potential for multiple delivery, and good cell/tissue penetration. Here, current knowledge, recent advances, and future possibilities of growth factor delivery strategies are outlined for periodontal regeneration. First, the role of those growth factors that have been implicated in the periodontal healing/regeneration process, general requirements for their delivery, and the different material types available are described. A detailed discussion follows of current strategies for the selection of devices for localized growth factor delivery, with particular emphasis placed upon their advantages and disadvantages and future prospects for ongoing studies in reconstructing the tooth supporting apparatus.
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Affiliation(s)
- Fa-Ming Chen
- Department of Periodontology and Oral Medicine, School of Stomatology, The Fourth Military Medical University, Shaanxi, People's Republic of China.
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Ripamonti U, Crooks J, Khoali L, Roden L. The induction of bone formation by coral-derived calcium carbonate/hydroxyapatite constructs. Biomaterials 2008; 30:1428-39. [PMID: 19081131 DOI: 10.1016/j.biomaterials.2008.10.065] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Accepted: 10/16/2008] [Indexed: 10/21/2022]
Abstract
The spontaneous induction of bone formation in heterotopic rectus abdominis and orthotopic calvarial sites by coral-derived biomimetic matrices of different chemical compositions was investigated in a long-term study in the non-human primate Papio ursinus. Coral-derived calcium carbonate constructs were converted to hydroxyapatite by hydrothermal exchange. Limited conversion produced hydroxyapatite/calcium carbonate (HA/CC) constructs of 5% and 13% hydroxyapatite. Rods of 20 mm in length and 7 mm in diameter were implanted in heterotopic rectus abdominis sites; discs 25 mm in diameter were implanted in orthotopic calvarial defects of six adult non-human primates P. ursinus. Heterotopic samples also included fully converted hydroxyapatite replicas sintered at 1100 degrees C. To further enhance spontaneous osteoinductive activity, fully converted hydroxyapatite replicas were coated with the synthetic peptide P15 known to increase the adhesion of fibroblasts to anorganic bovine mineral. Bone induction was assessed at 60, 90 and 365 days by histological examination, alkaline phosphatase and osteocalcin expression, as well as by the expression of BMP-7, GDF-10 and collagen type IV mRNAs. Induction of bone occurred in the concavities of the matrices at all time points. At 365 days, bone marrow was evident in the P15-coated and uncoated implants. Resorption of partially converted calcium carbonate/hydroxyapatite was apparent, as well as remodeling of the newly formed bone. Northern blot analyses of samples from heterotopic specimens showed high levels of expression of BMP-7 and collagen type IV mRNA in all specimen types at 60 days, correlating with the induction of the osteoblastic phenotype in invading fibrovascular cells. Orthotopic specimens showed prominent bone formation across the different implanted constructs. The concavities of the matrices biomimetize the remodeling cycle of the osteonic primate cortico-cancellous bone and promote the ripple-like cascade of the induction of bone formation. This study demonstrates for the first time that partially converted HA/CC constructs also induce spontaneous differentiation of bone, albeit only seen one year post-implantation.
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Affiliation(s)
- Ugo Ripamonti
- Bone Research Unit, Medical Research Council at the University of the Witwatersrand, Johannesburg, Medical School, 2193 Parktown, South Africa.
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Abstract
Bone formation by induction initiates by invocation of osteogenic soluble molecular signals of the transforming growth factor-β (TGF-β) superfamily; when combined with insoluble signals or substrata, the osteogenic soluble signals trigger the ripple-like cascade of cell differentiation into osteoblastic cell lines secreting bone matrix at site of surgical implantation. A most exciting and novel strategy to initiate bone formation by induction is to carve smart self-inducing geometric concavities assembled within biomimetic constructs. The assembly of a series of repetitive concavities within the biomimetic constructs is endowed with the striking prerogative of differentiating osteoblast-like cells attached to the biomimetic matrices initiating the induction of bone formation as a secondary response. Importantly, the induction of bone formation is initiated without the exogenous application of the osteogenic soluble molecular signals of the TGF-β superfamily. This manuscript reviews the available data on this fascinating phenomenon, i.e. biomimetic matrices that arouse and set into motion the mammalian natural ability to heal thus constructing biomimetic matrices that in their own right set into motion inductive regenerative phenomena initiating the cascade of bone differentiation by induction biomimetizing the remodelling cycle of the primate cortico-cancellous bone.
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Affiliation(s)
- Ugo Ripamonti
- Bone Research Unit, Medical Research Council/University of the Witwatersrand, Johannesburg, South Africa.
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Petrie TA, Reyes CD, Burns KL, García AJ. Simple application of fibronectin-mimetic coating enhances osseointegration of titanium implants. J Cell Mol Med 2008; 13:2602-2612. [PMID: 18752639 DOI: 10.1111/j.1582-4934.2008.00476.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Integrin-mediated cell adhesion to biomolecules adsorbed onto biomedical devices regulates device integration and performance. Because of the central role of integrin-fibronectin (FN) interactions in osteoblastic function and bone formation, we evaluated the ability of FN-inspired biomolecular coatings to promote osteoblastic differentiation and implant osseointegration. Notably, these biomolecular coatings relied on physical adsorption of FN-based ligands onto biomedical-grade titanium as a simple, clinically translatable strategy to functionalize medical implants. Surfaces coated with a recombinant fragment of FN spanning the central cell binding domain enhanced osteoblastic differentiation and mineralization in bone marrow stromal cell cultures and increased implant osseointegration in a rat cortical bone model compared to passively adsorbed arginine-glycine-aspartic acid peptides, serum proteins and full-length FN. Differences in biological responses correlated with integrin binding specificity and signalling among surface coatings. This work validates a simple, clinically translatable, surface biofunctionalization strategy to enhance biomedical device integration.
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Affiliation(s)
- Timothy A Petrie
- Woodruff School of Mechanical Engineering and Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA
| | - Catherine D Reyes
- Woodruff School of Mechanical Engineering and Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA
| | - Kellie L Burns
- Woodruff School of Mechanical Engineering and Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA
| | - Andrés J García
- Woodruff School of Mechanical Engineering and Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA
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