Ultrastructural study by backscattered electron imaging and elemental microanalysis of bone-to-biomaterial interface and mineral degradation of porcine xenografts used in maxillary sinus floor elevation

Sterility and bioactivity evaluation of two types of bone graft substitutes after removing the original packaging

Background

Xenograft and allograft bone substitutes are widely used to replace the missing bone in defects. Since removing the packaging of these grafts can nullify their sterilization, this study aimed to evaluate the sterility and bioactivity changes of an allograft and a xenograft following uncapping/recap.

Methods

Two types of commercial allograft and xenograft vials were unpacked and further exposed to operating room air, where implant surgery was performed for one second, ten minutes, and one hour. After three repetitions, samples were analyzed using microbiological tests and scanning electron microscopy (SEM) with energy dispersive x-ray analysis (EDX) for sterility and bioactivity evaluation.

Results

None of the bone graft samples showed microbial growth or bioactivity-negative changes after seven days of unpacking the vials.

Conclusion

Despite the positive results of this study, future studies and more analysis considering influential factors are required. Also, disinfection and air exchange must still be observed during biomaterial application and bone grafting procedures.

A Narrative Review on the Effectiveness of Bone Regeneration Procedures with OsteoBiol® Collagenated Porcine Grafts: The Translational Research Experience over 20 Years

Over the years, several bone regeneration procedures have been proposed using natural (autografts, allografts, and xenografts) and synthetic (i.e., metals, ceramics, and polymers) bone grafts. In particular, numerous in vitro and human and animal in vivo studies have been focused on the discovery of innovative and suitable biomaterials for oral and maxillofacial applications in the treatment of severely atrophied jaws. On this basis, the main objective of the present narrative review was to investigate the efficacy of innovative collagenated porcine bone grafts (OsteoBiol^®, Tecnoss^®, Giaveno, Italy), designed to be as similar as possible to the autologous bone, in several bone regeneration procedures. The scientific publications were screened by means of electronic databases, such as PubMed, Scopus, and Embase, finally selecting only papers that dealt with bone substitutes and scaffolds for bone and soft tissue regeneration. A total of 201 papers have been detected, including in vitro, in vivo, and clinical studies. The effectiveness of over 20 years of translational research demonstrated that these specific porcine bone substitutes are safe and able to improve the biological response and the predictability of the regenerative protocols for the treatment of alveolar and maxillofacial defects.

Preparation and characterization of two novel osteoinductive fishbone-derived biphasic calcium phosphate bone graft substitutes

Many studies have reported on the conversion of natural resources into xenografts with hydroxyapatite (HA) as major component, but the extraction of biphasic calcium phosphate (HA/β-TCP) from animal bones and transformation into bone graft substitutes are rarely reported. In this research, two kinds of fish bones were made into granular porous biphasic calcium phosphate bone graft substitutes with particle sizes between 500 to 1000 μm through a series of preparation procedures (Salmo salar calcined at 900°C named Sa900 and Anoplopoma fimbria calcined at 800°C named An800). The chemical composition was characterized by X-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FTIR). The morphology and porous structure of the scaffolds were comparatively analyzed by scanning electron microscopy (SEM) and mercury porosimeter. The specific surface area of materials was measured by the nitrogen adsorption technique based on BET theory. Cytotoxicity and ectopic osteogenesis were also carried out to investigate the biocompatibility and osteoinductive potential of these materials. The results showed that both fishbone-derived scaffolds were composed of HA and β-TCP with different proportions, and numerous interconnected pores with different sizes were observed at the surface of materials. An800 had higher total porosity reaching 74.8% with higher interconnectivity and micropores mostly distributed at 0.27 μm and 0.12 μm, while Sa900 had a higher specific surface area and higher intraparticle porosity with nanopores mostly distributed at 0.07 μm. CCK-8 assays and Live/dead staining demonstrated excellent biocompatibility. Material-induced osteoid formation were observed on the interface of both internal pores and periphery of materials after implantation in muscle pouch of Wistar rats for 8 weeks which indicated some extent of osteoinductive potential of materials. The possible mechanism of material-induced osteogenesis and the effects of chemical composition, surface topography, and spatial structure on osteogenesis were also discussed in this paper.

Histomorphometric Evaluation of Bone-Guided Regeneration in Maxillary Sinus Floor Augmentation Using Nano-Hydroxyapatite/Beta-Tricalcium Phosphate Composite Biomaterial: A Case Report

Background

The development of techniques in biomaterials design and production added to advanced surgical procedures which enabled better and more predictable clinical outcomes. Maxillary sinus floor augmentation (MSFA) is among the more studied bone-guided regeneration procedure in the literature. The MSFA could be considered the gold standard procedure for bone-guided regeneration as it provides suitable functional and aesthetic solutions to alveolar ridge atrophy due to tooth loss.

Purpose

This study aimed to conduct a detailed histomorphometric evaluation of collagen production in SFAs bone-guided regeneration, using nano-hydroxyapatite/ß-tricalcium phosphate (nano-HA/ß-TCP) composite.

Patients and Methods

A 52-year-old female had the left upper second premolar condemned due to periodontal disease, then a tooth implant replacement was planned. Due to maxillary sinus pneumatization, the MSFA had to be done before implant placement. Nano-HA/ß-TCP composite (2g) was used in the MSFA procedure. After nine months of the healing process, during the Cone Morse implant installation process, bone samples were collected for histologic analysis (sirius red, hematoxylin/eosin, polarized microscopy). Six months after implant installation, a ceramic crown was installed according to the patient’s request.

Results

Proper masticatory function and aesthetics were re-established. The histomorphometric evaluation indicated that nano-HA/ß-TCP composite did not show any area devoid of cellular activity in sirius red or hematoxylin/eosin staining and the percentage (%) of new bone collagen fibers was achieved using polarization technique evaluation.

Conclusion

According to these results, nano-HA/ß-TCP composite presented clinical and histomorphometric properties suit to be used as bone-guided regeneration biomaterial in MSFA. Furthermore, nano-HA/β-TCP composite provided a favorable nano-environment to bone cells, enhancing bone matrix production.

Advantages of Porcine Xenograft over Autograft in Sinus Lift: A Randomised Clinical Trial

This study aimed to compare the performance of intra-oral autologous bone grafts versus porcine xenografts in a two-step lateral window sinus lift. This split-mouth randomised controlled trial sequentially enrolled 12 patients with a 6-month follow-up. For each patient, a simultaneous randomised bilateral maxillary sinus lift was performed and filled with autologous bone from the mandible (control) or a porcine xenograft (test). A bone biopsy sample was collected during the implant placement for histological and histomorphometric analysis. CT scans were performed at the beginning and at the end of the trial to assess radiological evolution. A comparison of initial and six-month CT scans indicated statistically significant increases in bone level for both materials (7.8 ± 2.4 mm for autologous and 8.7 ± 2.2 mm for xenograft, p < 0.05), and there were no significant differences between the performance of the two materials over time (p = 0.26). The histological analysis showed various stages of the remodelling process and no cells or other signs of inflammation or infection were visible in both groups. The porcine xenografts presented similar results for the studied variables when compared to autologous bone, being a reasonable alternative for a sinus lift.

Collagenated Porcine Heterologous Bone Grafts: Histomorphometric Evaluation of Bone Formation Using Different Physical Forms in a Rabbit Cancellous Bone Model

Collagenated porcine-derived bone graft materials exhibit osteoconductive properties and the development of different formulations intends to enhance bone regeneration. This study aims to evaluate bone healing in a rabbit cancellous bone defect in response to grafting with different physicochemical forms of heterologous porcine bone. Twenty-six adult male New Zealand White rabbits received two critical size femoral bone defects per animal (n = 52), each randomly assigned to one of the five tested materials (Apatos, Gen-Os, mp3, Putty, and Gel 40). Animals were sacrificed at 15- and 30-days post-surgery. Qualitative and quantitative (new bone, particle and connective tissue percentages) histological analyses were performed. Histomorphometry showed statistically significant differences in all evaluated parameters between mp3 and both Putty and Gel 40 groups, regardless of the timepoint (p < 0.05). Moreover, statistical differences were observed between Apatos and both Putty (p = 0.014) and Gel 40 (p = 0.007) groups, at 30 days, in regard to particle percentage. Within each group, regarding new bone formation, mp3 showed significant differences (p = 0.028) between 15 (40.93 ± 3.49%) and 30 (52.49 ± 11.04%) days. Additionally, intragroup analysis concerning the percentage of particles revealed a significant reduction in particle occupied area from 15 to 30 days in mp3 and Gen-Os groups (p = 0.009). All mp3, Gen-Os and Apatos exhibited promising results in terms of new bone formation, thus presenting suitable alternatives to be used in bone regeneration.

Evaluation of Porcine Hybrid Bone Block for Bone Grafting in Dentistry

BACKGROUND/AIM

The purpose of this study was to develop hybrid bone blocks using porcine-derived collagen and low crystalline porcine-derived hydroxyapatite to overcome the disadvantages of commonly used bone grafts in dentistry.

MATERIALS AND METHODS

Collagen was added to hydroxyapatite particles to increase the spatial integration of particulate bone grafts. Physicochemical examination and in vivo tests were performed to analyze scaffold's characteristics and evaluate bone regeneration.

RESULTS

Porcine hybrid bone block had an irregular and interconnecting macroporous structure that was adequate for bone regeneration and bone ingrowth, and showed a good space-occupying ability to become well positioned. In addition, it showed higher angiogenesis and biodegradability than Bio-Oss Collagen®, a commercialized bone graft used in dental clinics.

CONCLUSION

Our results suggest that improved collagen hybrid bone block can be generated when porcine cancellous bone particles and collagen were reasonably mixed. This hybrid bone block was easy in handling had flexibility, good biodegradability and provided bone regeneration.

Novel cellulose/hydroxyapatite scaffolds for bone tissue regeneration: In vitro and in vivo study

Cellulose scaffolds containing nano- or micro-hydroxyapatite (nHA or μHA) were prepared by the regeneration of cellulose from its acetylated derivative and the mechanical immobilization of inorganic particles, followed by freeze-drying. Microtomographic (micro-computed tomography) evaluation revealed that both scaffolds presented a highly interconnected porous structure, with a mean pore diameter of 490 ± 94 and 540 ± 132 μm for cellulose/nHA and cellulose/μHA, respectively. In vitro and in vivo characterizations of the developed scaffolds were investigated. Commercially available bone allograft was used as a control material. For the in vitro characterization, osteoblastic cell cultures were used and characterized over time to evaluate cell adhesion, metabolic activity, and functional output (alkaline phosphatase activity and osteoblastic gene expression). The results revealed greater spreading cell distribution alongside an increased number of filopodia, higher MTT values, and significantly increased expression of osteoblastic genes (Runx-2, alkaline phosphatase, and BMP-2) for cellulose/nHA, compared with cellulose/μHA and the control. The in vivo biocompatibility was evaluated in a rabbit calvarial defect model. The investigated scaffolds were implanted in circular rabbit calvaria defects. Four- and 12-week bone biopsies were investigated using micro-computed tomography and histological analysis. Although both cellulose/HA scaffolds outperformed the assayed control, a significantly higher amount of newly formed mineralized tissue was found within the defects loaded with cellulose/nHA. Within the limitations of this study, the developed cellulose/HA scaffolds showed promising results for bone regeneration applications. The biological response to the scaffold seems to be greatly dependent on the HA particles' characteristics, with cellulose scaffolds loaded with nHA eliciting an enhanced bone response.

Microarchitecture of the Augmented Bone Following Sinus Elevation with an Albumin Impregnated Demineralized Freeze-Dried Bone Allograft (BoneAlbumin) versus Anorganic Bovine Bone Mineral: A Randomized Prospective Clinical, Histomorphometric, and Micro-Computed Tomography Study

Serum albumin has been identified as an endogenous protein that is integral to early bone regeneration. We hypothesized that albumin addition to allografts may result in better bone remodeling than what can be achieved with anorganic xenografts. Sinus elevations were performed at 32 sites of 18 patients with the lateral window technique. Sites either received filling with an anorganic bovine bone mineral (ABBM, BioOss, Geistlich, CH) or albumin impregnated allograft (BoneAlbumin, OrthoSera, AT). After 6-months patients received dental implants and 16 bone core biopsy samples were obtained from the ABBM filled, and 16 from the BoneAlbumin augmented sites. The biopsies were examined by histomorphometry and µCT. Percentage of the residual graft in the BoneAlbumin group was 0–12.7%, median 5.4% vs. ABBM 6.3–35.9%, median 16.9%, p < 0.05. Results of the µCT analysis showed that the microarchitecture of the augmented bone in the BoneAlbumin group resembles that of the native maxilla in morphometric parameters Trabecular Pattern Factor and Connectivity. Our data show that while ABBM successfully integrates into the newly formed bone tissue as persisting particles, BoneAlbumin is underway towards complete remodeling with new bone closely resembling that of the intact maxilla.

Morse Taper Connection Implants Placed in Grafted Sinuses in 65 Patients: A Retrospective Clinical Study with 10 Years of Follow-Up

PURPOSE

To investigate the 10-year survival and complication rates of Morse taper connection implants (MTCIs) placed in grafted sinuses.

METHODS

This study reports on patients treated with maxillary sinus augmentation (with the lateral window technique (LWT) or the transalveolar osteotomy technique (TOT)) and installed with MTCIs supporting fixed restorations (single crowns (SCs) and fixed partial dentures (FPDs)), in two dental clinics. The outcomes of the study were the 10-year implant survival and complication rates.

RESULTS

Sixty-five patients (30 males and 35 females) with a mean age of 62.7 (±10.2) years were installed with 142 MTCIs: 79 fixtures were inserted with the LWT and 63 were placed with the TOT. After ten years, five implants failed, for an overall survival rate of 96.5%. Three implants failed in the LWT group, for a survival rate of 96.3%; two implants failed in the TOT group, for a survival rate of 96.9%. The 10-year incidence of biologic complications was 11.9%. Prosthetic complications were all technical in nature and amounted to 7.6%.

CONCLUSIONS

MTCIs seem to represent a successful procedure for the prosthetic restoration of the grafted posterior maxilla, in the long term. This study was registered in the ISRCTN registry with number ISRCTN30772506.

Do Porous Titanium Granule Grafts Affect Bone Microarchitecture at Augmented Maxillary Sinus Sites? A Pilot Split-Mouth Human Study

BACKGROUND

The aim of this randomized controlled clinical study was to analyze the bone microarchitecture at augmented maxillary sinus sites by using different materials in patients to compare the effect of porous titanium granules as a sinus augmentation material with bone microstructural features.

MATERIALS AND METHODS

Eight subjects with bilateral atrophic posterior maxilla of residual bone height <4 mm included in this study and each patient was treated with bilateral sinus augmentation procedure using xenograft with equine origin (Apatos, Osteobiol; Tecnoss Dental) and xenograft (1 g) + porous titanium (1 g) granules (Natix; Tigran Technologies AB). Sixteen human bone biopsy samples were taken from patients receiving two-stage sinus augmentation therapy during implant installation and analyzed using microcomputerized tomography. Three-dimensional bone structural parameters were analyzed in details: tissue volume, bone volume, percentage of bone volume, bone surface and bone surface density, bone specific surface, trabecular thickness trabecular separation, trabecular number, trabecular pattern factor, structural model index, fractal dimension, and bone mineral density.

RESULTS

No statistically significant differences were found between groups according to bone structural parameters.

CONCLUSIONS

Porous titanium grafts may ensure a space for new bone formation in the granules, which may be a clinical advantage for long-term success.

Influence of hydroxyapatite granule size, porosity, and crystallinity on tissue reaction in vivo. Part A: synthesis, characterization of the materials, and SEM analysis

OBJECTIVE

The aim of this study was the synthesis and analysis of the tissue reaction to three different Hydroxyapatite (HA)-based bone substitute materials differing only in granule size, porosity, and crystallinity through an animal experimental model at 60 days.

MATERIALS AND METHODS

Three different HA-based biomaterials were synthesized and characterized by X-ray diffraction, SEM, and EDS analysis, the resultant product was ground in three particle sizes: Group I (2000-4000 μm), Group II (1000-2000 μm), and Group III (600-1000 μm). Critical size defects were created in both tibias of 15 rabbits. Four defects per rabbit for a total of 60 defects were grafted with the synthesized materials as follows: Group I (15 defects), Group II (15 defects), Group III (15 defects), and empty (15 defects control). After animals sacrifice at 60 days samples were obtained and processed for SEM and EDS evaluation of Ca/P ratios, elemental mapping was performed to determine the chemical degradation process and changes to medullary composition in all the four study groups.

RESULTS

The tendency for the density was to increase with the increasing annealing temperature; in this way it was possible to observe that the sample that shows highest crystallinity and crystal size corresponding to that of group I. The SEM morphological examination showed that group III implant showed numerous resorption regions, group II implant presented an average resorption rate of all the implants. The group I displayed smoother surface features, in comparison with the other two implants.

CONCLUSION

The data from this study show that changing the size, porosity, and crystallinity of one HA-based bone substitute material can influence the integration of the biomaterials within the implantation site and the new bone formation.

Bone response to collagenized xenografts of porcine origin (mp3(®) ) and a bovine bone mineral grafting (4BONE(™) XBM) grafts in tibia defects: experimental study in rabbits

OBJECTIVES

This study aimed to carry out the evaluation of bone response of new bone formation to two different xenografts (bovine and porcine) biomaterials inserted in rabbit tibiae.

MATERIALS AND METHODS

The study used a total of 20 male New Zealand albino rabbits. They received a total of 40 grafts in the proximal metaphyseal areas of both tibiae. Two biomaterials were evaluated: 20 porcine xenografts, as a bone granulate (OsteoBiol(®) MP3(®) ; Tecnoss srl, Giaveno, Italy), were placed in the proximal metaphyseal area of the right tibia, 20 anorganic bovine bone mineral grafting (4BONE(™) XBM, MIS Implants Inc., BARLEV, Israel) were placed in the left tibia. Following graft insertion, the animals were sacrificed in two groups of 10 animals, after 1 and 4 months, respectively. For each group, biomaterials were analyzed: newly formed bone, residual graft materials and the connective tissue. Histomorphometric, EDX analysis and element mapping were performed at 1 and 4 months after graft insertion.

RESULTS

At 4 months after treatment, the bone defects displayed radiological images that showed complete repair of osseous defects. Histomorphometric evaluation showed that for the porcine xenograft, the study averages for newly formed bone represented 84.23 ± 2.9%, while bovine matrix was 79.34 ± 2.1%. For residual graft material, the porcine biomaterial had 11.23 ± 1.7% and the bovine graft 31.56 ± 2.3%. Finally, the connective tissue for MP3 was 10.33 ± 1.8%, while for the 4BONE(™) XBM we obtained 14.34 ± 2.9%. Element analysis revealed higher percentages of Ca (54 ± 9%) and P (35 ± 6%) in the group B than group A and control group (P < 0.05).

CONCLUSIONS

Defects of a critical size in a rabbit tibia model can be sealed using a bovine porous biphasic calcium phosphate and MP3 material; this supports new bone formation, creates a bridge between borders, and facilitates bone ingrowth in both biomaterials. Furthermore, this study observed partial dissolution of the mineral phase of four bone graft and complete resorption of porcine MP3 biomaterial and its incorporation into the surrounding bone. Depending on clinical needs, each biomaterial could be useful in daily clinical practice.

Retracted: In vivo behavior of hydroxyapatite/β‐TCP /collagen scaffold in animal model. Histological, histomorphometrical, radiological, and SEM analysis at 15, 30, and 60 days

Retraction: Maté Sánchez de Val JE , Calvo Guirado JL , Ramírez Fernández MP , Delgado Ruiz RA , Mazón P, De Aza PN . In vivo behavior of hydroxyapatite/β‐TCP /collagen scaffold in animal model. Histological, histomorphometrical, radiological, and SEM analysis at 15, 30, and 60 days. Clin Oral Impl Res . The above article, published online on August 7, 2015, in Wiley Online Library (wileyonlinelibrary.com) has been retracted by agreement between the journal editor‐in‐chief, L Heitz‐Mayfield, and John Wiley & Sons Ltd. The retraction has been agreed due to image discrepancies resulting in unreliable data. It has not been possible to prove the validity of the images. Images in Figure 4 have been used in other publications representing different time points and materials. Images within Figure 4 have been manipulated to represent different time points and materials. Reference Maté Sánchez de Val JE , Calvo Guirado JL , Ramírez Fernández MP , Delgado Ruiz RA , Mazón P, De Aza PN . In vivo behavior of hydroxyapatite/β‐TCP /collagen scaffold in animal model. Histological, histomorphometrical, radiological, and SEM analysis at 15, 30, and 60 days. Clin Oral Impl Res . https://doi.org/10.1111/clr.12656

Assisted deposition of nano-hydroxyapatite onto exfoliated carbon nanotube oxide scaffolds

Electrodeposited nano-hydroxyapatite (nHAp) is more similar to biological apatite in terms of microstructure and dimension than apatites prepared by other processes. Reinforcement with carbon nanotubes (CNTs) enhances its mechanical properties and increases adhesion of osteoblasts. Here, we carefully studied nHAp deposited onto vertically aligned multi-walled CNT (VAMWCNT) scaffolds by electrodeposition and soaking in a simulated body fluid (SBF). VAMWCNTs are porous biocompatible scaffolds with nanometric porosity and exceptional mechanical and chemical properties. The VAMWCNT films were prepared on a Ti substrate by a microwave plasma chemical vapour deposition method, and then oxidized and exfoliated by oxygen plasma etching (OPE) to produce graphene oxide (GO) at the VAMWCNT tips. The attachment of oxygen functional groups was found to be crucial for nHAp nucleation during electrodeposition. A thin layer of plate-like and needle-like nHAp with high crystallinity was formed without any need for thermal treatment. This composite (henceforth referred to as nHAp-VAMWCNT-GO) served as the scaffold for in vitro biomineralization when soaked in the SBF, resulting in the formation of both carbonate-rich and carbonate-poor globular-like nHAp. Different steps in the deposition of biological apatite onto VAMWCNT-GO and during the short-term biomineralization process were analysed. Due to their unique structure and properties, such nano-bio-composites may become useful in accelerating in vivo bone regeneration processes.

Long-term in vivo experimental investigations on magnesium doped hydroxyapatite bone substitutes

Despite several efforts to find suitable alternatives to autologous bone, no bone substitute currently available provides the same characteristics and properties. Nevertheless, among the wide range of materials proposed as bone substitutes, calcium phosphate materials represent the most promising category and the present study is aimed at improving the knowledge on non-stoichiometric magnesium-doped hydroxyapatite substitutes (Mg-HA), tested in two different formulations: Mg-HA Putty and Mg-HA Granules. These bone substitutes were implanted bilaterally into iliac crest bone defects in healthy sheep and comparative histological, histomorphometric, microhardness and ultrastructural assessments were performed 9, 12, 18 and 24 months after surgery to elucidate bone tissue apposition, mineralization and material degradation in vivo. The results confirmed that the biomimetic bone substitutes provide a histocompatible and osteoconductive structural support, during the bone formation process, and give essential information about the in vivo resorption process and biological behavior of biomimetic bone substitutes.

Gene expression and morphometric parameters of human bone biopsies after maxillary sinus floor elevation with autologous bone combined with Bio-Oss® or BoneCeramic®

OBJECTIVES

Although the clinical success of Bio-Oss(®) and BoneCeramic(®) has been corroborated by histologic and histomorphometric findings, the biological events that occur during healing after maxillary sinus floor elevation (MSFE) are unknown. Here, we evaluated biopsies of grafted bone with a mixture of autologous bone and Bio-Oss(®) or BoneCeramic(®) after two different healing time periods to understand the molecular process underlying bone formation after MSFE.

MATERIAL AND METHODS

Seven patients, following a bilateral split-mouth design model and needing a MSFE to allow implant placement, were recruited for this study. Right or left sinuses were grafted with autologous maxillary bone combined either with Bio-Oss(®) or BoneCeramic(®) , respectively. Twenty biopsies were taken at the time of implant insertion after 4-5 months or 6-8 months of MSFE, and analyzed by micro-computed tomography (microCT) and gene-expression analysis.

RESULTS

MicroCT analysis revealed no differences in the morphometric parameters or BMD either after 4-5 months or 6-8 months of MSFE between Bio-Oss(®) and BoneCeramic(®) . At molecular level, a higher expression of bone forming gene Runx2 was observed after 4-5 months of MSFE in the Bio-Oss(®) compared with the BoneCeramic(®) group.

CONCLUSIONS

Our results indicate that differences found at the molecular level between Bio-Oss(®) and BoneCeramic(®) are not translated to important differences in the 3D microstructure and BMD of the grafted bone.

Comparison of three hydroxyapatite/β-tricalcium phosphate/collagen ceramic scaffolds: an in vivo study

Calcium-phosphate ceramics, which have a composition similar to bone mineral, represent a potentially interesting synthetic bone graft substitute. In the present study, three porous hydroxyapatite (HA)/β-tricalcium phosphate (β-TCP)/collagen ceramic scaffolds were developed, characterized, and tested for their bone repairing capacity and osteoinductive potential in a New Zealand Rabbit model. The ratio of the ceramic components HA/-TCP/collagen varied from 40/30/30 to 50/20/30 and 60/20/20 (in wt %), respectively. None of the ceramic scaffolds succeeded in completely bridging the 6 mm calvarian defect with new bone after 60 days implantation. 60/20/20 ceramic scaffolds showed significantly more bone formation in the pores and in the periphery of the graft than the other two materials. Histomorphometric analysis revealed that the 40/30/30 scaffold produced best bone-to-implant contact (67.23 ± 0.34% with higher quality, closer contact) in comparison with 50/20/30 (54.87 ± 0.32%), and 60/20/20 (48.53 ± 0.31%). Both physicochemical and structural properties of the ceramic composites affected their in vivo behavior, either dependently or independently, emphasizing the importance of assessing bone repair parameters individually. The scaffolds may offer clinical applications in reconstructive surgery for treating bone pathologies.