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Ivanovski S, Breik O, Carluccio D, Alayan J, Staples R, Vaquette C. 3D printing for bone regeneration: challenges and opportunities for achieving predictability. Periodontol 2000 2023; 93:358-384. [PMID: 37823472 DOI: 10.1111/prd.12525] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/18/2023] [Accepted: 08/26/2023] [Indexed: 10/13/2023]
Abstract
3D printing offers attractive opportunities for large-volume bone regeneration in the oro-dental and craniofacial regions. This is enabled by the development of CAD-CAM technologies that support the design and manufacturing of anatomically accurate meshes and scaffolds. This review describes the main 3D-printing technologies utilized for the fabrication of these patient-matched devices, and reports on their pre-clinical and clinical performance including the occurrence of complications for vertical bone augmentation and craniofacial applications. Furthermore, the regulatory pathway for approval of these devices is discussed, highlighting the main hurdles and obstacles. Finally, the review elaborates on a variety of strategies for increasing bone regeneration capacity and explores the future of 4D bioprinting and biodegradable metal 3D printing.
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Affiliation(s)
- Saso Ivanovski
- School of Dentistry, Centre for Orofacial Regeneration, Reconstruction and Rehabilitation (COR3), The University of Queensland, Queensland, Herston, Australia
| | - Omar Breik
- Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Danilo Carluccio
- Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Jamil Alayan
- School of Dentistry, Centre for Orofacial Regeneration, Reconstruction and Rehabilitation (COR3), The University of Queensland, Queensland, Herston, Australia
| | - Ruben Staples
- School of Dentistry, Centre for Orofacial Regeneration, Reconstruction and Rehabilitation (COR3), The University of Queensland, Queensland, Herston, Australia
| | - Cedryck Vaquette
- School of Dentistry, Centre for Orofacial Regeneration, Reconstruction and Rehabilitation (COR3), The University of Queensland, Queensland, Herston, Australia
- Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
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Preliminary results of customized bone graft made by robocasting hydroxyapatite and tricalcium phosphates for oral surgery. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 135:192-203. [PMID: 36089487 DOI: 10.1016/j.oooo.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/24/2022] [Accepted: 06/05/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study was to assess the mechanical characteristics and the clinical usefulness of beta-tricalcium phosphate (β-TCP) and hydroxyapatite (HA) bioblocks grafted in edentulous jaws of 12 patients. METHODS The scaffolds were produced by robocasting ceramic inks containing 80%/20% β-TCP and HA, respectively, with an overall porosity of 60%, with a macropore size between 300 and 500 μm. The mechanical performance of cylindrical vs conical specimens was compared using a universal testing machine. The clinical study was performed on 12 edentulous patients who received 4 cylindrical bone bioblocks. After 10 to 16 weeks of osseointegration, the bioblocks were explanted with trephine for histologic analysis by Goldner and Von Kossa staining. RESULTS Conical shapes were significantly stronger (96.4 ± 8.7 MPa) than cylindrical shapes (87.8 ± 12.2 MPa). The overall degree of porosity ranged from 53.4% to 58.1% in the coronal region to 62.5% to 66.9% at the apex. After the maturation period, 41 valid bioblocks (85.4%) were obtained for histologic study. Bone showing some cellularity was found in 68.4% of the samples, indicating biologically active bone, and adequate calcification was found in 31.7% of the samples. In terms of biomaterial degradation, 73.2% of the samples were completely resorbed or showed significant resorption. CONCLUSIONS The 80%/20% β-TCP and HA grafts customized by robocasting appear adequate for regenerating self-contained defects.
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Current Approaches in Vertical Bone Augmentation and Large Bone Deficiencies in the Orofacial Region. Regen Med 2023. [DOI: 10.1007/978-981-19-6008-6_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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4
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Sufaru IG, Macovei G, Stoleriu S, Martu MA, Luchian I, Kappenberg-Nitescu DC, Solomon SM. 3D Printed and Bioprinted Membranes and Scaffolds for the Periodontal Tissue Regeneration: A Narrative Review. MEMBRANES 2022; 12:membranes12090902. [PMID: 36135920 PMCID: PMC9505571 DOI: 10.3390/membranes12090902] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 05/31/2023]
Abstract
Numerous technologies and materials were developed with the aim of repairing and reconstructing the tissue loss in patients with periodontitis. Periodontal guided bone regeneration (GBR) and guided tissue regeneration (GTR) involves the use of a membrane which prevents epithelial cell migration, and helps to maintain the space, creating a protected area in which tissue regeneration is favored. Over the time, manufacturing procedures of such barrier membranes followed important improvements. Three-dimensional (3D) printing technology has led to major innovations in periodontal regeneration methods, using technologies such as inkjet printing, light-assisted 3D printing or micro-extrusion. Besides the 3D printing of monophasic and multi-phasic scaffolds, bioprinting and tissue engineering have emerged as innovative technologies which can change the way we see GTR and GBR.
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Affiliation(s)
- Irina-Georgeta Sufaru
- Department of Periodontology, Grigore T. Popa University of Medicine and Pharmacy, Universitatii Street 16, 700115 Iasi, Romania
| | - Georgiana Macovei
- Department of Oral and Dental Diagnostics, Grigore T. Popa University of Medicine and Pharmacy, Universitatii Street 16, 700115 Iasi, Romania
| | - Simona Stoleriu
- Department of Cariology and Restorative Dental Therapy, Grigore T. Popa University of Medicine and Pharmacy, Universitatii Street 16, 700115 Iasi, Romania
| | - Maria-Alexandra Martu
- Department of Periodontology, Grigore T. Popa University of Medicine and Pharmacy, Universitatii Street 16, 700115 Iasi, Romania
| | - Ionut Luchian
- Department of Periodontology, Grigore T. Popa University of Medicine and Pharmacy, Universitatii Street 16, 700115 Iasi, Romania
| | | | - Sorina Mihaela Solomon
- Department of Periodontology, Grigore T. Popa University of Medicine and Pharmacy, Universitatii Street 16, 700115 Iasi, Romania
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Tang Y, Zhang Y, Meng Z, Sun Q, Peng L, Zhang L, Lu W, Liang W, Chen G, Wei Y. Accuracy of additive manufacturing in stomatology. Front Bioeng Biotechnol 2022; 10:964651. [PMID: 36051587 PMCID: PMC9424550 DOI: 10.3389/fbioe.2022.964651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
With the rapid development of the three-dimensional (3D) printing technology in recent decades, precise and personalized manufacturing has been achieved gradually, bringing benefit to biomedical application, especially stomatology clinical practice. So far, 3D printing has been widely applied to prosthodontics, orthodontics, and maxillofacial surgery procedures, realizing accurate, efficient operation processes and promising treatment outcomes. Although the printing accuracy has improved, further exploration is still needed. Herein, we summarized the various additive manufacturing techniques and their applications in dentistry while highlighting the importance of accuracy (precision and trueness).
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Affiliation(s)
- Yao Tang
- Department of Orthodontics, Cranial Facial Growth and Development Center, Peking University School and Hospital of Stomatology, Beijing, China
- NMPA Key Laboratory for Dental Materials, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China
| | - Yunfan Zhang
- Department of Orthodontics, Cranial Facial Growth and Development Center, Peking University School and Hospital of Stomatology, Beijing, China
- NMPA Key Laboratory for Dental Materials, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China
| | - Zhaoqiang Meng
- Department of Geriatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Qiannan Sun
- Department of Orthodontics, Cranial Facial Growth and Development Center, Peking University School and Hospital of Stomatology, Beijing, China
- NMPA Key Laboratory for Dental Materials, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China
| | - Liying Peng
- Department of Orthodontics, Cranial Facial Growth and Development Center, Peking University School and Hospital of Stomatology, Beijing, China
- NMPA Key Laboratory for Dental Materials, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China
| | - Lingyun Zhang
- Department of Orthodontics, Cranial Facial Growth and Development Center, Peking University School and Hospital of Stomatology, Beijing, China
- NMPA Key Laboratory for Dental Materials, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China
| | - Wenhsuan Lu
- Department of Orthodontics, Cranial Facial Growth and Development Center, Peking University School and Hospital of Stomatology, Beijing, China
- NMPA Key Laboratory for Dental Materials, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China
| | - Wei Liang
- Department of Orthodontics, Cranial Facial Growth and Development Center, Peking University School and Hospital of Stomatology, Beijing, China
- NMPA Key Laboratory for Dental Materials, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China
- *Correspondence: Wei Liang, ; Gui Chen, ; Yan Wei,
| | - Gui Chen
- Department of Orthodontics, Cranial Facial Growth and Development Center, Peking University School and Hospital of Stomatology, Beijing, China
- NMPA Key Laboratory for Dental Materials, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China
- *Correspondence: Wei Liang, ; Gui Chen, ; Yan Wei,
| | - Yan Wei
- Department of Geriatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
- *Correspondence: Wei Liang, ; Gui Chen, ; Yan Wei,
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Vaquette C, Mitchell J, Ivanovski S. Recent Advances in Vertical Alveolar Bone Augmentation Using Additive Manufacturing Technologies. Front Bioeng Biotechnol 2022; 9:798393. [PMID: 35198550 PMCID: PMC8858982 DOI: 10.3389/fbioe.2021.798393] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/13/2021] [Indexed: 11/26/2022] Open
Abstract
Vertical bone augmentation is aimed at regenerating bone extraskeletally (outside the skeletal envelope) in order to increase bone height. It is generally required in the case of moderate to severe atrophy of bone in the oral cavity due to tooth loss, trauma, or surgical resection. Currently utilized surgical techniques, such as autologous bone blocks, distraction osteogenesis, and Guided Bone Regeneration (GBR), have various limitations, including morbidity, compromised dimensional stability due to suboptimal resorption rates, poor structural integrity, challenging handling properties, and/or high failure rates. Additive manufacturing (3D printing) facilitates the creation of highly porous, interconnected 3-dimensional scaffolds that promote vascularization and subsequent osteogenesis, while providing excellent handling and space maintaining properties. This review describes and critically assesses the recent progress in additive manufacturing technologies for scaffold, membrane or mesh fabrication directed at vertical bone augmentation and Guided Bone Regeneration and their in vivo application.
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Nanostructured Zn-Substituted Monetite Based Material Induces Higher Bone Regeneration Than Anorganic Bovine Bone and β-Tricalcium Phosphate in Vertical Augmentation Model in Rabbit Calvaria. NANOMATERIALS 2021; 12:nano12010143. [PMID: 35010093 PMCID: PMC8746457 DOI: 10.3390/nano12010143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/21/2021] [Accepted: 12/24/2021] [Indexed: 11/17/2022]
Abstract
The capacity of a nanostructured multicomponent material composed of Zn-substituted monetite, amorphous calcium phosphate, hydroxyapatite and silica gel (MSi) to promote vertical bone augmentation was compared with anorganic bovine bone (ABB) and synthetic β-tricalcium phosphate (β-TCP). The relation between biological behavior and physicochemical properties of the materials was also studied. The in vivo study was conducted in a vertical bone augmentation model in rabbit calvaria for 10 weeks. Significant differences in the biological behavior of the materials were observed. MSi showed significantly higher bone regeneration (39%) than ABB and β-TCP (24%). The filled cylinder volume was similar in MSi (92%) and ABB (91%) and significantly lower in β-TCP (81%) implants. In addition, β-TCP showed the highest amount of non-osteointegrated particles (17%). MSi was superior to the control materials because it maintains the volume of the defect almost full, with the highest bone formation, the lowest number of remaining particles, which are almost fully osteointegrated and having the lowest amount of connective tissue. Besides, the bone formed was mature, with broad trabeculae, high vascularization and osteogenic activity. MSi resorbs gradually over time with an evident increment of the porosity and simultaneous colonization for vascularized new bone. In addition, the osteoinductive behavior of MSi material was evidenced.
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Zhou H, Yang L, Gbureck U, Bhaduri SB, Sikder P. Monetite, an important calcium phosphate compound-Its synthesis, properties and applications in orthopedics. Acta Biomater 2021; 127:41-55. [PMID: 33812072 DOI: 10.1016/j.actbio.2021.03.050] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 12/15/2022]
Abstract
This review recognizes a unique calcium phosphate (CaP) phase known as monetite or dicalcium phosphate anhydrous (DCPA, CaHPO4), and presents an overview of its properties, processing, and applications in orthopedics. The motivation for the present effort is to highlight the state-of-the-art research and development of monetite and propel the research community to explore more of its potentials in orthopedics. After a brief introduction of monetite, we provide a summary of its various synthesis routes like dehydration, solvent-based, energy-assisted processes and also discuss the formation of different crystal structures with respect to the synthesis conditions. Subsequently, we discuss the material's noteworthy physico-chemical properties including the crystal structure, vibrational spectra, solubility, thermal decomposition, and conversion to other phases. Of note, we focus on the biological (in vitro and in vivo) properties of monetite, given its ever-increasing popularity as a biomaterial for medical implants. Appropriately, we discuss various orthopedic applications of monetite as bone cement, implant coatings, granules for defect fillers, and scaffolds. Many in vitro and in vivo studies confirmed the favorable osteointegration and osteoconduction properties of monetite products, along with a better balance between implant resorption and new bone formation as compared to other CaP phases. The review ends with translational aspects of monetite and presents thoughts about its possible future research directions. Further research may explore but not limited to improvements in mechanical strength of monetite-based scaffolds, using monetite particles as a therapeutic agent delivery, and tissue engineering strategies where monetite serves as the biomaterial. STATEMENT OF SIGNIFICANCE: This is the first review that focusses on the favorable potential of monetite for hard tissue repair and regeneration. The article accurately covers the "Synthesis-Structure-Property-Applications" correlations elaborating on monetite's diverse material properties. Special focus is put on the in vitro and in vivo properties of the material highlighting monetite as an orthopedic material-of-choice. The synthesis techniques are discussed which provide important information about the different fabrication routes for monetite. Most importantly, the review provides comprehensive knowledge about the diverse biomedical applications of monetite as granules, defect--specific scaffolds, bone cements and implant coatings. This review will help to highlight monetite's potential as an effective regenerative medicine and catalyze the continuing translation of this bioceramic from the laboratory to clinics.
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Affiliation(s)
- H Zhou
- Center for Health Science and Engineering, School of Materials Science and Engineering, Hebei University of Technology, Tianjin, China; International Research Center for Translational Orthopaedics (IRCTO), Jiangsu, China
| | - L Yang
- Center for Health Science and Engineering, School of Materials Science and Engineering, Hebei University of Technology, Tianjin, China; International Research Center for Translational Orthopaedics (IRCTO), Jiangsu, China
| | - U Gbureck
- Department for Functional Materials in Medicine and Dentistry, University Hospital of Würzburg, Würzburg, Germany
| | - S B Bhaduri
- Department of Mechanical, Industrial & Manufacturing Engineering, The University of Toledo, Toledo, OH, USA; ENG-EEC Division, The National Science Foundation (NSF), Alexandria, VA, USA
| | - P Sikder
- Department of Mechanical Engineering, Cleveland State University, Cleveland, OH, USA.
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Montero J, Becerro A, Pardal-Peláez B, Quispe-López N, Blanco JF, Gómez-Polo C. Main 3D Manufacturing Techniques for Customized Bone Substitutes. A Systematic Review. MATERIALS 2021; 14:ma14102524. [PMID: 34066290 PMCID: PMC8152095 DOI: 10.3390/ma14102524] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/01/2021] [Accepted: 05/09/2021] [Indexed: 12/12/2022]
Abstract
Clinicians should be aware of the main methods and materials to face the challenge of bone shortage by manufacturing customized grafts, in order to repair defects. This study aims to carry out a bibliographic review of the existing methods to manufacture customized bone scaffolds through 3D technology and to identify their current situation based on the published papers. A literature search was carried out using "3D scaffold", "bone regeneration", "robocasting" and "3D printing" as descriptors. This search strategy was performed on PubMed (MEDLINE), Scopus and Cochrane Library, but also by hand search in relevant journals and throughout the selected papers. All the papers focusing on techniques for manufacturing customized bone scaffolds were reviewed. The 62 articles identified described 14 techniques (4 subtraction + 10 addition techniques). Scaffold fabrication techniques can be also be classified according to the time at which they are developed, into Conventional techniques and Solid Freeform Fabrication techniques. The conventional techniques are unable to control the architecture of the pore and the pore interconnection. However, current Solid Freeform Fabrication techniques allow individualizing and generating complex geometries of porosity. To conclude, currently SLA (Stereolithography), Robocasting and FDM (Fused deposition modeling) are promising options in customized bone regeneration.
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姚 钟, 贾 搏, 林 少, 邵 军. [Effect of Straumann implant on crown appearance in immediate implant restoration of maxillary anterior teeth]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:1365-1368. [PMID: 32990231 PMCID: PMC7544573 DOI: 10.12122/j.issn.1673-4254.2020.09.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the effect of Straumann implant on crown appearance in the immediate implant restoration of maxillary anterior teeth. METHODS This study was conducted among 86 patients undergoing immediate implant restoration of maxillary anterior teeth between January and December, 2018. We randomized the patients into control group for treatment with immediate implant restoration and study group receiving additional Straumann implant. The effects of restoration, bone absorption at 6 months, implant length, implant diameter, root protrusion, gingival color, far and middle gingival papilla, lip side gingival height, near and middle gingival papilla, and lip side gingival curve were compared between the two groups. RESULTS The repair effect in the study group was better than that in the control group (P < 0.05). The implant length and implant diameter were significantly greater in the study group than in the control group. The root protrusion, gingival color, far and middle gingival papilla, lip side gingival height, near and middle gingival papilla, and lip side gingival curve were all better in the study group. The height of marginal bone in the study group was significantly higher than that in the control group (P < 0.05). CONCLUSIONS Straumann implant can be used in immediate implant restoration of maxillary anterior teeth to achieve a better aesthetic effect.
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Affiliation(s)
- 钟雄 姚
- 广州市中西医结合医院口腔科,广东 广州 510800Department of Stomatology, Guangzhou Hospital of Integrated Traditional and West Medicine, Guangzhou 510800, China
| | - 搏 贾
- 南方医科大学附属口腔医院,广东 广州 510220Stomatological Hospital of Southern Medical University, Guangzhou 510220, China
| | - 少群 林
- 广州市中西医结合医院口腔科,广东 广州 510800Department of Stomatology, Guangzhou Hospital of Integrated Traditional and West Medicine, Guangzhou 510800, China
| | - 军 邵
- 广州市中西医结合医院口腔科,广东 广州 510800Department of Stomatology, Guangzhou Hospital of Integrated Traditional and West Medicine, Guangzhou 510800, China
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Toledo Stuani VD, do Prado Manfredi GG, Miyahara Kondo VA, Noritomi PY, Lisboa-Filho PN, Passanezi Sant’Ana AC. The use of additively manufactured scaffolds for treating gingival recession associated with interproximal defects. ACTA ACUST UNITED AC 2020. [DOI: 10.2217/3dp-2020-0008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Gingival recessions are a highly prevalent issue that is often associated with interproximal tissue deficiency. An intervention in these scenarios is of extreme importance since these defects can lead to aesthetic, phonetic and other dental problems. Unfortunately, the treatment of advanced gingival recessions is a major challenge in periodontics because of its unpredictability. In such cases, the use of injectable fillings, connective tissue grafts or bone grafts for vertical regeneration in interproximal area presents limited results. Considering that, this special report reviewed the possible use of additively manufactured scaffolds as a therapeutic option. A 3D-printed personalized therapy is expected to simplify the regeneration of interproximal area, enabling bone regeneration, new papilla formation and root coverage.
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Affiliation(s)
- Vitor de Toledo Stuani
- Discipline of Periodontology, Bauru School of Dentistry – University of Sao Paulo, Bauru, Brazil
| | | | | | - Pedro Yoshito Noritomi
- Nucleus of Three-Dimensional Technologies (NT3D), Center for Information Technology Renato Archer, Campinas, Brazil
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Effects of additional collagen in biphasic calcium phosphates: a study in a rabbit calvaria. Clin Oral Investig 2020; 24:3093-3103. [PMID: 31953682 DOI: 10.1007/s00784-019-03181-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 12/19/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Biphasic calcium phosphates (BCP) are synthetic biomaterials developed as an alternative to the autogenous bone grafts and xenografts. The aim of the present study was to assess the influence of the addition of collagen onto the BCP resorption rate and bone formation. MATERIAL AND METHODS Eighteen male NWZ rabbits approximately 12 weeks of age were used. Critical size defects were randomly treated with bilayered BCP materials comprising 12% HA and 88% α-TCP with and without collagen or sham-operated, respectively. All defects were covered with a resorbable collagen membrane. Animals were euthanized after 3 and 12 weeks of healing and investigated by micro-CT, histologic, and histomorphometric analysis. RESULTS Woven bone formation was observed from the original bone at 3-week healing in all samples. After 3 months, mainly lamellar new bone in the peripheral area was observed. In the central region, both woven and lamellar bone were seen. Samples containing collagen showed less residual biomaterial than without collagen at both healing periods. Both types of granules were in close contact with new bone, yielding a complete defect closure at 3 months of healing. However, new bone volume and area was similar for both biomaterials. CONCLUSIONS Within its limitations, the study results qualify collagen as a biocompatible carrier for BCPs. The presence of collagen indicated neither significant impact on the resorption of the BCPs nor on bone formation. CLINICAL RELEVANCE The addition of collagen to BCPs might not be beneficial for the augmentation of extended bone deficiencies.
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Anavi Lev K, Chaushu L, Schwarz F, Artzi Z. Bone-implant-contact and new bone formation around implants placed in FDB blocks compared to placement at the adjunction of particulate FDB. Clin Implant Dent Relat Res 2019; 22:21-28. [PMID: 31746114 DOI: 10.1111/cid.12856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 07/29/2019] [Accepted: 09/22/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The efficacy of human freeze-dried bone (h-FDB) as particulate vs block forms as a proper onlay augmented bone graft material to accommodate implants is undetermined. PURPOSE To evaluate osseointegration and new bone formation at implants placed in FDB blocks (BL group) and those at the adjunction of particulate FDB (PR group). MATERIALS AND METHODS Twelve pairs of h-FDB blocks were stabilized bilaterally to the calvaria of 12 rabbits. Twenty-four SLA implants were placed at the remodeled grafted blocks, 4 months later. A circumferential gap was created around one implant in each pair and packed with particulate h-FDB. Section biopsies were obtained at 2-month post implant placement (6 months post-block grafting). Bone-to-implant contact (BIC) and bone-area fraction (BAF) were histomorphometrically calculated. RESULTS The mean BIC was 34.4% and 33.5% for the BL and PR groups, respectively. The mean BAF was 23.9% and 26.4% for the corresponding groups, respectively. Osseointegration and newly formed bone were evident mostly between the threaded portions of the implants in proximity to the host rabbit calvaria compared to its cervical neck. CONCLUSION The particulate and the cancellous block h-FDB forms yielded similar BIC and BAF outcome. Full revascularization/revitalization is questioned.
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Affiliation(s)
- Karen Anavi Lev
- Department of Periodontology and Oral Implantology, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liat Chaushu
- Department of Periodontology and Oral Implantology, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Frank Schwarz
- Department of Oral Surgery and Implantology at the Centre for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt, Germany
| | - Zvi Artzi
- Department of Periodontology and Oral Implantology, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
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Masaeli R, Zandsalimi K, Rasoulianboroujeni M, Tayebi L. Challenges in Three-Dimensional Printing of Bone Substitutes. TISSUE ENGINEERING PART B-REVIEWS 2019; 25:387-397. [DOI: 10.1089/ten.teb.2018.0381] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Reza Masaeli
- Department of Dental Biomaterials, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Kavosh Zandsalimi
- Department of Life Sciences Engineering, Faculty of New Sciences and Technologies, University of Tehran, Tehran, Iran
| | | | - Lobat Tayebi
- Marquette University School of Dentistry, Milwaukee, Wisconsin
- Department of Engineering Science, University of Oxford, Oxford, United Kingdom
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15
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Charbonnier B, Abdulla M, Gorgy A, Shash H, Zhang Z, Gbureck U, Harvey E, Makhoul N, Gilardino M, Barralet J. Treatment of Critical-Sized Calvarial Defects in Rats with Preimplanted Transplants. Adv Healthc Mater 2019; 8:e1900722. [PMID: 31414583 DOI: 10.1002/adhm.201900722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/30/2019] [Indexed: 12/12/2022]
Abstract
The local environment and the defect features have made the skull one of the most difficult regions to repair. Finding alternative strategies to repair large cranial defects, thereby avoiding the current limitations of autograft or polymeric and ceramic prostheses constitute an unmet need. In this study, the regeneration of an 8 mm critical-sized calvarial defect treated by autograft or by a monetite scaffold directly placed in the defect or preimplanted (either cranial bone transplant or subcutaneous pocket) and then transplanted within the bone defect is compared. The data reveal that transplantation of preimplanted monetite transplant scaffolds greatly improves the skull vault closure compared to subcutaneously preimplanted or directly placed materials. Autografts, while clearly filling the defect volume with bone appear effective since bone volume inside the defect volume is obviously high, but are not well fused to the skull. The preimplantation site has a large influence on the regeneration of the defect. Transplantation of induced bone inside materials has the potential to reduce the need for autograft harvest without damaging the skeleton. This first demonstration indicates that cranial repair may be possible without recourse to bioactives or cultured cell therapies.
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Affiliation(s)
- Baptiste Charbonnier
- Department of Mechanical EngineeringMcGill University 817 Sherbrooke Street West Montreal H3G 1C3 Quebec Canada
| | - Mohamed Abdulla
- Department of SurgeryFaculty of MedicineMontreal General HospitalMcGill University Montreal H3G 1A4 Canada
| | - Andrew Gorgy
- Department of SurgeryFaculty of MedicineMontreal General HospitalMcGill University Montreal H3G 1A4 Canada
| | - Hani Shash
- Department of SurgeryFaculty of MedicineMontreal General HospitalMcGill University Montreal H3G 1A4 Canada
| | - Zishuai Zhang
- Faculty of Dentistry 3640 University St. Montreal H3A 0C7 Canada
| | - Uwe Gbureck
- Department of Functional Materials in Medicine and DentistryUniversity Hospital of Würzburg Pleicherwall 2 Würzburg 97070 Germany
| | - Ed Harvey
- Department of Mechanical EngineeringMcGill University 817 Sherbrooke Street West Montreal H3G 1C3 Quebec Canada
| | - Nicholas Makhoul
- Department of SurgeryFaculty of MedicineMontreal General HospitalMcGill University Montreal H3G 1A4 Canada
| | - Mirko Gilardino
- Department of Mechanical EngineeringMcGill University 817 Sherbrooke Street West Montreal H3G 1C3 Quebec Canada
| | - Jake Barralet
- Department of SurgeryFaculty of MedicineMontreal General HospitalMcGill University Montreal H3G 1A4 Canada
- Faculty of Dentistry 3640 University St. Montreal H3A 0C7 Canada
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16
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Synthetic Blocks for Bone Regeneration: A Systematic Review and Meta-Analysis. Int J Mol Sci 2019; 20:ijms20174221. [PMID: 31466409 PMCID: PMC6747264 DOI: 10.3390/ijms20174221] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/25/2019] [Accepted: 08/26/2019] [Indexed: 12/15/2022] Open
Abstract
This systematic review is aimed at evaluating the effectiveness of synthetic block materials for bone augmentation in preclinical in vivo studies. An electronic search was performed on Pubmed, Scopus, EMBASE. Articles selected underwent risk-of-bias assessment. The outcomes were: new bone formation and residual graft with histomorphometry, radiographic bone density, soft tissue parameters, complications. Meta-analysis was performed to compare new bone formation in test (synthetic blocks) vs. control group (autogenous blocks or spontaneous healing). The search yielded 214 articles. After screening, 39 studies were included, all performed on animal models: rabbits (n = 18 studies), dogs (n = 4), rats (n = 7), minipigs (n = 4), goats (n = 4), and sheep (n = 2). The meta-analysis on rabbit studies showed significantly higher new bone formation for synthetic blocks with respect to autogenous blocks both at four-week (mean difference (MD): 5.91%, 95% confidence intervals (CI): 1.04, 10.79%, p = 0.02) and at eight-week healing (MD: 4.44%, 95% CI: 0.71, 8.17%, p = 0.02). Other animal models evidenced a trend for better outcomes with synthetic blocks, though only based on qualitative analysis. Synthetic blocks may represent a viable resource in bone regenerative surgery for achieving new bone formation. Differences in the animal models, the design of included studies, and the bone defects treated should be considered when generalizing the results. Clinical studies are needed to confirm the effectiveness of synthetic blocks in bone augmentation procedures.
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17
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Liao W, Xu L, Wangrao K, Du Y, Xiong Q, Yao Y. Three-dimensional printing with biomaterials in craniofacial and dental tissue engineering. PeerJ 2019; 7:e7271. [PMID: 31328038 PMCID: PMC6622164 DOI: 10.7717/peerj.7271] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 06/10/2019] [Indexed: 02/05/2023] Open
Abstract
With the development of technology, tissue engineering (TE) has been widely applied in the medical field. In recent years, due to its accuracy and the demands of solid freeform fabrication in TE, three-dimensional printing, also known as additive manufacturing (AM), has been applied for biological scaffold fabrication in craniofacial and dental regeneration. In this review, we have compared several types of AM techniques and summarized their advantages and limitations. The range of printable materials used in craniofacial and dental tissue includes all the biomaterials. Thus, basic and clinical studies were discussed in this review to present the application of AM techniques in craniofacial and dental tissue and their advances during these years, which might provide information for further AM studies in craniofacial and dental TE.
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Affiliation(s)
- Wen Liao
- Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.,State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Lin Xu
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Kaijuan Wangrao
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yu Du
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Qiuchan Xiong
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.,Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yang Yao
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.,Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
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18
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Fine N, Sheikh Z, Al‐Jaf F, Oveisi M, Borenstein A, Hu Y, Pilliar R, Grynpas M, Glogauer M. Differential response of human blood leukocytes to brushite, monetite, and calcium polyphosphate biomaterials. J Biomed Mater Res B Appl Biomater 2019; 108:253-262. [DOI: 10.1002/jbm.b.34385] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 03/30/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Noah Fine
- Faculty of DentistryUniversity of Toronto Toronto Ontario Canada
| | - Zeeshan Sheikh
- Faculty of DentistryUniversity of Toronto Toronto Ontario Canada
- Lunenfeld‐Tanenbaum Research Institute (LTRI), Mount Sinai Hospital Toronto Ontario Canada
- Department of Laboratory Medicine and Pathobiology (LMP)University of Toronto Toronto Ontario Canada
| | - Faik Al‐Jaf
- Faculty of DentistryUniversity of Toronto Toronto Ontario Canada
| | - Morvarid Oveisi
- Faculty of DentistryUniversity of Toronto Toronto Ontario Canada
| | - Alon Borenstein
- Faculty of DentistryUniversity of Toronto Toronto Ontario Canada
| | - Youxin Hu
- Institute of Biomaterials and Biomedical Engineering (IBBME), University of Toronto Toronto Ontario Canada
| | - Robert Pilliar
- Faculty of DentistryUniversity of Toronto Toronto Ontario Canada
- Institute of Biomaterials and Biomedical Engineering (IBBME), University of Toronto Toronto Ontario Canada
| | - Marc Grynpas
- Lunenfeld‐Tanenbaum Research Institute (LTRI), Mount Sinai Hospital Toronto Ontario Canada
- Department of Laboratory Medicine and Pathobiology (LMP)University of Toronto Toronto Ontario Canada
- Institute of Biomaterials and Biomedical Engineering (IBBME), University of Toronto Toronto Ontario Canada
| | - Michael Glogauer
- Faculty of DentistryUniversity of Toronto Toronto Ontario Canada
- Princess Margaret Cancer Centre, Department of Dental Oncology and Maxillofacial Prosthetics Toronto Ontario Canada
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19
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Meininger S, Moseke C, Spatz K, März E, Blum C, Ewald A, Vorndran E. Effect of strontium substitution on the material properties and osteogenic potential of 3D powder printed magnesium phosphate scaffolds. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 98:1145-1158. [PMID: 30812998 DOI: 10.1016/j.msec.2019.01.053] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 01/11/2019] [Accepted: 01/12/2019] [Indexed: 12/27/2022]
Abstract
3D powder printing is a versatile method for the fabrication of individual bone implants and was used for the processing of in vivo degradable ceramic scaffolds based on ammonium magnesium phosphate hexahydrate (struvite). In this study, synergetic effects could be achieved by the substitution of magnesium phosphate cements with strontium carbonate. This substitution resulted in 8.2 wt%, 16.4 wt%, and 24.6 wt% Sr2+ doped scaffolds, with a 1.9-3.1 times increased radiopacity compared to pure struvite. The maximal compressive strength of (16.1 ± 1.1) MPa found for strontium substituted magnesium phosphate was in the range of cancelleous bone, which makes these 3D printed structures suitable for medical application in low-load-bearing bone areas. In an ion release study over a course of 18 days, the release of strontium, magnesium, calcium, and phosphate ions from scaffolds was analyzed by means of inductively coupled plasma mass spectrometry. Independent of the scaffold composition the Mg2+ concentrations (83-499 mg/l) continuously increased in the cell media. The Sr2+ release varied between 4.3 μg/day and 15.1 μg/day per g scaffold, corresponding to a Sr2+ concentration in media between 1.14 mg/l and 7.24 mg/l. Moreover, decreasing calcium and phosphate concentrations indicated the precipitation of an amorphous calcium phosphate phase. The superior osteogenic properties of strontium substituted magnesium phosphate, e.g. the increase of osteoblast activity and cell number and the simultaneous suppression of osteoclast differentiation could be verified in vitro by means of WST-assay, TRAP-staining, and SEM imaging.
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Affiliation(s)
- Susanne Meininger
- Department for Functional Materials in Medicine and Dentistry, University of Würzburg, Germany
| | - Claus Moseke
- Institute for Biomedical Engineering (IBMT), University of Applied Sciences Mittelhessen (THM), Gießen, Germany
| | - Kerstin Spatz
- Department for Functional Materials in Medicine and Dentistry, University of Würzburg, Germany
| | - Emilie März
- Department for Functional Materials in Medicine and Dentistry, University of Würzburg, Germany
| | - Carina Blum
- Department for Functional Materials in Medicine and Dentistry, University of Würzburg, Germany
| | - Andrea Ewald
- Department for Functional Materials in Medicine and Dentistry, University of Würzburg, Germany
| | - Elke Vorndran
- Department for Functional Materials in Medicine and Dentistry, University of Würzburg, Germany.
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20
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Gul M, Arif A, Ghafoor R. Role of three-dimensional printing in periodontal regeneration and repair: Literature review. J Indian Soc Periodontol 2019; 23:504-510. [PMID: 31849394 PMCID: PMC6906903 DOI: 10.4103/jisp.jisp_46_19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Three-dimensional (3D) printing is the process of building 3D objects by additive manufacturing approach. It is being used in endodontics, periodontology, maxillofacial surgery, prosthodontics, orthodontics, and restorative dentistry, but our review article is focused on periodontal application. A detailed literature search was done on PubMed/Medline and Google Scholar using various key terms. A total of 45 articles were included in this study. Most of the studies were in vitro, preclinical, case reports, retrospective, and prospective studies. Few clinical trials have also been done. Periodontal applications included education models, scaffolds, socket preservation, and sinus and bone augmentation and guided implant placement. It showed better alveolar ridge preservation, better regenerative capabilities, greater reduction in pocket depth and bony fill, ease of implant placement in complex cases with greater precision and reduced time with improved outcome and an important tool for education and training using simulated models.
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Affiliation(s)
- Meisha Gul
- Department of Surgery, JHS Building 1st Floor Dental Clinics, Aga Khan University Hospital, Karachi, Pakistan
| | - Aysha Arif
- Department of Surgery, JHS Building 1st Floor Dental Clinics, Aga Khan University Hospital, Karachi, Pakistan
| | - Robia Ghafoor
- Department of Surgery, JHS Building 1st Floor Dental Clinics, Aga Khan University Hospital, Karachi, Pakistan
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21
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de N. Dias F, Pecorari V, Martins C, Del Fabbro M, Casati M. Short implants versus bone augmentation in combination with standard-length implants in posterior atrophic partially edentulous mandibles: systematic review and meta-analysis with the Bayesian approach. Int J Oral Maxillofac Surg 2019; 48:90-96. [DOI: 10.1016/j.ijom.2018.05.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 04/04/2018] [Accepted: 05/03/2018] [Indexed: 10/16/2022]
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22
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Applications of 3D printing on craniofacial bone repair: A systematic review. J Dent 2019; 80:1-14. [DOI: 10.1016/j.jdent.2018.11.004] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 09/09/2018] [Accepted: 11/07/2018] [Indexed: 12/14/2022] Open
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23
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Evaluation of a new tricalcium phosphate for guided bone regeneration: an experimental study in the beagle dog. Odontology 2018; 107:209-218. [DOI: 10.1007/s10266-018-0384-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 08/01/2018] [Indexed: 10/28/2022]
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24
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Shi R, Huang Y, Ma C, Wu C, Tian W. Current advances for bone regeneration based on tissue engineering strategies. Front Med 2018; 13:160-188. [PMID: 30047029 DOI: 10.1007/s11684-018-0629-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 12/14/2017] [Indexed: 01/07/2023]
Abstract
Bone tissue engineering (BTE) is a rapidly developing strategy for repairing critical-sized bone defects to address the unmet need for bone augmentation and skeletal repair. Effective therapies for bone regeneration primarily require the coordinated combination of innovative scaffolds, seed cells, and biological factors. However, current techniques in bone tissue engineering have not yet reached valid translation into clinical applications because of several limitations, such as weaker osteogenic differentiation, inadequate vascularization of scaffolds, and inefficient growth factor delivery. Therefore, further standardized protocols and innovative measures are required to overcome these shortcomings and facilitate the clinical application of these techniques to enhance bone regeneration. Given the deficiency of comprehensive studies in the development in BTE, our review systematically introduces the new types of biomimetic and bifunctional scaffolds. We describe the cell sources, biology of seed cells, growth factors, vascular development, and the interactions of relevant molecules. Furthermore, we discuss the challenges and perspectives that may propel the direction of future clinical delivery in bone regeneration.
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Affiliation(s)
- Rui Shi
- Institute of Traumatology and Orthopaedics, Beijing Laboratory of Biomedical Materials, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Yuelong Huang
- Department of Spine Surgery of Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, Beijing, 100035, China
| | - Chi Ma
- Institute of Traumatology and Orthopaedics, Beijing Laboratory of Biomedical Materials, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Chengai Wu
- Institute of Traumatology and Orthopaedics, Beijing Laboratory of Biomedical Materials, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Wei Tian
- Institute of Traumatology and Orthopaedics, Beijing Laboratory of Biomedical Materials, Beijing Jishuitan Hospital, Beijing, 100035, China. .,Department of Spine Surgery of Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, Beijing, 100035, China.
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25
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Abrahamsson P, Wälivaara DÅ, Anderud J, Jimbo R. Vertical bone augmentation with titanium granule blocks in rabbit calvaria. Clin Exp Dent Res 2018; 3:100-106. [PMID: 29744186 PMCID: PMC5719821 DOI: 10.1002/cre2.67] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/22/2017] [Accepted: 03/27/2017] [Indexed: 11/17/2022] Open
Abstract
To determine whether it is possible to vertically augment bone utilizing a block graft from compressed titanium granules mainly used previously for contained bone defects and to determine whether there exists a difference in osteoconductive properties between the white and the grey granules. In 11 rabbits, 4 titanium blocks were inserted on each rabbit's skull bone according to a randomized scheme. These blocks were made from standardized compressed titanium granules. Type A: PTG grey, small granules (Pourus Titanium Granules, Tigran, Malmö, Sweden); Type B: PTG grey, large granules; Type C: PTG white, small granules; Type D: PTG white large granules. After 12 weeks, the animals were sacrificed and specimens were collected for histology and μCT scanning. From both the μCT and histology, it can be said that bone formation was successfully achieved for all groups, and the granules maintained their volume. The histomorphometric BA (bone area) evaluation in the entire grafted area presented that there were no statistical differences between all groups tested. The lowest 1/4 BA in contact with the rabbit skull presented that groups A and C presented the highest mean BA, and group A presented significantly higher BA than that of group D (p = 0,049). No significant differences were noted between groups A, B and C. Within the limitation of this study, no differences were noted between small white or grey PTG blocks. The large granules presented less bone ingrowth area compared to the small granules and this trend was regardless of the different PTG types. The entire grafted area was not filled with new bone suggesting that bone migration occurred mostly from the existing cortical bone side suggesting contact osteogenesis.
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Affiliation(s)
| | | | | | - Ryo Jimbo
- Department of Oral and Maxillofacial Surgery and Oral Medicine Malmö University SE Sweden
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26
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Yen HH, Stathopoulou PG. CAD/CAM and 3D-Printing Applications for Alveolar Ridge Augmentation. ACTA ACUST UNITED AC 2018; 5:127-132. [PMID: 30505646 DOI: 10.1007/s40496-018-0180-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Purpose of review CAD/CAM and 3D-printing are emerging manufacturing technologies in dentistry. In the field of alveolar ridge augmentation, graft customization utilizing these technologies can result in significant reduction of surgical time. A review of the literature on materials, techniques and applications of CAD/CAM and 3D-printing available for alveolar ridge augmentation was performed. Recent findings CAD/CAM applications for milling of customized block grafts of allogeneic, xenogeneic, and alloplastic origins have been reported, and currently only limited products are commercially available. 3D-printing applications are limited to alloplastic graft materials and containment shells, and have been mostly used in animal studies for optimizing biomaterials' properties. Summary While current data support the potential use of CAD/CAM and 3D-printing for graft customization for alveolar ridge augmentation procedures, additional research is needed on predictability and long-term stability of the grafted sites.
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Affiliation(s)
- Howard H Yen
- Postdoctoral Periodontics Resident, Department of Periodontics, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA
| | - Panagiota G Stathopoulou
- Assistant Professor of Periodontics and Director of Postdoctoral Periodontics, Department of Periodontics, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA
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27
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Comparison of three block bone substitutes for bone regeneration: long-term observation in the beagle dog. Odontology 2018; 106:398-407. [PMID: 29557992 DOI: 10.1007/s10266-018-0352-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/02/2018] [Indexed: 10/17/2022]
Abstract
This study aimed to evaluate the impact of three types of block bone substitute material on bone formation and graft resorption in vivo. Standardized bone defects (n = 4 defects/animal) were created in the calvaria of nine dogs. Block bone substitutes made of deproteinized bovine bone mineral (DBBM), beta-tricalcium phosphate (β-TCP) and a mixture alpha-TCP and hydroxyapatite (α-TCP/HA) were inserted into the bone defects. A fourth defect was left untreated (empty). All sites were covered with a collagenous membrane. Block biopsies were harvested at 3, 6 and 12 months post-implantation and analyzed by micro-CT and histology. Biomaterial absorption was minimal and incorporation within the defect margin was good for all biomaterials. However, β-TCP demonstrated a relatively greater volume of new bone formation and less residual material volume when compared with DBBM and α-TCP/HA. Conversely, α-TCP/HA showed higher osteoconductive potential and a greater new bone area compared with the other two biomaterials. The block bone substitutes used in the present in vivo study showed advantageous in terms of maintenance of their original form in bony defect. However, the positive impact of all biomaterials on new bone formation and replacement of bone was minor even at 12 months. These findings indicate that block bone substitutes are not well suited to vertical bone augmentation. Further investigations are required to improve the insufficient new bone volume for promising clinical results.
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28
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Trbakovic A, Hedenqvist P, Mellgren T, Ley C, Hilborn J, Ossipov D, Ekman S, Johansson CB, Jensen-Waern M, Thor A. A new synthetic granular calcium phosphate compound induces new bone in a sinus lift rabbit model. J Dent 2018; 70:31-39. [PMID: 29258851 DOI: 10.1016/j.jdent.2017.12.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 11/29/2017] [Accepted: 12/15/2017] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate if a synthetic granular calcium phosphate compound (CPC) and a composite bisphosphonate-linked hyaluronic acid-calcium phosphate hydrogel (HABP·CaP) induced similar or more amount of bone as bovine mineral in a modified sinus lift rabbit model. MATERIAL AND METHODS Eighteen adult male New Zeeland White rabbits, received randomly one of the two test materials on a random side of the face, and bovine mineral as control on the contralateral side. In a sinus lift, the sinus mucosa was elevated and a titanium mini-implant was placed in the alveolar bone. Augmentation material (CPC, HABP·CaP or bovine bone) was applied in the space around the implant. The rabbits were euthanized three months after surgery and qualitative and histomorphometric evaluation were conducted. Histomorphometric evaluation included three different regions of interest (ROIs) and the bone to implant contact on each installed implant. RESULTS Qualitative assessment (p = <.05), histomorphometric evaluations (p = < .01), and implant incorporation (p = <.05) showed that CPC and bovine mineral induced similar amount of bone and more than the HABP·CaP hydrogel. CONCLUSION CPC induced similar amount of bone as bovine mineral and both materials induced more bone than HABP·CaP hydrogel. CLINICAL SIGNIFICANCE The CPC is suggested as a synthetic alternative for augmentations in the maxillofacial area.
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Affiliation(s)
- Amela Trbakovic
- Department of Surgical Sciences, Plastic & Oral and Maxillofacial Surgery, Uppsala University, 751 85 Uppsala, Sweden.
| | - Patricia Hedenqvist
- Swedish University of Agricultural Sciences, Department of Clinical Sciences, PO Box 7054, 750 07 Uppsala, Sweden.
| | - Torbjörn Mellgren
- Polymer Chemistry, Department of Chemistry, Ångströms Laboratory, Uppsala University, Box 538, 75121 Uppsala, Sweden.
| | - Cecilia Ley
- Swedish University of Agricultural Sciences, Department of Biomedical Sciences and Veterinary Public Health, Division of Pathology, PO Box 7028, 750 07 Uppsala, Sweden.
| | - Jöns Hilborn
- Polymer Chemistry, Department of Chemistry, Ångströms Laboratory, Uppsala University, Box 538, 75121 Uppsala, Sweden.
| | - Dmitri Ossipov
- Polymer Chemistry, Department of Chemistry, Ångströms Laboratory, Uppsala University, Box 538, 75121 Uppsala, Sweden
| | - Stina Ekman
- Swedish University of Agricultural Sciences, Department of Biomedical Sciences and Veterinary Public Health, Division of Pathology, PO Box 7028, 750 07 Uppsala, Sweden.
| | - Carina B Johansson
- University of Gothenburg, The Sahlgrenska Academy, Institute of Odontology, Department of Prosthodontics, Dental Materials Science, P.O. Box 450, 405 30 Gothenburg, Sweden.
| | - Marianne Jensen-Waern
- Swedish University of Agricultural Sciences, Department of Clinical Sciences, PO Box 7054, 750 07 Uppsala, Sweden.
| | - Andreas Thor
- Department of Surgical Sciences, Plastic & Oral and Maxillofacial Surgery, Uppsala University, 751 85 Uppsala, Sweden.
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29
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Sheikh Z, Zhang YL, Tamimi F, Barralet J. Effect of processing conditions of dicalcium phosphate cements on graft resorption and bone formation. Acta Biomater 2017; 53:526-535. [PMID: 28213100 DOI: 10.1016/j.actbio.2017.02.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 01/21/2017] [Accepted: 02/13/2017] [Indexed: 11/18/2022]
Abstract
Dicalcium phosphate cements (brushite and monetite) are resorbable biomaterials with osteoconductive potential for bone repair and regeneration that have yet to gain widespread commercial use. Brushite can be converted to monetite by heat treatments additionally resulting in various changes in the physico-chemical properties. However, since conversion is most commonly performed using autoclave sterilisation (wet heating), it is uncertain whether the properties observed for monetite as a result of heating brushite under dry conditions affect resorption and bone formation favourably. This study was designed to produce monetite grafts of differing physical form by autoclaving and dry heating (under vacuum) to be compared with brushite biomaterials in an orthotopic pre-clinical implantation model in rabbit for 12weeks. It was observed that monetite grafts had higher porosity and specific surface area than their brushite precursors. The autoclaved monetite grafts had compressive strength reduced by 50% when compared with their brushite precursors. However, the dry heat converted monetite grafts had compressive strength comparable with brushite. Results from in vivo experiments revealed that both types of monetite graft materials resorbed faster than brushite and more bone formation was achieved. There was no significant difference in the amount of bone formed between the two types of monetite grafts. The implanted brushite grafts underwent phase transformation to form hydroxyapatite, which ultimately limited bioresorption. However, this was not observed in both types of monetite grafts. In summary, both autoclaving and dry heating the preset brushite cement grafts resulted in monetite biomaterials which were more resorbable with potential to be investigated and optimized for orthopaedic and maxillofacial bone repair and regeneration applications. STATEMENT OF SIGNIFICANCE We present in this original research article a comparison between dicalcium phosphate cement based grafts (brushite and 2 types of monetite grafts prepared by wet and dry thermal processing) with regards to resorption and bone formation in vivo after orthotopic implantation in rabbit condylar femural region. To the best of our knowledge this is the first in vivo study that reports a comparison resorption and bone formation using brushite and two types of monetite biomaterials. Also, we have included in the manuscript a summary of all the in vivo studies performed on brushite and monetite biomaterials to date. This includes cement composition, physical properties (porosity and surface area), implantation and histomorphometrical details such as animal species, site of implantation, observation period, percentage bone tissue formation and residual graft material. In addition, we calculated the percentage resorption of graft materials based upon various implantation sites and included that into the discussion section. The results of this original research provides greater understanding of the resorption processes of dicalcium phosphate based grafts, allowing preparation of bone substitute materials with more predictable resorption profiles in future.
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Affiliation(s)
- Zeeshan Sheikh
- Faculty of Dentistry, McGill University, 3640, Strathcona Anatomy and Dentistry Building, Rue University, Montreal, Quebec H3A 0C7, Canada.
| | - Yu Ling Zhang
- Faculty of Dentistry, McGill University, 3640, Strathcona Anatomy and Dentistry Building, Rue University, Montreal, Quebec H3A 0C7, Canada.
| | - Faleh Tamimi
- Faculty of Dentistry, McGill University, 3640, Strathcona Anatomy and Dentistry Building, Rue University, Montreal, Quebec H3A 0C7, Canada.
| | - Jake Barralet
- Faculty of Dentistry, McGill University, 3640, Strathcona Anatomy and Dentistry Building, Rue University, Montreal, Quebec H3A 0C7, Canada; Division of Orthopaedics, Department of Surgery, Faculty of Medicine, McGill University, 1650 Cedar Ave, Montreal General Hospital, Montreal, Quebec H3G 1A4, Canada.
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Drager J, Sheikh Z, Zhang YL, Harvey EJ, Barralet JE. Local delivery of iron chelators reduces in vivo remodeling of a calcium phosphate bone graft substitute. Acta Biomater 2016; 42:411-419. [PMID: 27449336 DOI: 10.1016/j.actbio.2016.07.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/01/2016] [Accepted: 07/19/2016] [Indexed: 12/18/2022]
Abstract
UNLABELLED Iron chelators are known activators of the Hypoxia Includible Factor-1α (HIF-1α) pathway, a critical cellular pathway involved in angiogenic responses to hypoxia. Local delivery of these chelators has shown promise in bone tissue engineering strategies by inducing angiogenesis and osteogenesis. Hypoxic microenvironments are also a stimulus for osteoclast differentiation and resorptive activity, a process likely mediated by HIF-1α. In vitro, low doses of the iron chelator Deferoxamine (DFO) has shown to induce HIF-1α mediated osteoclast formation and function. However other studies have proposed an opposite in vitro effect likely through HIF independent mechanisms. To investigate use of these medications in bioceramic based bone tissue engineering strategies this study aimed to determine the in vivo effect of local delivery of iron chelators on bioceramic remodeling. A non-weight bearing cranial onlay model was used to assess monetite resorption and new bone formation in the presence or absence of a repeated delivery of two iron chelators, DFO and 1,10 Phenanthroline (PHT) at doses known to induce HIF. We found a marked reduction graft resorption and remodeling associated with iron chelation. This was correlated to a 3-fold reduction in osteoclast number at the bone graft interface. Iron is needed for mitochondrial biogenesis during osteoclastic differentiation and reducing extracellular iron levels may inhibit this process and possibly overpower any HIF induced osteoclast formation. Our findings suggest that these inexpensive and widely available molecules may be used to locally reduce bioceramic scaffold resorption and encourages future investigations of iron chelators as bone anti-resorptive agents in other clinical contexts. STATEMENT OF SIGNIFICANCE Low doses of iron chelators can induce angiogenesis and osteogenesis in repairing bone by stimulating the oxygen sensitive gene; hypoxia inducible factor. These medications have potential to augment bioceramic based bone tissue engineering strategies without the downsides of protein-based growth factors. HIF activation is also known to stimulate osteoclast-mediated resorption and could potentially accelerate remodeling of biocermaics, however we have shown that the local delivery of iron chelation at doses known to induce HIF resulted in a reduction of monetite resorption and a significant decrease in osteoclast number at the bone graft interface. This maybe due to HIF independent mechanism. This is the first study to show a local effect of iron chelators in vivo on osteoclast-mediated resorption. This opens the potential of further study of these bifunctional medications to modulate resorption of biocermaics in environments where a prolonged presence of material is desired for graft site stability. Moreover these safe widely used medications can be explored to locally reduce osteoclasts in pathological bone resorption.
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Affiliation(s)
- Justin Drager
- Division of Orthopaedics, McGill University Health Center, 1650 Cedar Ave, Montreal, Qc H3G 1A4, Canada.
| | - Zeeshan Sheikh
- Faculty of Dentistry, University of Toronto, 150 College Street, Toronto, ON M5S 3E2, Canada.
| | - Yu Ling Zhang
- Division of Orthopaedics, McGill University Health Center, 1650 Cedar Ave, Montreal, Qc H3G 1A4, Canada; Faculty of Dentistry, McGill University, 3640, Rue University, Montreal, Qc H3A 0C7, Canada.
| | - Edward J Harvey
- Division of Orthopaedics, McGill University Health Center, 1650 Cedar Ave, Montreal, Qc H3G 1A4, Canada.
| | - Jake E Barralet
- Division of Orthopaedics, McGill University Health Center, 1650 Cedar Ave, Montreal, Qc H3G 1A4, Canada; Faculty of Dentistry, McGill University, 3640, Rue University, Montreal, Qc H3A 0C7, Canada.
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Powder-based 3D printing for bone tissue engineering. Biotechnol Adv 2016; 34:740-753. [DOI: 10.1016/j.biotechadv.2016.03.009] [Citation(s) in RCA: 184] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/20/2016] [Accepted: 03/27/2016] [Indexed: 12/19/2022]
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Sheikh Z, Drager J, Zhang YL, Abdallah MN, Tamimi F, Barralet J. Controlling Bone Graft Substitute Microstructure to Improve Bone Augmentation. Adv Healthc Mater 2016; 5:1646-55. [PMID: 27214877 DOI: 10.1002/adhm.201600052] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 03/28/2016] [Indexed: 01/10/2023]
Abstract
Vertical bone augmentation procedures are frequently carried out to allow successful placement of dental implants in otherwise atrophic ridges and represent one of the most common bone grafting procedures currently performed. Onlay autografting is one of the most prevalent and predictable techniques to achieve this; however, there are several well documented complications and drawbacks associated with it and synthetic alternatives are being sought. Monetite is a bioresorbable dicalcium phosphate with osteoconductive and osteoinductive potential that has been previously investigated for onlay bone grafting and it is routinely made by autoclaving brushite to simultaneously sterilize and phase convert. In this study, monetite disc-shaped grafts are produced by both wet and dry heating methods which alter their physical properties such as porosity, surface area, and mechanical strength. Histological observations after 12 weeks of onlay grafting on rabbit calvaria reveal higher bone volume (38%) in autoclaved monetite grafts in comparison with the dry heated monetite grafts (26%). The vertical bone height gained is similar for both the types of monetite grafts (up to 3.2 mm). However, it is observed that the augmented bone height is greater in the lateral than the medial areas of both types of monetite grafts. It is also noted that the higher porosity of autoclaved monetite grafts increases the bioresorbability, whereas the dry heated monetite grafts having lower porosity but higher surface area resorb to a significantly lesser extent. This study provides information regarding two types of monetite onlay grafts prepared with different physical properties that can be further investigated for clinical vertical bone augmentation applications.
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Affiliation(s)
- Zeeshan Sheikh
- Faculty of Dentistry; McGill University, 3640, Strathcona Anatomyand Dentistry Building; Rue University; Montreal Quebec H3A 0C7 Canada
| | - Justin Drager
- Division of Orthopaedics; Department of Surgery; Faculty of Medicine; McGill University, 1650 Cedar Ave; Montreal General Hospital; Montreal Quebec H3G 1A4 Canada
| | - Yu Ling Zhang
- Faculty of Dentistry; McGill University, 3640, Strathcona Anatomyand Dentistry Building; Rue University; Montreal Quebec H3A 0C7 Canada
| | - Mohamed-Nur Abdallah
- Faculty of Dentistry; McGill University, 3640, Strathcona Anatomyand Dentistry Building; Rue University; Montreal Quebec H3A 0C7 Canada
| | - Faleh Tamimi
- Faculty of Dentistry; McGill University, 3640, Strathcona Anatomyand Dentistry Building; Rue University; Montreal Quebec H3A 0C7 Canada
| | - Jake Barralet
- Faculty of Dentistry; McGill University, 3640, Strathcona Anatomyand Dentistry Building; Rue University; Montreal Quebec H3A 0C7 Canada
- Division of Orthopaedics; Department of Surgery; Faculty of Medicine; McGill University, 1650 Cedar Ave; Montreal General Hospital; Montreal Quebec H3G 1A4 Canada
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Trombetta R, Inzana JA, Schwarz EM, Kates SL, Awad HA. 3D Printing of Calcium Phosphate Ceramics for Bone Tissue Engineering and Drug Delivery. Ann Biomed Eng 2016; 45:23-44. [PMID: 27324800 DOI: 10.1007/s10439-016-1678-3] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 06/08/2016] [Indexed: 01/16/2023]
Abstract
Additive manufacturing, also known as 3D printing, has emerged over the past 3 decades as a disruptive technology for rapid prototyping and manufacturing. Vat polymerization, powder bed fusion, material extrusion, and binder jetting are distinct technologies of additive manufacturing, which have been used in a wide variety of fields, including biomedical research and tissue engineering. The ability to print biocompatible, patient-specific geometries with controlled macro- and micro-pores, and to incorporate cells, drugs and proteins has made 3D-printing ideal for orthopaedic applications, such as bone grafting. Herein, we performed a systematic review examining the fabrication of calcium phosphate (CaP) ceramics by 3D printing, their biocompatibility in vitro, and their bone regenerative potential in vivo, as well as their use in localized delivery of bioactive molecules or cells. Understanding the advantages and limitations of the different 3D printing approaches, CaP materials, and bioactive additives through critical evaluation of in vitro and in vivo evidence of efficacy is essential for developing new classes of bone graft substitutes that can perform as well as autografts and allografts or even surpass the performance of these clinical standards.
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Affiliation(s)
- Ryan Trombetta
- Department of Biomedical Engineering, University of Rochester, Robert B. Goergen Hall, Rochester, NY, 14627, USA.,Center for Musculoskeletal Research, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA
| | - Jason A Inzana
- Center for Musculoskeletal Research, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA.,AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - Edward M Schwarz
- Department of Biomedical Engineering, University of Rochester, Robert B. Goergen Hall, Rochester, NY, 14627, USA.,Center for Musculoskeletal Research, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA.,Department of Orthopedics, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA
| | - Stephen L Kates
- Center for Musculoskeletal Research, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA.,Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, 23298, USA
| | - Hani A Awad
- Department of Biomedical Engineering, University of Rochester, Robert B. Goergen Hall, Rochester, NY, 14627, USA. .,Center for Musculoskeletal Research, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA. .,Department of Orthopedics, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
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Sheikh Z, Abdallah MN, Hanafi AA, Misbahuddin S, Rashid H, Glogauer M. Mechanisms of in Vivo Degradation and Resorption of Calcium Phosphate Based Biomaterials. MATERIALS (BASEL, SWITZERLAND) 2015; 8:7913-7925. [PMID: 28793687 PMCID: PMC5458904 DOI: 10.3390/ma8115430] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 11/09/2015] [Accepted: 11/13/2015] [Indexed: 12/21/2022]
Abstract
Calcium phosphate ceramic materials are extensively used for bone replacement and regeneration in orthopedic, dental, and maxillofacial surgical applications. In order for these biomaterials to work effectively it is imperative that they undergo the process of degradation and resorption in vivo. This allows for the space to be created for the new bone tissue to form and infiltrate within the implanted graft material. Several factors affect the biodegradation and resorption of calcium phosphate materials after implantation. Various cell types are involved in the degradation process by phagocytic mechanisms (monocytes/macrophages, fibroblasts, osteoblasts) or via an acidic mechanism to reduce the micro-environmental pH which results in demineralization of the cement matrix and resorption via osteoclasts. These cells exert their degradation effects directly or indirectly through the cytokine growth factor secretion and their sensitivity and response to these biomolecules. This article discusses the mechanisms of calcium phosphate material degradation in vivo.
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Affiliation(s)
- Zeeshan Sheikh
- Faculty of Dentistry, University of Toronto, Toronto, ON M5S 3E2, Canada.
| | | | | | - Syed Misbahuddin
- Faculty of Dentistry, Department of Dental Public Health, University of Toronto, Toronto, ON M5S 3E2, Canada.
| | - Haroon Rashid
- College of Dentistry, Division of Prosthodontics, Ziauddin University, Karachi 75530, Pakistan.
| | - Michael Glogauer
- Matrix Dynamics Group, Faculty of Dentistry, University of Toronto, Toronto, ON M5S 3E2, Canada.
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Abstract
Rapid prototyping (RP) technologies have found many uses in dentistry, and especially oral and maxillofacial surgery, due to its ability to promote product development while at the same time reducing cost and depositing a part of any degree of complexity theoretically. This paper provides an overview of RP technologies for maxillofacial reconstruction covering both fundamentals and applications of the technologies. Key fundamentals of RP technologies involving the history, characteristics, and principles are reviewed. A number of RP applications to the main fields of oral and maxillofacial surgery, including restoration of maxillofacial deformities and defects, reduction of functional bone tissues, correction of dento-maxillofacial deformities, and fabrication of maxillofacial prostheses, are discussed. The most remarkable challenges for development of RP-assisted maxillofacial surgery and promising solutions are also elaborated.
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Affiliation(s)
- Qian Peng
- Xiangya Stomatological Hospital, Central South University , Changsha, Hunan 410008 , China
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Lim HC, Song KH, You H, Lee JS, Jung UW, Kim SY, Choi SH. Effectiveness of biphasic calcium phosphate block bone substitutes processed using a modified extrusion method in rabbit calvarial defects. J Periodontal Implant Sci 2015; 45:46-55. [PMID: 25932338 PMCID: PMC4415001 DOI: 10.5051/jpis.2015.45.2.46] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 02/20/2015] [Indexed: 11/08/2022] Open
Abstract
PURPOSE This study evaluated the mechanical and structural properties of biphasic calcium phosphate (BCP) blocks processed using a modified extrusion method, and assessed their in vivo effectiveness using a rabbit calvarial defect model. METHODS BCP blocks with three distinct ratios of hydroxyapatite (HA):tricalcium phosphate (TCP) were produced using a modified extrusion method:HA8 (8%:92%), HA48 (48%:52%), and HA80 (80%:20%). The blocks were examined using scanning electron microscopy, X-ray diffractometry, and a universal test machine. Four circular defects 8 mm in diameter were made in 12 rabbits. One defect in each animal served as a control, and the other three defects received the BCP blocks. The rabbits were sacrificed at either two weeks (n=6) or eight weeks (n=6) postoperatively. RESULTS The pore size, porosity, and compressive strength of the three types of bone block were 140-170 µm, >70%, and 4-9 MPa, respectively. Histologic and histomorphometric observations revealed that the augmented space was well maintained, but limited bone formation was observed around the defect base and defect margins. No significant differences were found in the amount of new bone formation, graft material resorption, or bone infiltration among the three types of BCP block at either of the postoperative healing points. CONCLUSIONS Block bone substitutes with three distinct compositions (i.e., HA:TCP ratios) processed by a modified extrusion method exhibited limited osteoconductive potency, but excellent space-maintaining capability. Further investigations are required to improve the processing method.
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Affiliation(s)
- Hyun-Chang Lim
- Department of Periodontology, Kyung Hee University School of Dentistry, Seoul, Korea
| | - Kyung-Ho Song
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, Korea
| | - Hoon You
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, Korea
| | - Jung-Seok Lee
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, Korea
| | - Ui-Won Jung
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, Korea
| | - Suk-Young Kim
- School of Materials Science & Engineering, Yeungnam University, Gyeongsan, Korea
| | - Seong-Ho Choi
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, Korea
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Rodrigues MC, Hewer TLR, de Souza Brito GE, Arana-Chavez VE, Braga RR. Calcium phosphate nanoparticles functionalized with a dimethacrylate monomer. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2014; 45:122-6. [DOI: 10.1016/j.msec.2014.08.066] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 08/06/2014] [Accepted: 08/29/2014] [Indexed: 01/01/2023]
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Benic GI, Hämmerle CHF. Horizontal bone augmentation by means of guided bone regeneration. Periodontol 2000 2014; 66:13-40. [DOI: 10.1111/prd.12039] [Citation(s) in RCA: 214] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 12/18/2022]
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Wung N, Acott SM, Tosh D, Ellis MJ. Hollow fibre membrane bioreactors for tissue engineering applications. Biotechnol Lett 2014; 36:2357-66. [PMID: 25064452 DOI: 10.1007/s10529-014-1619-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 07/11/2014] [Indexed: 01/28/2023]
Abstract
Hollow fibre membrane bioreactors (HFB) provide a novel approach towards tissue engineering applications in the field of regenerative medicine. For adherent cell types, HFBs offer an in vivo-like microenvironment as each fibre replicates a blood capillary and the mass transfer rate across the wall is independent from the shear stresses experienced by the cell. HFB also possesses the highest surface area to volume ratio of all bioreactor configurations. In theory, these factors enable a high quantity of the desired cellular product with less population variation, and favourable operating costs. Experimental analyses of different cell types and bioreactor designs show encouraging steps towards producing a clinically relevant device. This review discusses the basic HFB design for cell expansion and in vitro models; compares data produced on commercially available systems and addresses the operational differences between theory and practice. HFBs are showing some potential for mammalian cell culture but further work is needed to fully understand the complexities of cell culture in HFBs and how best to achieve the high theoretical cell yields.
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Affiliation(s)
- Nelly Wung
- Department of Chemical Engineering, Centre for Regenerative Medicine, University of Bath, Bath, BA2 7AY, UK
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Tamimi F, Torres J, Al-Abedalla K, Lopez-Cabarcos E, Alkhraisat MH, Bassett DC, Gbureck U, Barralet JE. Osseointegration of dental implants in 3D-printed synthetic onlay grafts customized according to bone metabolic activity in recipient site. Biomaterials 2014; 35:5436-45. [DOI: 10.1016/j.biomaterials.2014.03.050] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 03/20/2014] [Indexed: 10/25/2022]
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Gross BC, Erkal JL, Lockwood SY, Chen C, Spence DM. Evaluation of 3D printing and its potential impact on biotechnology and the chemical sciences. Anal Chem 2014; 86:3240-53. [PMID: 24432804 DOI: 10.1021/ac403397r] [Citation(s) in RCA: 739] [Impact Index Per Article: 73.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Nearing 30 years since its introduction, 3D printing technology is set to revolutionize research and teaching laboratories. This feature encompasses the history of 3D printing, reviews various printing methods, and presents current applications. The authors offer an appraisal of the future direction and impact this technology will have on laboratory settings as 3D printers become more accessible.
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Affiliation(s)
- Bethany C Gross
- Department of Chemistry, Michigan State University , 578 South Shaw Lane, East Lansing, Michigan 48824, United States
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Castilho M, Dias M, Gbureck U, Groll J, Fernandes P, Pires I, Gouveia B, Rodrigues J, Vorndran E. Fabrication of computationally designed scaffolds by low temperature 3D printing. Biofabrication 2013; 5:035012. [PMID: 23887064 DOI: 10.1088/1758-5082/5/3/035012] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The development of artificial bone substitutes that mimic the properties of bone and simultaneously promote the desired tissue regeneration is a current issue in bone tissue engineering research. An approach to create scaffolds with such characteristics is based on the combination of novel design and additive manufacturing processes. The objective of this work is to characterize the microstructural and the mechanical properties of scaffolds developed by coupling both topology optimization and a low temperature 3D printing process. The scaffold design was obtained using a topology optimization approach to maximize the permeability with constraints on the mechanical properties. This procedure was studied to be suitable for the fabrication of a cage prototype for tibial tuberosity advancement application, which is one of the most recent and promising techniques to treat cruciate ligament rupture in dogs. The microstructural and mechanical properties of the scaffolds manufactured by reacting α/β-tricalcium phosphate with diluted phosphoric acid were then assessed experimentally and the scaffolds strength reliability was determined. The results demonstrate that the low temperature 3D printing process is a reliable option to create synthetic scaffolds with tailored properties, and when coupled with topology optimization design it can be a powerful tool for the fabrication of patient-specific bone implants.
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Affiliation(s)
- Miguel Castilho
- Institute of Mechanical Engineering/IST, Technical University of Lisbon, Portugal.
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Moroni L, Nandakumar A, de Groot FB, van Blitterswijk CA, Habibovic P. Plug and play: combining materials and technologies to improve bone regenerative strategies. J Tissue Eng Regen Med 2013; 9:745-59. [PMID: 23671062 DOI: 10.1002/term.1762] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 02/12/2013] [Accepted: 04/04/2013] [Indexed: 11/11/2022]
Abstract
Despite recent advances in the development of biomaterials intended to replace natural bone grafts for the regeneration of large, clinically relevant defects, most synthetic solutions that are currently applied in the clinic are still inferior to natural bone grafts with regard to regenerative potential and are limited to non-weight-bearing applications. From a materials science perspective, we always face the conundrum of the preservation of bioactivity of calcium phosphate ceramics in spite of better mechanical and handling properties and processability of polymers. Composites have long been investigated as a method to marry these critical properties for the successful regeneration of bone and, indeed, have shown a significant improvement when used in combination with cells or growth factors. However, when looking at this approach from a clinical and regulatory perspective, the use of cells or biologicals prolongs the path of new treatments from the bench to the bedside. Applying 'smart' synthetic materials alone poses the fascinating challenge of instructing tissue regeneration in situ, thereby tremendously facilitating clinical translation. In the journey to make this possible, and with the aim of adding up the advantages of different biomaterials, combinations of fabrication technologies arise as a new strategy for generating instructive three-dimensional (3D) constructs for bone regeneration. Here we provide a review of recent technologies and approaches to create such constructs and give our perspective on how combinations of technologies and materials can help in obtaining more functional bone regeneration.
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Affiliation(s)
- Lorenzo Moroni
- Department of Tissue Regeneration, Institute for Biomedical Technology and Technical Medicine (MIRA), University of Twente, Enschede, The Netherlands
| | - Anandkumar Nandakumar
- Department of Tissue Regeneration, Institute for Biomedical Technology and Technical Medicine (MIRA), University of Twente, Enschede, The Netherlands
| | | | - Clemens A van Blitterswijk
- Department of Tissue Regeneration, Institute for Biomedical Technology and Technical Medicine (MIRA), University of Twente, Enschede, The Netherlands
| | - Pamela Habibovic
- Department of Tissue Regeneration, Institute for Biomedical Technology and Technical Medicine (MIRA), University of Twente, Enschede, The Netherlands
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Moseke C, Bayer C, Vorndran E, Barralet JE, Groll J, Gbureck U. Low temperature fabrication of spherical brushite granules by cement paste emulsion. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2012; 23:2631-2637. [PMID: 22903599 DOI: 10.1007/s10856-012-4740-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 08/02/2012] [Indexed: 06/01/2023]
Abstract
Secondary protonated calcium phosphates such as brushite (CaHPO(4)·2H(2)O) or monetite (CaHPO(4)) have a higher resorption potential in bone defects than sintered ceramics, e.g. tricalcium phosphate or hydroxyapatite. However, processing of these phosphates to monolithic blocks or granules is not possible by sintering due to thermal decomposition of protonated phosphates at higher temperatures. In this study a low temperature technique for the preparation of spherical brushite granules in a cement setting reaction is presented. These granules were synthesized by dispersing a calcium phosphate cement paste composed of β-tricalcium phosphate and monocalcium phosphate together with a surfactant to an oil/water emulsion. The reaction products were characterized regarding their size distribution, morphology, and phase composition. Clinically relevant granule sizes ranging from 200 μm to 1 mm were obtained, whereas generally smaller granules were received with higher oil viscosity, increasing temperature or higher powder to liquid ratios of the cement paste. The hardened granules were microporous with a specific surface area of 0.7 m(2)/g and consisted of plate-like brushite (>95 % according to XRD) crystals of 0.5-7 μm size. Furthermore it was shown that the granules may be also used for drug delivery applications. This was demonstrated by adsorption of vancomycin from an aqueous solution, where a load of 1.45-1.88 mg drug per g granules and an almost complete release within 2 h was obtained.
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Affiliation(s)
- Claus Moseke
- Department for Functional Materials in Medicine and Dentistry, University of Würzburg, Würzburg, Germany.
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Hwang JW, Park JS, Lee JS, Jung UW, Kim CS, Cho KS, Lee YK, Choi SH. Comparative evaluation of three calcium phosphate synthetic block bone graft materials for bone regeneration in rabbit calvaria. J Biomed Mater Res B Appl Biomater 2012; 100:2044-52. [DOI: 10.1002/jbm.b.32768] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 06/07/2012] [Accepted: 06/12/2012] [Indexed: 11/06/2022]
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