Membrane-guided bone regeneration. Segmental radius defects studied in the rabbit

Varying degrees of spontaneous osteogenesis of Masquelet's induced membrane: experimental and clinical observations

BACKGROUND

Masquelet's induced membrane (IM) has osteogenesis activity, but IM spontaneous osteogenesis (SO) has not been described previously.

OBJECTIVES

To report on varying degrees of IMSO and analyze its possible causes.

METHODS

Twelve eight-week-old male Sprague-Dawley rats with 10 mm right femoral bone defects who received the first stage of IM technique (IMT) were used to observe the SO. In addition, clinical data from patients with bone defects who received the first stage of IMT with an interval of > 2 months post-operatively and exhibited SO between January 2012 and June 2020 were retrospectively analyzed. The SO was divided into four grades according to the amount and characteristics of the new bone formation.

RESULTS

At twelve weeks, grade II SO was observed in all rats, and more new bone was formed in the IM near the bone end forming an uneven margin. Histology revealed bone and cartilage foci in the new bone. Four of the 98 patients treated with the first stage of IMT exhibited IMSO, including one female and three males with a median age of 40.5 years (range 29-52 years). The bone defects were caused by severe fractures and infection in two cases and by infection or tumor in one case each. Partial or segmental defects occurred in two cases. The time interval between inserting a cement spacer and diagnosis of SO ranged from six months to nine years. Two cases were grade I, and one case each of grades III and IV.

CONCLUSION

Varying degrees of SO confirm the existence of the IMSO phenomenon. Bioactive bone tissue or local inflammation and a long time interval are the primary reasons underlying enhancement of the osteogenic activity of IM and leading to SO, which tends to take place as endochondral osteogenesis.

Use of Porous Titanium Trabecular as a Bone Defect Regenerator: In Vivo Study

The application of porous materials is increasingly being used in orthopaedic surgery due to its good results. Bone growth within the pores results in excellent mechanical fixation with the bone, as well as good bone regeneration. The pores, in addition to being colonised by bone, produce a decrease in the modulus of elasticity that favours the transfer of loads to the bone. This research shows the results of an experimental study where we have created critical osteoperiosteal defects of 10 mm on rabbit’s radius diaphysis. In one group of 10 rabbits (experimental group) we have implanted a bioactive porous titanium cylinder, and in another group we have allowed spontaneous regeneration (control group). Mechanical tests were performed to assess the material. Image diagnostic techniques (X-ray, scanner and 3D scan: there are no references on the literature with the use of CT-scan in bone defects) and histological and histomorphometric studies post-op and after 3, 6 and 12 months after the surgery were performed. All the control cases went through a pseudoarthrosis. In 9 of the 10 cases of the experimental group complete regeneration was observed, with a normal cortical-marrow structure established at 6 months, similar to normal bone. Titanium trabecular reached a bone percentage of bone inside the implant of 49.3% on its surface 3 months post-op, 75.6% at 6 months and 81.3% at 12 months. This porous titanium biomaterial has appropriate characteristics to allow bone ingrowth, and it can be proposed as a bone graft substitute to regenerate bone defects, as a scaffold, or as a coating to achieve implant osteointegration.

A Resorbable Biomaterial Shaped as a Tubular Chamber and Containing Stem Cells: A Pilot Study on Artificial Bone Regeneration

In a previous study, we showed how healing of non-union defects in rabbit radii can be achieved by means of a tubular resorbable chamber, in comparison with untreated defects. In the present study, we placed bone marrow stem cells inside the chamber. Bone marrow was obtained by percutaneous aspiration from the iliac crest in 9 adult New Zealand rabbits. Stem cells were separated by the centrifugation technique. In the same animals, a defect of 10 mm was created in both radii. On the left side, the defect was treated with the poly-DL-Lactide chamber, in which a suspension of autologous cells was injected; on the right side, only autologous cells were used. Radiological and histomorphometric data were compared within this study as well as with the results of our previous study. At 3, 6 and 9 months, there was no healing on the right side. On the left side, progressive bone formation with reunion of the stumps was observed in the chamber. We conclude that stem cells can accelerate bone healing when contained in the tubular chamber.

Vancomycin-impregnated electrospun polycaprolactone (PCL) membrane for the treatment of infected bone defects: An animal study

There is no consensus for the management of critical infected bone defects. The purpose of this study was to produce a vancomycin-impregnated electrospun polycaprolactone (PCL) membrane for the treatment of infected critical bone defects, and test it in a rabbit model. Electrospinning produced a resorbable PCL fiber membrane containing vancomycin approximately 1 mm in thickness, with a pore diameter of <10 μm. Femur defects were made in the limbs of 18 rabbits and infected with Staphylococcus aureus. The rabbits were divided into three groups according to treatment: (1) Experimental group: rabbit freeze-dried allogeneic bone graft and the vancomycin-PCL membrane. (2) Control group 1: bone graft. (3) Control group 2: vancomycin-PCL membrane only. Culture showed no difference in osteoclast activity between the three groups. Transwell testing showed that almost no fibroblasts passed through the membrane during the first 24 h, but some fibroblasts were able to pass it after 72 h. At 12 weeks after surgery, there was significantly less inflammatory cell infiltration in the experimental compared to the control groups. New bone formation and fracture bone callus were greater in the experimental group than control groups. We thus conclude the resorbable electrospun vancomycin-impregnated PCL membrane was effective at controlling bone infection, and in the regeneration of bone in a critical bone defect animal model.

* Engineering Membranes for Bone Regeneration

This review is focused on the use of membranes for the specific application of bone regeneration. The first section focuses on the relevance of membranes in this context and what are the specifications that they should possess to improve the regeneration of bone. Afterward, several techniques to engineer bone membranes by using "bulk"-like methods are discussed, where different parameters to induce bone formation are disclosed in a way to have desirable structural and functional properties. Subsequently, the production of nanostructured membranes using a bottom-up approach is discussed by highlighting the main advances in the field of bone regeneration. Primordial importance is given to the promotion of osteoconductive and osteoinductive capability during the membrane design. Whenever possible, the films prepared using different techniques are compared in terms of handability, bone guiding ability, osteoinductivity, adequate mechanical properties, or biodegradability. A last chapter contemplates membranes only composed by cells, disclosing their potential to regenerate bone.

The role of barrier membranes for guided bone regeneration and restoration of large bone defects: current experimental and clinical evidence

Treatment of large bone defects represents a great challenge in orthopedic and craniomaxillofacial surgery. Although there are several methods for bone reconstruction, they all have specific indications and limitations. The concept of using barrier membranes for restoration of bone defects has been developed in an effort to simplify their treatment by offering a single-staged procedure. Research on this field of bone regeneration is ongoing, with evidence being mainly attained from preclinical studies. The purpose of this review is to summarize the current experimental and clinical evidence on the use of barrier membranes for restoration of bone defects in maxillofacial and orthopedic surgery. Although there are a few promising preliminary human studies, before clinical applications can be recommended, future research should aim to establish the 'ideal' barrier membrane and delineate the need for additional bone grafting materials aiming to 'mimic' or even accelerate the normal process of bone formation. Reproducible results and long-term observations with barrier membranes in animal studies, and particularly in large animal models, are required as well as well-designed clinical studies to evaluate their safety, efficacy and cost-effectiveness.

Effects of an antibacterial membrane on osteoblast-like cells in vitro

Infection around membranes is often found in guided bone regeneration (GBR). The excellent antibacterial properties of Ag-nHA-nTiO₂/polyamide-66 (PA66) nanocomposite membranes have been demonstrated previously. The aim of this study was to observe the microstructure of an Ag-nHA-nTiO₂/PA66 membrane and its effects on osteoblast-like cells in vitro. An Ag-nHA-nTiO₂/PA66 membrane was used in the experimental group, and both nHA/PA66 and expanded poly tetrafluroethylene (e-PTFE) membranes were set as control. MG63 osteoblast-like cells were cultured on the three kinds of membrane and tissue culture polystyrene (TCP). The microstructure of the above membranes and the cells adhered on them were detected by scanning electronic microscope (SEM). Cell proliferation was determined by 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, cell viability with a cell viability analyzer, and alkaline phosphatase (ALP) activity and Ca²⁺ concentration of osteoblast-like cell matrix by enzyme-linked immunosorbent assay. SEM showed that both Ag-nHA-nTiO₂/PA66 membranes and nHA/PA66 membranes were composed of porous obverse face and smooth opposite face. The e-PTFE membranes showed elliptic surface structure with many tiny lined cracks. The MG63 cells adhered and proliferated well on all three kinds of membranes. Though cell viability on Ag-nHA-nTiO₂/PA66 membranes was significantly lower than that of the control groups (P < 0.05), MTT values, ALP activity, and Ca²⁺ concentration did not differ significantly among the three kinds of membranes (P > 0.05). From these findings, it can be concluded that Ag-nHA-nTiO₂/PA66 membranes are as biocompatible as nHA/ PA66 membranes and TCP, thus may be applied safely in GBR.

Effect of water-soluble P-chitosan and S-chitosan on human primary osteoblasts and giant cell tumor of bone stromal cells

Water-soluble phosphorylated chitosan (P-chitosan) and disodium (1 → 4)-2-deoxy-2-sulfoamino-β-D-glucopyranuronan (S-chitosan) are two chemically modified chitosans. In this study, we found that P-chitosan significantly promotes cell proliferation of both human primary osteoblasts (OBs) and the OB like stromal cell component of the giant cell tumor of bone (GCTB) cells at the concentration from 125 to 1000 µg ml⁻¹ at all time points of 1, 3, 5 and 7 days after treatment. Further investigation of the osteogenic effect of the P-chitosan suggested that it regulates the levels of osteoclastogenic factors, receptor activator of nuclear factor kappa B ligand and osteoprotegerin expression. An interesting finding is that S-chitosan at lower concentration (100 µg ml⁻¹) stimulates cell proliferation while a higher dose (1000 µg ml⁻¹) of S-chitosan inhibits it. The inhibitory effect of S-chitosan on human primary GCT stromal cells was greater than that of OBs (p < 0.05). Taken together, our findings elucidated the osteogenic effect of P-chitosan and the varying effects of S-chitosan on the proliferation of human primary OBs and GCT stromal cells and provided us the rationale for the construction of novel bone repair biomaterials with the dual properties of bone induction and bone tumor inhibition.

Closing capacity of segmental radius defects in rabbits

In the research of synthetic bone graft substitutes, the relevance for bone regeneration can be confirmed in a critical-sized model. In this study the rabbit radial defect was investigated as an ingenious model of critical size, due to its defect immobilizing intact ulna. In addition, the influence of poly(DL-lactic-co-glycolic acid) (PLGA) on bone regeneration was determined. Sixteen, 4-month-old rabbits received bilateral segmental radial defects of 15 or 20 mm. The osteotomy ends were marked with small titanium pins. Half of the group received injected PLGA microparticle/carboxymethylcellulose implants. Implantation time was 12 weeks. Evaluation consisted of radiographs after surgery and sacrifice, microcomputed tomography and histology. The radiographs revealed that the created defects were significantly smaller after sacrifice. Further a number of radii showed fibrocartilaginous interposition. Both findings indicated instability of the created defect. All evaluation techniques revealed that 15 and 20 mm were not of critical size, as most defects were more or less regenerated. PLGA microparticles did not influence bone regeneration significantly. In conclusion, 15- and 20-mm radius defects in 4-month-old rabbits were not a suitable model for bone regeneration as these defects were neither critical size nor stable. PLGA-microparticle degradation did not influence bone regeneration.

Assessment of bovine biomaterials containing bone morphogenetic proteins bound to absorbable hydroxyapatite in rabbit segmental bone defects

PURPOSE: To evaluate the osteo-regenerative capacity of two proprietary bone grafting materials, using a segmental defect model in both radial diaphyses of rabbits. METHODS: The right defect was filled with pooled bone morphogenetic proteins (pBMPs) bound to absorbable ultrathin powdered hydroxyapatite (HA) mixed with inorganic and demineralized bone matrix and bone-derived collagen, derived from bovine bone (Group A). The left defect was filled with bovine demineralized bone matrix and pBMPs bound to absorbable ultrathin powdered HA (Group B). In both groups, an absorbable membrane of demineralized bovine cortical was used to retain the biomaterials in the bone defects, and to guide the tissue regeneration. The rabbits were euthanized 30, 90 and 150 days after surgery. Radiographic, tomographic and histologic evaluations were carried out on all specimens. RESULTS: At 30 days, the demineralized cortical bone cover was totally resorbed in both groups. HA was totally resorbed from Group A defects, whereas HA persisted in Group B defects. A prominent foreign body reaction was evident with both products, more pronounced in sections from Group B. At 90 days, the defects in Group B exhibited more new bone than Group A. However, at 150 days after surgery, neither treatment had stimulated complete repair of the defect. CONCLUSION: The partial bone healing of the segmental defect occurred with low or none performance of the biomaterials tested.

Bioabsorbable scaffold for in situ bone regeneration

A non-porous poly-DL-lactide tubular chamber filled by demineralised bone matrix (DBM) and bone marrow stromal cells (BMSC) in combination, was evaluated as a scaffold for guided bone regeneration (GBR) in an experimental model using the rabbit radius. The tubular chamber had an internal diameter of 4.7 mm, a wall thickness of 0.4 mm and a length of 18 mm. Autologous BMSC were obtained, under general anaesthesia from rabbit iliac crest and isolated by centrifugation technique. Allogenic DBM was obtained from cortico-cancellous bone of rabbits. In general anaesthesia, a 10-mm defect was bilaterally created in the radii of 10 rabbits. On the right side (experimental side) the defect was bridged with the chamber filled with both BMSC and DBM. On the left side (control side) the defect was treated by positioning DBM and BMSC between the two stumps. At an experimental time of 4 months histology and histomorphometry demonstrated that the presence of a tubular chamber significantly improved bone regrowth in the defect The mean thickness of newly-formed bone inside the chamber was about 56.7+/-3.74% of the normal radial cortex, in comparison with 46.7+/-10.7% when DBM and BMSC without the chamber were placed in the defect, P<0.05). These results confirmed the effectiveness of the chamber as a container for factors promoting bone regeneration.

Demineralized bone matrix and hydroxyapatite/tri-calcium phosphate mixture for bone healing in rats

PURPOSE

Hydroxyapatite/tri-calcium phosphate (HA/TCP) mixture is an osteoconductive material used as a bone graft substitute, and demineralised bone matrix (DBM) is an osteoinductive material. A combination of DBM and HA/TCP mixture would probably create a composite with both osteoconductive and osteoinductive properties. The purpose of this study was to determine the effect of the combination of DBM and HA/TCP mixture on healing of rat radius segmental defects.

METHODS

Twenty-four adult male Wistar rats were used. Bilateral radial defects were created in each animal. Radial defects were implanted with DBM, HA/TCP mixture and a combination of both substances. Control defects were left unfilled. Ten weeks after implantation, the animals were sacrificed, and the radii were evaluated by radiograhic and histopathological studies.

RESULTS

The use of DBM alone demonstrated improved healing on radiographic and histological studies compared to other groups and the control group. There were no differences between the other two groups and the control group.

CONCLUSION

The DBM group showed the best healing response. Combined use of DBM and HA/TCP mixture did not improve bone healing, and the osteoinductive properties of DBM were inhibited by HA/TCP mixture.

Prosthetic devices shaped as tubular chambers for the treatment of large diaphyseal defects by guided bone regeneration

Guided tissue regeneration is based on the hypothesis that the different tissues have unequal abilities to penetrate a wounded area during the healing process. The use of a device acting as a chamber allows the growth of a particular tissue and prevents the ingrowth of other tissues which impair the healing process. At the same time the chamber protects and maintains in situ the intrinsic growth factors so that they may perform their specific activity. Guided tissue regeneration currently plays a well-recognized role mostly in dentistry and peripheral nerve surgery but interesting perspectives have also opened up in orthopedics. Considering the possibility of using guided bone regeneration in the repair of diaphyseal bone defects, this updated survey highlights some critical points and pathways related to the state-of-the-art of this promising procedure, focusing particularly on the properties of the material to make the tubular chamber, the use of osteopromotive factors and the most appropriate animal model to be used for the experimental evaluation.

Treatment of segmental bone defects in rats by the stimulation of bone marrow osteo-progenitor cells with prostaglandin E2

An alternative to bone grafting is engineered osteo-conductive material that carries osteo-progenitor cells with osteo-stimulant factors impregnated on a malleable osteo-conductive material. We used bone marrow stem cells as the source of osteo-progenitor cells and stimulated them with prostaglandin E2 using demineralised bone matrix as a carrier. We treated 35 skeletally mature male Wistar albino rats with segmentary radial bone defects using five different treatment groups. Group I received no treatment; the remaining four groups all received a mixture of bone marrow and demineralised bone matrix. In group III, a copolymer was added. In group IV, prostaglandin E2 and in group V prostaglandin E2 within a copolymer was added to the mixture. Eight weeks after the surgical procedure, the rats were sacrificed. Radiological and histological evaluation of the radial bone showed that while there was no significant healing in groups I, II and III, there was a significant healing response in groups IV and V.

Spontaneous recanalization of the divided lactiferous duct in the rat

The objectives of the current study were to test the hypotheses that ductus lactiferous may regenerate after its transection and to develop a reproducible model for future studies. A total of 168 nipples from 14 Wistar female rats were used in this experimental study. This study was conducted in 2 parts. During part 1, the normal anatomy of the lactiferous duct and its histomorphologic features were studied. This group was also used for histologic and morphometric comparison. During part 2, the lactiferous duct was exposed through a vertical incision and was transected by scissors. A small gap was produced by elastic retraction of the surrounding tissue. The authors assessed patency mainly by histologic evaluation. Galactography was performed to collect additional support for the recanalization process. The patency rate of the lactiferous ducts was 66.6%. Luminal narrowing was observed in all specimens. A significant difference did occur in the mean cross-sectional area (P < 0.01) and the wall thickness (P < 0.05) between 2 groups. A computed stereologic image analyzer was used to estimate the mean surface area of a lactiferous duct and the wall thickness.

Effect of drying history on swelling properties and cell attachment to oligo(poly(ethylene glycol) fumarate) hydrogels for guided tissue regeneration applications

In these experiments, the effects of the drying history of hydrogels made from a novel polymer, oligo(poly(ethylene glycol) fumarate) (OPF) with two different poly(ethylene glycol) (PEG) molecular weights (approximately 920 (1K) and 9110 (10K) g/mol), were investigated. The hydrogels were either formed, dried and then swelled, representing what may occur in the case of a pre-formed membrane for guided tissue regeneration, or were formed and swelled immediately, as may occur with an injectable material for such applications. Subsequently, swelling properties, sol fraction and polymer network structure (as indicated by differential scanning calorimetry), as well as attachment of human dermal fibroblasts to these hydrogels at 4 and 24 h was examined. It was found that drying before swelling caused a significant reduction in final fold swelling of OPF hydrogels, regardless of OPF formulation or method of drying (air-dried or vacuum-dried) (e.g. PEG 10K swollen first: 13.94 +/- 0.35 vs. vacuum first: 6.53 +/- 0.12; PEG 1K swollen first: 8.99 +/- 0.47 vs. vacuum first: 2.26 +/- 0.08). This decreased swelling correlated to significantly higher cell attachment (% seeded) to these hydrogels at 24 h (PEG 10K vacuum first: 21.1 +/- 4.7% vs. swollen first: 7.1 +/- 5.5%; PEG 1K vacuum first: 58.2 +/- 2% vs. swollen first: 7.4 +/- 2.2%). LIVE/DEAD staining followed by microscopic analysis revealed attached cells were viable, yet rounded, and that, in the case of the PEG 1K dried-first samples, undulations in the surface visible in the hydrated state may have affected cell adhesion. Regardless of treatment, all hydrogels showed significantly less cell attachment than the tissue culture polystyrene control after 24 h (104.9 +/- 4.4%). These results suggest that, by altering the PEG molecular weight used in synthesis, OPF hydrogels may be tailored to produce desired swelling properties and reduce non-specific cell adhesion for either injectable or pre-formed applications, thus providing a potential alternative material for use in guided tissue regeneration procedures.

Effect of GBR in combination with deproteinized bovine bone mineral and/or enamel matrix proteins on the healing of critical-size defects

OBJECTIVES

To evaluate the effect of guided bone regeneration (GBR) in combination with or without deproteinized bovine bone mineral (DBBM) and/or an enamel matrix derivative (EMD) on the healing of critical-size calvarial defects.

MATERIAL AND METHODS

Forty rats were used. In all animals, a standardized critical-size calvarial defect was created surgically. The animals were randomly allocated into 4 groups of 10 animals each. Group A: One calvarial defect was left untreated, while the galeal and the cerebral aspect of the contralateral defect were covered with a bioresorbable membrane (GBR). Group B: One calvarial defect was filled with EMD, while the contralateral defect was treated with GBR and EMD. Group C: One defect was filled with DBBM, while the contralateral defect was treated with combination of GBR and DBBM. Group D: One defect was filled with DBBM combined with EMD, while the contralateral defect was treated with combination of GBR, DBBM and EMD. The healing period was 4 months. Five specimens from each group were macerated and the length, the width and the vertical dimension (thickness) of the remaining defect were evaluated by a stereomicroscope. The remaining specimens in each group were analyzed histologically.

RESULTS

The defects of the macerated specimens that were left untreated or were treated only by EMD, DBBM and combination of EMD and DBBM did not present predictably complete healing of the defects. All the defects where GBR was applied alone or combined with DBBM and/or EMD presented always complete healing (P<0.05). The combined use of GBR with EMD and/or DBBM did not offer any significant advantage above GBR alone in terms of healing of the length and the width of the defect. However, the vertical dimension of the defect was significantly higher (P<0.05) in the GBR-treated specimens of Groups C and D. The histological analysis supported these findings.

CONCLUSION

The predictability of bone formation in critical-size defects depends mainly on the presence or absence of barrier membranes (GBR). The combined use with deproteinized bovine bone mineral and/or enamel matrix proteins did not significantly enhance the potential for complete healing provided by the GBR procedure.

Preformed grafts of porcine small intestine submucosa (SIS) for bridging segmental bone defects

Previous studies suggest that fresh, morselized porcine small intestine submucosa (SIS) may have promise in the treatment of large bone defects. This study evaluated the bone regenerative potential of preformed tubular SIS grafts, designed to provide a scaffold for regeneration of diaphyseal bone. Critical length segmental defects in the femurs of male rats were either left unfilled (n = 11) or filled with morselized cancellous bone (n = 12), or spanned with intramedullary tubes (n = 12) or periosteal sleeves (n = 12) fabricated from SIS. All of the animals were euthanized 12 weeks postoperatively. Healing was assessed with biweekly radiographs, routine histology, and mechanical testing. Copious new bone formed in the defects of all of the animals treated with cancellous bone; 10 of the 12 animals in that group had healed their defects. In contrast, no new bone was formed in the defects left unfilled or treated with SIS; only fibrous tissue was found. In both of the SIS-treated groups, the SIS persisted at twelve weeks. The cellular response to the SIS involved a mild mononuclear infiltrate in the loose or delaminated superficial layers of the tubes and sleeves, with few cells in the deeper layers. The results of this study cast doubt on the ability of SIS to support or stimulate growth of bone across a critical length segmental bone defect. Additional work will be required to determine whether our results reflect the protocols used to prepare and fabricate the SIS grafts used in the study or the inherent inability of SIS to support new bone growth.

Quantification of guided regeneration of weight-bearing bones

An accurate histological evaluation system was established to improve and quantify the compatibility of membranes to provide bone regeneration in a large mid-diaphyseal bone defect, complementing radiographic evaluation. New bone formation obtained in critical segmental defects covered with tubular ethyl cellulose membranes was examined. Computerized radiography showed gradual new bone formation, which slows after 6 weeks. In a parallel histomorphological assessment, a characteristic process of new bone formation occurs inside the confined space and surrounding tissues. Histological findings are summarized according to the new scoring system, which clarifies the mechanism and provides complementary quantification of guided bone regeneration.

In vitro change in mechanical strength of beta-tricalcium phosphate/copolymerized poly-L-lactide composites and their application for guided bone regeneration

Novel composites of bioactive beta-tricalcium phosphate [Ca(3)(PO(4))(2)] and biodegradable copolymerized poly-L-lactide (CPLA) were prepared by a heat-kneading method. The mechanical and chemical changes of the composites were evaluated in vitro by soaking in physiological saline and Dulbecco's phosphate buffered saline. When soaked in physiological saline, the 3-point mechanical strength decreased rapidly from 60 to 30 MPa in the initial 4 weeks and then gradually reached a plateau; the initial decrease in the mechanical strength was ascribed to the dissolution of beta-tricalcium phosphate from the surface. The mechanical properties evident at 8-12 weeks were sufficient for the composites to be used as a biodegradable material for regeneration of bone because the hydrolysis of CPLA was inhibited in both physiological saline and phosphate-buffered saline as a result of a pH-buffering effect. Composite membranes 250-microm thick were used to regenerate large bone defects in beagle dogs: 10 x 10 x 10 mm(3) in volume in the mandible and 20 mm in length in the tibia. The afflicted areas covered with the composite membranes were almost perfectly filled with new bone 12 weeks after the operation, whereas those covered with a CPLA membrane or without any membranes were invaded by soft tissue.

Spontaneous bone regeneration in surgically induced bone defects in young rabbits

Defects of the femoral shaft (15%, 20%, 25%, and 30% of the femoral length) with intact periosteum were made in young rabbits to investigate differences in union time. The mean union time was 7.3, 7.1, 7.4, and 7.0 weeks, respectively and there was no significant difference ( >0.05) between the groups. The mean healing indices were 6.7, 4.6, 3.9, and 3.1 weeks/cm, respectively and these were significantly different ( <0.05) between the 15% bone defect group and the other bone defect groups. These results suggested that union time was not affected by the amount of bone defect. Femoral lengthening of 20% was performed to compare the quality of callus with those of the femoral defect of 20%. The mean healing indices of defect and lengthening were 4.6 and 5.7, respectively and the difference was significant ( = 0.004). The callus stiffness of femoral defect was higher ( = 0.02) than that after femoral lengthening whereas the bone mineral density of the callus showed no significant difference ( = 0.37) between two groups. The method of filling bone defect with callus generated from the intact periosteum may be a new therapeutic option for the reconstruction of large bone defects in children when other treatments are not available.

Bone tissue engineering: treatment of cranial bone defects in rabbits using self-reinforced poly-L,D-lactide 96/4 sheets

This study is one of a series in which the authors evaluate various absorbable sheets to guide bone regeneration in cranial bone defects. The aim was to evaluate the use of self-reinforced poly-L,D-lactide 96/4 (SR-PLA96) sheets for cranial bone tissue engineering in experimental defects in rabbits. Square defects of 10 x 10 mm were created in the right parietal bone. SR-PLA96 implants (15 x 15 mm) were used to cover these defects in 12 New Zealand White rabbits. Similar defects were created in the left parietal bone, but no sheets were used (controls). The rabbits were killed after 6, 24, or 48 weeks. Histology and histomorphometry were used to evaluate healing of the defects. Defects covered with SR-PLA96 sheets showed more abundant bone formation than control (non-covered) defects. At 6 weeks, the defects were occupied mainly by fibrous tissue. At 24 weeks, healing with bone formation was more obvious in the covered defects. At 48 weeks, bone completely bridged defects covered with SR-PLA96 sheets, and incomplete bridging was seen in non-covered control defects. Hence, bone tissue engineering in experimental cranial bone defects in rabbits can be achieved using SR-PLA96 sheets to guide bone regeneration.

Enhanced guided bone regeneration with a resorbable chamber containing demineralized bone matrix

BACKGROUND

The effectiveness of a nonporous poly-DL-lactide tubular chamber in guiding bone regeneration through a long bone defect had already been assessed in an experimental model using the rabbit radius. The injection of bone marrow stem cells into the chamber had proven to enhance bone regeneration.

METHODS

The present study reports on the development of the above research project in a subsequent stage. Demineralized bone matrix (DBM) obtained by milling New Zealand rabbit femoral and tibial diaphyses was placed into a tubular chamber. A 10-mm defect was bilaterally created in the radii of 10 rabbits. On the left side (chamber side) the defect was treated by means of a poly-DL-lactide chamber filled with DBM, whereas DBM alone was used on the right side (control).

RESULTS

Controls were performed at 3 and 6 months by radiographs and histomorphometry and demonstrated better bone growth on the chamber side versus the control side. A comparison with the results previously obtained by stem cell injection into the chamber revealed significant acceleration of bone regrowth in the first 3 months because of the addition of DBM to the chamber. However, no significant difference was found between the two sides after 6 months.

CONCLUSION

These results have confirmed the effectiveness of the chamber as a container for the factors promoting bone regeneration, probably because the osteogenetic activity is maintained in situ.

Alveolar ridge augmentation using a resorbable copolymer membrane and autogenous bone grafts. An experimental study in the rat

The aim of the present study was to compare the result of maxillary alveolar ridge augmentation by the combined use of mandibular bone grafts and resorbable membranes (Resolut), with that achieved by the use of the same type of bone graft combined with the placement of e-PTFE membranes (Gore-Tex). The experiment was carried out in 30 rats. In one side of the maxillary jaw, the edentulous alveolar ridge between the incisor and the first molar was augmented by means of an autogenous mandibular bone graft that was fixed with a titanium microimplant and covered with a resorbable membrane. The contralateral side, serving as control, was treated in the same way, with the difference that an e-PTFE membrane was placed over the bone graft. Histological analysis at 15, 30, 60, 120 and 180 days after surgery demonstrated that, in both test and control sites where the membrane was properly adapted and not exposed, the bone grafts presented no resorption and were integrated into the maxillary bone at the recipient site. In cases where the membrane was exposed, however, the bone grafts presented extensive resorption and lack of continuity between the graft and the recipient bed. At 60-180 days after surgery, the exposure of both types of membrane had frequently led to complete resorption of the grafts, encapsulation of the titanium microimplant by fibrous connective tissue, or exfoliation of the microimplant. It is concluded that alveolar ridge augmentation can be predictably accomplished by combining mandibular bone grafting with the placement of resorbable or non-resorbable membranes according to the GTR principle, provided that the membrane is properly adapted over the graft and complete closure of the treated area is maintained during healing.

Augmentation of the rat jaw with autogeneic cortico-cancellous bone grafts and guided tissue regeneration

The aim of the present study was to evaluate the effect of augmenting the maxillary alveolar ridge and the lateral aspect of the mandible with onlay autogeneic cortico-cancellous bone grafts that were covered with e-PTFE membranes. The experiment was carried out in 51 rats. In 15 rats, the edentulous maxillary jaw between the incisor and the first molar was augmented by means of an autogeneic ischiac bone graft that was fixed with a gold-coated microimplant. In one side, the graft was covered with an e-PTFE membrane, while the other side, which served as control, was treated without a membrane. In the other 36 rats, the lateral aspect of the mandible was augmented in both sides by means of an autogeneic ischiac bone graft that was fixed with a gold-coated or a titanium microimplant. In one side, the augmented area was covered with an e-PTFE membrane, while the contralateral side was treated without a membrane. Histological analysis at 60, 120 and 180 days after augmentation of the maxilla showed that, in the case of the test sites (where most of the membranes were either exposed or lost), the bone grafts presented extensive resorption and there was a lack of bone continuity between the graft and the recipient site. Similar findings were made at the non-membrane-treated control sides. In the case of augmentation of the mandible with membranes, the bone grafts were not resorbed, but were integrated into newly formed bone at the recipient site. In the control sides, the grafts presented varying degrees of resorption and integration into the recipient bone. It is concluded that, in comparison to bone grafting alone, onlay ischiac bone grafting combined with guided tissue regeneration eliminates the risk of bone graft resorption and ensures integration of the graft into newly formed bone at the recipient site, provided that closure of the operated area can be maintained during healing.

Characteristics of newly formed bone during guided bone regeneration: observations by immunohistochemistry and confocal laser scanning microscopy

The purpose of this study was to investigate the characteristics of new bone formation during guided bone regeneration (GBR) using immunohistochemistry and confocal laser scanning microscopy. e-PTFE membranes were applied to defects created in the tibiae of rats, and some animals were sacrificed 6, 8, or 10 days later. Serial paraffin sections were cut, stained with H-E, and examined to analyze the ratio of new bone formation. Immunohistochemical staining with a monoclonal antibody specific for PCNA was used to evaluate the proliferating activity. In other experimental rats, calcein was injected at 6, 8, and 10 days after the surgery, and the animals were sacrificed 48 hr after injection. Their tibiae were removed, and Villanueva bone staining was performed before observation using confocal laser scanning microscopy to investigate the mineralization of new bones. The bone occupation ratio increased day by day, but the experimental groups had significantly higher ratios than control groups (without membrane) at each of the time periods. However, PCNA positive cells decreased over time in all groups, and there were no significant differences among the groups. Mineralization occurred more rapidly in the experimental groups than in the control groups. These results suggest that GBR accelerates the migration of osteogenic cells, the formation of new bone, and mineralization in the defect created by the e-PTFE membrane.

Preparation of EVAL membranes with smooth and particulate morphologies for neuronal culture

In this work, the in vitro interaction of cerebellar granule neurons prepared from 7-day-old Wistar rats and poly ethylene-co-vinyl alcohol (EVAL) membranes was investigated. Cells were cultured in smooth and particulate EVAL membranes for up to 7 days. Particulate membranes were prepared by using 1-octanol to precipitate EVAL solutions in DMSO. Such a membrane was microporous characterized by a packed bed of particles. Voids left between the aggregated particles formed a continuous and interconnected porous network. Crystallization of the EVAL polymer induced by 1-octanol is responsible for the formation of particulate morphology. The membrane structure and its relationship with cells were examined by scanning electron microscopy and the MTT assay. It was observed that the particulate membrane was more favorable for the neuron culture than the smooth membrane. Neurons seeded on the particulate membrane were able to regenerate with formation of an extensive neuritic network. Therefore, the particulate structure may spatially mediate cellular response that can promote neuronal cell attachment, differentiation and neuritic growth, indicating that the particulate structure should be useful as a new polymer scaffold for nerve repair.

Bioabsorbable scaffolds for guided bone regeneration and generation

Several different bioabsorbable scaffolds designed and manufactured for guided bone regeneration and generation have been developed. In order to enhance the bioactivity and potential osteoconductivity of the scaffolds, different bioabsorbable polymers, composites of polymer and bioactive glass, and textured surface structures of the manufactured devices and composites were investigated in in vitro studies and experimental animal models. Solid, self-reinforced polyglycolide (SR-PGA) rods and self-reinforced poly L-lactide (SR-PLLA) rods were successfully used as scaffolds for bone formation in muscle by free tibial periosteal grafts in animal experiments. In an experimental maxillary cleft model, a bioabsorbable composite membrane of epsilon-caprolactone and L-lactic acid 50/50 copolymer (PCL/LLA) film and mesh and poly 96L,4D-lactide (PLA96) mesh were found to be suitable materials for guiding bone regeneration in the cleft defect area. The idea of solid layer and porous layer combined together was also transferred to stiff composite of poly 70L,30DL-lactide (PLA70) plate and PLA96 mesh which structure is introduced. The osteoconductivity of several different biodegradable composites of polymers and bioactive glass (BG) was shown by apatite formation in vitro. Three composites studied were self-reinforced composite of PLA70 and bioactive glass (SR-(PLA70 + BG)), SR-PLA70 plate coated with BG spheres, and Polyactive with BG.

Polylactide bioabsorbable polymers for guided tissue regeneration

OBJECTIVE

Guided tissue regeneration is a procedure to improve tissue repair, which creates an optimal environment for the intrinsic growth ability of tissues.

METHODS

A prerequisite for guided tissue regeneration is the availability of materials with suitable physicochemical and biocompatibility properties for the preparation of the devices. We investigated bone and peripheral nerve guided tissue regeneration, making two conduits from poly[L-lactide-co-6-caprolactone] (PLLC--peripheral nerve) and with poly [DL-lactide] (PDLLA--bone) with different features. After the polymer synthesis and chemical characterization, the conduits were evaluated in vivo in rat sciatic nerve gaps and in rabbit radius defects.

RESULTS

The results demonstrated good biocompatibility of both polymeric conduits. A good axonal regeneration and the restoration of the nerve trunk continuity, similar to that observed with autologous grafts has been obtained with PLLC conduits, that slowly degrade in about 6 months. PDLLA conduits protected the bone defect against the invasion of surrounding soft tissues; an effective bone growth bridging the defect was observed in their lumen.

CONCLUSION

These results confirm the versatility of polylactides as biomaterials and will encourage further investigations on hard and soft tissues.

Autogenous onlay grafting for enhancement of extracortical tissue formation over porous-coated segmental replacement prostheses

BACKGROUND

Prosthetic reconstruction with extracortical bone-bridging is an effective method of limb salvage after resection of a malignant or locally invasive benign bone tumor. Use of cancellous bone graft alone is less effective in achieving extracortical bone-bridging. The present study was performed to investigate the effects of a corticocancellous onlay graft on bone and soft-tissue formation over a porous-coated replacement prosthesis in the mid-diaphyseal region of canine femora.

METHODS

Bilateral resection of a six-centimeter segment of the femoral diaphysis and reconstruction with a porous-coated segmental prosthesis was performed in six mongrel dogs. In one limb (the experimental side), eight strips of corticocancellous bone were evenly placed around the junctions between the femur and the prosthetic surface. Cancellous bone was placed under and between the strips of cortical bone. No graft was used in the other limb (the control side). The animals were followed for twelve weeks, with sequential assessments of load-bearing and radiographic evaluation. Biomechanical, histological, and microradiographic analyses of the specimens were performed after death.

RESULTS

On the control side, load-bearing at four weeks postoperatively was significantly decreased compared with the preoperative value (p<0.05); no difference in these values could be detected on the experimental side. Both the area of the callus and the contact area between the bone and the prosthetic shoulder were greater on the experimental side (p<0.05). The mechanical stiffness and the maximum torque at failure of the extracortical bridging tissue across the junction between the bone and the prosthetic shoulder were eighteen (p<0.007) and five times greater (p<0.05), respectively, on the experimental side.

CONCLUSIONS

Extracortical bone-bridging was accomplished with corticocancellous onlay bone-grafting. Without bone-grafting, bone formed only occasionally. Bone-grafting also enhanced the formation of a soft-tissue capsule around the prosthesis.

Treatment of segmental defects in long bones using osteopromotive membranes and recombinant human bone morphogenetic protein-2. An experimental study in rabbits

The purpose of this study was to investigate whether barrier membranes that were earlier shown to promote bone healing in the craniofacial skeleton are capable of producing bone healing in long bone. defects by themselves or in combination with recombinant human bone morphogenetic protein 2 (rhBMP-2). Segmental defects (10 mm long) in the rabbit radius, known to heal as pseudoarthrosis-like defects, were used as the experimental model. Treatment with expanded polytetrafluoroethylene membranes (GORE-TEX Membrane) (n = 10) resulted in only minor amounts of bone formation within the defect and collapse of the membranes was common. When placement of membranes was combined with implantation of rhBMP-2 in a beaded biodegradable copolymeric PLA/PGA carrier, total bony bridging of the defects was accomplished within 10 weeks (n = 5). Osteopromotive membranes combined with mBMP-2 can therefore bring about complete healing of long bones. The membranes exclude soft tissue from the defect and at the same time keep the growth-stimulatory implant in place and maintain the anatomical contour of the bone. The combination of osteopromotive membranes and rhBMP-2 may be of. value in reconstructive bone surgery.