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Han Y, Tong X, Zhou R, Wang Y, Chen Y, Chen L, Hong X, Wu L, Lin Z, Zhang Y, Zhang X, Hu C, Li B, Ping Y, Cao Z, Ye Z, Song Z, Li Y, Wen C, Zhou Y, Lin J, Huang S. Biodegradable Zn-5Dy Alloy with Enhanced Osteo/Angio-Genic Activity and Osteointegration Effect via Regulation of SIRT4-Dependent Mitochondrial Function. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2307812. [PMID: 38243646 PMCID: PMC10987155 DOI: 10.1002/advs.202307812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/30/2023] [Indexed: 01/21/2024]
Abstract
Zinc (Zn)-dysprosium (Dy) binary alloys are promising biodegradable bone fracture fixation implants owing to their attractive biodegradability and mechanical properties. However, their clinical application is a challenge for bone fracture healing, due to the lack of Zn-Dy alloys with tailored proper bio-mechanical and osteointegration properties for bone regeneration. A Zn-5Dy alloy with high strength and ductility and a degradation rate aligned with the bone remodeling cycle is developed. Here, mechanical stability is further confirmed, proving that Zn-5Dy alloy can resist aging in the degradation process, thus meeting the mechanical requirements of fracture fixation. In vitro cellular experiments reveal that the Zn-5Dy alloy enhances osteogenesis and angiogenesis by elevating SIRT4-mediated mitochondrial function. In vivo Micro-CT, SEM-EDS, and immunohistochemistry analyses further indicate good biosafety, suitable biodegradation rate, and great osteointegration of Zn-5Dy alloy during bone healing, which also depends on the upregulation of SIRT4-mediated mitochondrial events. Overall, the study is the first to report a Zn-5Dy alloy that exerts remarkable osteointegration properties and has a strong potential to promote bone healing. Furthermore, the results highlight the importance of mitochondrial modulation and shall guide the future development of mitochondria-targeting materials in enhancing bone fracture healing.
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Affiliation(s)
- Yue Han
- Institute of StomatologySchool and Hospital of StomatologyWenzhou Medical UniversityWenzhou325027China
| | - Xian Tong
- Institute of StomatologySchool and Hospital of StomatologyWenzhou Medical UniversityWenzhou325027China
| | - Runqi Zhou
- Institute of StomatologySchool and Hospital of StomatologyWenzhou Medical UniversityWenzhou325027China
| | - Yilin Wang
- Institute of StomatologySchool and Hospital of StomatologyWenzhou Medical UniversityWenzhou325027China
| | - Yuge Chen
- Institute of StomatologySchool and Hospital of StomatologyWenzhou Medical UniversityWenzhou325027China
- Department of DentistryFaculty of Medicine and DentistryUniversity of AlbertaEdmontonT6G2R3Canada
| | - Liang Chen
- Institute of StomatologySchool and Hospital of StomatologyWenzhou Medical UniversityWenzhou325027China
| | - Xinhua Hong
- Institute of StomatologySchool and Hospital of StomatologyWenzhou Medical UniversityWenzhou325027China
| | - Linmei Wu
- Institute of StomatologySchool and Hospital of StomatologyWenzhou Medical UniversityWenzhou325027China
| | - Zhiqiang Lin
- Institute of StomatologySchool and Hospital of StomatologyWenzhou Medical UniversityWenzhou325027China
| | - Yichi Zhang
- Institute of StomatologySchool and Hospital of StomatologyWenzhou Medical UniversityWenzhou325027China
| | - Xuejia Zhang
- Institute of StomatologySchool and Hospital of StomatologyWenzhou Medical UniversityWenzhou325027China
| | - Chaoming Hu
- Institute of StomatologySchool and Hospital of StomatologyWenzhou Medical UniversityWenzhou325027China
| | - Bin Li
- Institute of StomatologySchool and Hospital of StomatologyWenzhou Medical UniversityWenzhou325027China
| | - Yifan Ping
- Institute of StomatologySchool and Hospital of StomatologyWenzhou Medical UniversityWenzhou325027China
| | - Zelin Cao
- Institute of StomatologySchool and Hospital of StomatologyWenzhou Medical UniversityWenzhou325027China
| | - Zhou Ye
- Applied Oral Sciences and Community Dental CareFaculty of DentistryUniversity of Hong KongHong Kong999077China
| | - Zhongchen Song
- Department of PeriodontologyNinth People's HospitalShanghai Jiao Tong University School of MedicineShanghai200125China
| | - Yuncang Li
- School of EngineeringRMIT UniversityMelbourneVIC3001Australia
| | - Cuie Wen
- School of EngineeringRMIT UniversityMelbourneVIC3001Australia
| | - Yongsheng Zhou
- Department of ProsthodonticsNational Center for StomatologyNational Engineering Research Center of Oral Biomaterials and Digital Medical DevicesNational Clinical Research Center for Oral DiseaseBeijing Key Laboratory of Digital StomatologyResearch Center of Engineering and Technology for Computerized Dentistry Ministry of HealthPeking University School and Hospital of StomatologyBeijing100081China
| | - Jixing Lin
- Institute of StomatologySchool and Hospital of StomatologyWenzhou Medical UniversityWenzhou325027China
| | - Shengbin Huang
- Institute of StomatologySchool and Hospital of StomatologyWenzhou Medical UniversityWenzhou325027China
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Adamuz-Jiménez A, Manzano-Moreno FJ, Vallecillo C. Regeneration Membranes Loaded with Non-Antibiotic Anti-2 Microbials: A Review. Polymers (Basel) 2023; 16:95. [PMID: 38201760 PMCID: PMC10781067 DOI: 10.3390/polym16010095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/10/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
Both guided bone and guided tissue regeneration are techniques that require the use of barrier membranes. Contamination and infection of the surgical area is one of the most feared complications. Some current lines of research focus on functionalizing these membranes with different antimicrobial agents. The objective of this study was to carry out a review of the use and antibacterial properties of regeneration membranes doped with antimicrobials such as zinc, silver, chlorhexidine, and lauric acid. The protocol was based on PRISMA recommendations, addressing the PICO question: "Do membranes doped with non-antibiotic antimicrobials have antibacterial activity that can reduce or improve infection compared to membranes not impregnated with said antimicrobial?" Methodological quality was evaluated using the RoBDEMAT tool. A total of 329 articles were found, of which 25 met the eligibility criteria and were included in this review. Most studies agree that zinc inhibits bacterial growth as it decreases colony-forming units, depending on the concentration used and the bacterial species studied. Silver compounds also decreased the secretion of proinflammatory cytokines and presented less bacterial adhesion to the membrane. Some concentrations of chlorhexidine that possess antimicrobial activity have shown high toxicity. Finally, lauric acid shows inhibition of bacterial growth measured by the disk diffusion test, the inhibition zone being larger with higher concentrations. Antimicrobial agents such as zinc, silver, chlorhexidine, and lauric acid have effective antibacterial activity and can be used to dope regenerative membranes in order to reduce the risk of bacterial colonization.
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Affiliation(s)
- Ana Adamuz-Jiménez
- Faculty of Dentistry, Colegio Máximo de Cartuja s/n, University of Granada, 18071 Granada, Spain; (A.A.-J.); (C.V.)
| | - Francisco-Javier Manzano-Moreno
- Faculty of Dentistry, Colegio Máximo de Cartuja s/n, University of Granada, 18071 Granada, Spain; (A.A.-J.); (C.V.)
- Biomedical Group (BIO277), Department of Stomatology, University of Granada, 18071 Granada, Spain
- Instituto Investigación Biosanitaria, 18012 Granada, Spain
| | - Cristina Vallecillo
- Faculty of Dentistry, Colegio Máximo de Cartuja s/n, University of Granada, 18071 Granada, Spain; (A.A.-J.); (C.V.)
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Kim K, Su Y, Kucine AJ, Cheng K, Zhu D. Guided Bone Regeneration Using Barrier Membrane in Dental Applications. ACS Biomater Sci Eng 2023; 9:5457-5478. [PMID: 37650638 DOI: 10.1021/acsbiomaterials.3c00690] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Guided bone regeneration (GBR) is a widely used technique in preclinical and clinical studies due to its predictability. Its main purpose is to prevent the migration of soft tissue into the osseous wound space, while allowing osseous cells to migrate to the site. GBR is classified into two main categories: resorbable and non-resorbable membranes. Resorbable membranes do not require a second surgery but tend to have a short resorption period. Conversely, non-resorbable membranes maintain their mechanical strength and prevent collapse. However, they require removal and are susceptible to membrane exposure. GBR is often used with bone substitute graft materials to fill the defect space and protect the bone graft. The membrane can also undergo various modifications, such as surface modification and biological factor loading, to improve barrier functions and bone regeneration. In addition, bone regeneration is largely related to osteoimmunology, a new field that focuses on the interactions between bone and the immune system. Understanding these interactions can help in developing new treatments for bone diseases and injuries. Overall, GBR has the potential to be a powerful tool in promoting bone regeneration. Further research in this area could lead to advancements in the field of bone healing. This review will highlight resorbable and non-resorbable membranes with cellular responses during bone regeneration, provide insights into immunological response during bone remodeling, and discuss antibacterial features.
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Affiliation(s)
- Kakyung Kim
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York 11794, United States
| | - Yingchao Su
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York 11794, United States
| | - Allan J Kucine
- Department of Oral and Maxillofacial Surgery, Stony Brook University, Stony Brook, New York 11794, United States
| | - Ke Cheng
- Department of Biomedical Engineering, Columbia University, New York City, New York 10027, United States
| | - Donghui Zhu
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York 11794, United States
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Pan X, Ou M, Lu Y, Nie Q, Dai X, Liu O. Immunomodulatory zinc-based materials for tissue regeneration. BIOMATERIALS ADVANCES 2023; 152:213503. [PMID: 37331243 DOI: 10.1016/j.bioadv.2023.213503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/04/2023] [Accepted: 06/05/2023] [Indexed: 06/20/2023]
Abstract
Zinc(Zn)-based materials have contributed greatly to the rapid advancements in tissue engineering. The qualities they possess that make them so beneficial include their excellent biodegradability, biocompatibility, anti-bacterial activity, among and several others. Biomedical materials that act as a foreign body, will inevitably cause host immune response when introduced to the human body. As the osteoimmunology develops, the immunomodulatory characteristics of biomaterials have become an appealing concept to improve implant-tissue interaction and tissue restoration. Recently, Zn-based materials have also displayed immunomodulatory functions, especially macrophage polarization states. It can promote the transformation of M1 macrophages into M2 macrophages to enhance the tissue regeneration and reconstruction. This review covers mainly Zn-based materials and their characteristics, including metallic Zn alloys and Zn ceramics. We highlight the current advancements in the type of immune responses, as well as the mechanisms, that are induced by Zn-based biomaterials, most importantly the regulation of innate immunity and the mechanism of promoting tissue regeneration. To this end, we discuss their applications in biomedicine, and conclude with an outlook on future research challenges.
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Affiliation(s)
- Xiaoman Pan
- Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha 410005, China
| | - Mingning Ou
- Xiangya Hospital & Xiangya School of Medicine, Central South University, Changsha 410005, China
| | - Yixuan Lu
- Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha 410005, China
| | - Qian Nie
- Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha 410005, China
| | - Xiaohan Dai
- Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha 410005, China.
| | - Ousheng Liu
- Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha 410005, China.
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Toledano M, Vallecillo C, Serrera-Figallo MA, Vallecillo-Rivas M, Gutierrez-Corrales A, Lynch CD, Toledano-Osorio M. Doped Electrospinned Material-Guides High Efficiency Regional Bone Regeneration. Polymers (Basel) 2023; 15:polym15071726. [PMID: 37050340 PMCID: PMC10097153 DOI: 10.3390/polym15071726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/29/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
The main target of bone tissue engineering is to design biomaterials that support bone regeneration and vascularization. Nanostructured membranes of (MMA)1-co-(HEMA)1/(MA)3-co-(HEA)2 loaded with 5% wt of SiO2-nanoparticles (Si-M) were doped with zinc (Zn-Si-M) or doxycycline (Dox-Si-M). Critical bone defects were effectuated on six New Zealand-bred rabbit skulls and then they were covered with the membranes. After six weeks, a histological analysis (toluidine blue technique) was employed to determine bone cell population as osteoblasts, osteoclasts, osteocytes, M1 and M2 macrophages and vasculature. Membranes covering the bone defect determined a higher count of bone cells and blood vessels than in the sham group at the top regions of the defect. Pro-inflammatory M1 appeared in a higher number in the top regions than in the bottom regions, when Si-M and Dox-Si-M were used. Samples treated with Dox-Si-M showed a higher amount of anti-inflammatory and pro-regenerative M2 macrophages. The M1/M2 ratio obtained its lowest value in the absence of membranes. On the top regions, osteoblasts were more abundant when using Si-M and Zn-Si-M. Osteoclasts were equally distributed at the central and lateral regions. The sham group and samples treated with Zn-Si-M attained a higher number of osteocytes at the top regions. A preferential osteoconductive, osteoinductive and angiogenic clinical environment was created in the vicinity of the membrane placed on critical bone defects.
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Immune microenvironment: novel perspectives on bone regeneration disorder in osteoradionecrosis of the jaws. Cell Tissue Res 2023; 392:413-430. [PMID: 36737519 DOI: 10.1007/s00441-023-03743-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 01/18/2023] [Indexed: 02/05/2023]
Abstract
Osteoradionecrosis of the jaws (ORNJ) is a severe complication that occurs after radiotherapy of head and neck malignancies. Clinically, conservative treatments and surgeries for ORNJ exhibited certain therapeutic effects, whereas the regenerative disorder of the post-radiation jaw remains a pending problem to be solved. In recent years, the recognition of the role of the immune microenvironment has led to a shift from an osteoblasts (OBs) or bone marrow mesenchymal stromal cells (BMSCs)-centered view of bone regeneration to the concept of a complicated microecosystem that supports bone regeneration. Current advances in osteoimmunology have uncovered novel targets within the immune microenvironment to help improve various regeneration therapies, notably therapies potentiating the interaction between BMSCs and immune cells. However, these researches lack a thorough understanding of the immune microenvironment and the interaction network of immune cells in the course of bone regeneration, especially for the post-operative defect of ORNJ. This review summarized the composition of the immune microenvironment during bone regeneration, how the immune microenvironment interacts with the skeletal system, and discussed existing and potential strategies aimed at targeting cellular and molecular immune microenvironment components.
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Calcium Phosphate-Based Biomaterials for Bone Repair. J Funct Biomater 2022; 13:jfb13040187. [PMID: 36278657 PMCID: PMC9589993 DOI: 10.3390/jfb13040187] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022] Open
Abstract
Traumatic, tumoral, and infectious bone defects are common in clinics, and create a big burden on patient's families and society. Calcium phosphate (CaP)-based biomaterials have superior properties and have been widely used for bone defect repair, due to their similarities to the inorganic components of human bones. The biological performance of CaPs, as a determining factor for their applications, are dependent on their physicochemical properties. Hydroxyapatite (HAP) as the most thermally stable crystalline phase of CaP is mostly used in the form of ceramics or composites scaffolds with polymers. Nanostructured CaPs with large surface areas are suitable for drug/gene delivery systems. Additionally, CaP scaffolds with hierarchical nano-/microstructures have demonstrated excellent ability in promoting bone regeneration. This review focuses on the relationships and interactions between the physicochemical/biological properties of CaP biomaterials and their species, sizes, and morphologies in bone regeneration, including synthesis strategies, structure control, biological behavior, and the mechanisms of CaP in promoting osteogenesis. This review will be helpful for scientists and engineers to further understand CaP-based biomaterials (CaPs), and be useful in developing new high-performance biomaterials for bone repair.
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Toledano M, Vallecillo C, Gutierrez-Corrales A, Torres-Lagares D, Toledano-Osorio M, Serrera-Figallo MA. Histomorphometric Analysis of Differential Regional Bone Regeneration Induced by Distinct Doped Membranes. Polymers (Basel) 2022; 14:polym14102078. [PMID: 35631960 PMCID: PMC9147672 DOI: 10.3390/polym14102078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/13/2022] [Accepted: 05/17/2022] [Indexed: 11/20/2022] Open
Abstract
Our objective is to evaluate the regional regenerative potential of calvarial bone in critical-sized defects in a rabbit model using novel nanostructured silica-loaded membranes doped with zinc or doxycycline. Nanostructured membranes of (MMA)1-co-(HEMA)1/(MA)3-co-(HEA)2 loaded with 5 wt% of SiO2 nanoparticles (HOOC-Si-Membranes) were doped with zinc (Zn-HOOC-Si-Membrane) or doxycycline (Dox-HOOC-Si-Membrane). Critical bone defects were created on six New-Zealand-breed rabbit skulls and covered with the membranes. A sham defect without a membrane was used as the control. After six weeks, a histological analysis (toluidine blue technique) was employed to determine the area percentages of newly formed bone, osteoid bone, and soft tissue. The measurements were performed by dividing the total defect area into top (close to the membrane) and bottom (close to the dura mater) regions, or peripheral (adjacent to the old bone) and central (the sum of the remaining zones) regions. The peripheral regions of the defects showed higher osteogenic capacity than the central areas when the membranes were present. The proportion of new bone adjacent to the dura was similar to that adjacent to the membrane only when the HOOC-Si-Membranes and Zn-HOOC-Si-Membranes were used, indicating a direct osteoinductive effect of the membranes.
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Affiliation(s)
- Manuel Toledano
- Faculty of Dentistry, Colegio Máximo de Cartuja s/n, University of Granada, 18071 Granada, Spain; (M.T.); (C.V.)
| | - Cristina Vallecillo
- Faculty of Dentistry, Colegio Máximo de Cartuja s/n, University of Granada, 18071 Granada, Spain; (M.T.); (C.V.)
| | - Aida Gutierrez-Corrales
- Faculty of Dentistry, Oral Surgery Section, University of Sevilla, Avicena s/n, 41009 Sevilla, Spain; (A.G.-C.); (D.T.-L.); (M.-A.S.-F.)
| | - Daniel Torres-Lagares
- Faculty of Dentistry, Oral Surgery Section, University of Sevilla, Avicena s/n, 41009 Sevilla, Spain; (A.G.-C.); (D.T.-L.); (M.-A.S.-F.)
| | - Manuel Toledano-Osorio
- Faculty of Dentistry, Colegio Máximo de Cartuja s/n, University of Granada, 18071 Granada, Spain; (M.T.); (C.V.)
- Correspondence: ; Tel.: +34-958-243-789
| | - María-Angeles Serrera-Figallo
- Faculty of Dentistry, Oral Surgery Section, University of Sevilla, Avicena s/n, 41009 Sevilla, Spain; (A.G.-C.); (D.T.-L.); (M.-A.S.-F.)
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Concentrated Growth Factors (CGF) Combined with Melatonin in Guided Bone Regeneration (GBR): A Case Report. Diagnostics (Basel) 2022; 12:diagnostics12051257. [PMID: 35626412 PMCID: PMC9141849 DOI: 10.3390/diagnostics12051257] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/06/2022] [Accepted: 05/16/2022] [Indexed: 12/23/2022] Open
Abstract
During implant restorative dentistry, common and crippling postoperative complications are pain and swelling of perioral soft tissues which engraving on patient quality of life. Concentrated growth factors (CGF), a novel generation of autologous platelet concentrate, and melatonin, endogenous indoleamine with also bone regenerative properties, may be useful for reconstruction of bony defects as well as in prosthetic and esthetic rehabilitation. We report a clinical case in which guided bone regeneration was performed combining CGF, melatonin and heterologous biomaterial. Great postoperative recovery without any complications was reported. In conclusion, in restorative dentistry the combined use of CGF and melatonin may have important roles in restoring bone defect, in improving implant osteointegration and, not less important, in preventing postoperative complications.
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Zalama E, Karrouf G, Rizk A, Salama B, Samy A. Does zinc oxide nanoparticles potentiate the regenerative effect of platelet-rich fibrin in healing of critical bone defect in rabbits? BMC Vet Res 2022; 18:130. [PMID: 35366880 PMCID: PMC8976312 DOI: 10.1186/s12917-022-03231-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 03/15/2022] [Indexed: 11/20/2022] Open
Abstract
Background Many encouraging studies confirmed the ability of Zinc Oxide Nanoparticles (ZnONPs) in accelerating bone growth and mineralization. The use of Platelet Rich-Fibrin (PRF) as a sole filling material for large segmental bone defects remains questionable. The objectives are to investigate the regenerative efficacy of autologous Platelet Rich-Fibrin (PRF) and Zinc Oxide Nanoparticles (ZnONPs) in repairing large segmental bone ulnar defects in a randomized controlled study in rabbits using computed tomographic interpretations. A 12 mm critical size defect was surgically induced in the ulna of 30 rabbits (n = 10/ group). In the control group, the defect was left empty. In the PRF group, the defect is filled with PRF. In the PRF/ZnONPs group, the defect is filled with PRF that was inoculated with 0.1 ml of 0.2% ZnONPs. Radiologic healing capacity was evaluated at the first, second, and third postoperative months. Results Statistical analysis showed significant differences in the radiologic healing scores between the groups (P = 0.000–0.0001) at all-time points (P = 0.000–0.047) during the study. Conclusion Rabbits in the PRF/ZnONPs group showed the highest appreciable bone quality and quantity followed by the PRF group with high quantity but low bone quality meanwhile, rabbits in the control group showed minimal quantity but medium bone quality. Interestingly, the addition of ZnONPs to PRF can accelerate the healing of ulnar critical-size defects in rabbits.
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