Spontaneous healing capacity of rabbit cranial defects of various sizes

Comparative Analysis of Bone Regeneration According to Particle Type and Barrier Membrane for Octacalcium Phosphate Grafted into Rabbit Calvarial Defects

This animal study was aimed to evaluate the efficacy of new bone formation and volume maintenance according to the particle type and the collagen membrane function for grafted octacalcium phosphate (OCP) in rabbit calvarial defects. The synthetic bone substitutes were prepared in powder form with 90% OCP and granular form with 76% OCP, respectively. The calvarial defects were divided into four groups according to the particle type and the membrane application. All specimens were acquired 2 weeks (n = 5) and 8 weeks (n = 5) after surgery. According to the micro-CT results, the new bone volume increased at 2 weeks in the 76% OCP groups compared to the 90% OCP groups, and the bone volume ratio was significantly lower in the 90% OCP group after 2 weeks. The histomorphometric analysis results indicated that the new bone area and its ratio in all experimental groups were increased at 8 weeks except for the group with 90% OCP without a membrane. Furthermore, the residual bone graft area and its ratio in the 90% OCP groups were decreased at 8 weeks. In conclusion, all types of OCP could be applied as biocompatible bone graft materials regardless of its density and membrane application. Neither the OCP concentration nor the membrane application had a significant effect on new bone formation in the defect area, but the higher the OCP concentration, the less graft volume maintenance was needed.

A novel micro-CT analysis for evaluating the regenerative potential of bone augmentation xenografts in rabbit calvarias

Guided Bone Regeneration is a common procedure, yet, as new grafting materials are being introduced into the market, a reliable evaluation method is required. Critical size defect in animal models provides an accurate simulation, followed by histological sections to evaluate the new bone formation. However, histology is destructive, two-dimensional and technique-sensitive. In this study we developed a novel volumetric Micro-CT analysis to quantify new bone formation characteristics. Eight adult female New Zealand white rabbits were subjected to calvarial critical-size defects. Four 8 mm in diameter circular defects were preformed in each animal, to allow random allocation of four treatment modalities. All calvarias were scanned using Micro-CT. Each defect was segmented into four equal parts: pristine bone, outer, middle, and inner. Amira software (v. 6.3, www.fei.com ) was used to calculate the new bone volume in each region and compare it to that of the pristine bone. All grafting materials demonstrated that new bone formation decreased as it moved inward. Only the inner region differed across grafting materials (p = 0.001). The new Micro-CT analysis allowed us to divide each defect into 3D regions providing better understanding of the bone formation process. Amongst the various advantages of the Micro-CT, it enables us to quantify the graft materials and the newly formed bone independently, and to describe the defect morphology in 3D (bi- vs. uni-cortical defects). Providing an insight into the inner region of the defect can better predict the regenerative potential of the bone augmentation graft material. Therefore, the suggested Micro-CT analysis is beneficial for further developing of clinical approaches.

Comparison of the Volume and Histological Properties of Newly Formed Bone after the Application of Three Types of Bone Substitutes in Critical-Sized Bone Defects

This study aimed to compare the volume and quality of the newly formed bone following application of two types of xenografts and one synthetic material in bone defects in rabbit calvaria from histological and micro-CT aspects. Four 8-mm defects were created in 12 rabbit calvaria. Three defects were filled with bone substitutes and one was left unfilled as the control group. The newly formed bone was evaluated histologically and also by micro-CT at 8 and 12 weeks after the intervention. The percentage of osteogenesis was comparable in histomor-phometric assessment and micro-CT. Histological analysis showed that the percentage of the newly formed bone was 10.92 ± 5.17%, 14.70 ± 11.02%, 11.47 ± 7.04%, and 9.45 ± 5.18% in groups bovine 1, bovine 2, synthetic, and negative control, respectively after 8 weeks. These values were 33.70 ± 11.48%, 26.30 ± 18.05%, 22.92 ± 6.30%, and 14.82 ± 8.59%, respectively at 12 weeks. The difference in the percentage of the new bone formation at 8 and 12 weeks was not significant in any group (P > 0.05) except for bovine 1 group (P < 0.05). Micro-CT confirmed new bone formation in all groups but according to the micro-CT results, the difference between the control and other groups was significant in this respect (P < 0.05). All bone substitutes enhanced new bone formation compared with the control group. Micro-CT assessment yielded more accurate and different results compared with histological assessment.

Photo-crosslinked gelatin methacryloyl hydrogel strengthened with calcium phosphate-based nanoparticles for early healing of rabbit calvarial defects

PURPOSE

The aim of this study was to investigate the efficacy of photo-crosslinked gelatin methacryloyl (GelMa) hydrogel containing calcium phosphate nanoparticles (CNp) when applying different fabrication methods for bone regeneration.

METHODS

Four circular defects were created in the calvaria of 10 rabbits. Each defect was randomly allocated to the following study groups: 1) the sham control group, 2) the GelMa group (defect filled with crosslinked GelMa hydrogel), 3) the CNp-GelMa group (GelMa hydrogel crosslinked with nanoparticles), and 4) the CNp+GelMa group (crosslinked GelMa loaded with nanoparticles). At 2, 4, and 8 weeks, samples were harvested, and histological and micro-computed tomography analyses were performed.

RESULTS

Histomorphometric analysis showed that the CNp-GelMa and CNp+GelMa groups at 2 weeks had significantly greater total augmented areas than the control group (P<0.05). The greatest new bone area was observed in the CNp-GelMa group, but without statistical significance (P>0.05). Crosslinked GelMa hydrogel with nanoparticles exhibited good biocompatibility with a minimal inflammatory reaction.

CONCLUSIONS

There was no difference in the efficacy of bone regeneration according to the synthesized method of photo-crosslinked GelMa hydrogel with nanoparticles. However, these materials could remain within a bone defect up to 2 weeks and showed good biocompatibility with little inflammatory response. Further improvement in mechanical properties and resistance to enzymatic degradation would be needed for the clinical application.

Effect of strontium substitution on functional activity of phosphate-based glass

Phosphate-based glass (PBG) is a bioactive agent, composed of a glass network with phosphate as the primary component and can be substituted with various therapeutic ions for functional enhancement. Strontium (Sr) has been shown to stimulate osteogenic activity and inhibit pro-inflammatory responses. Despite this potential, there are limited studies that focus on the proportion of Sr substituted and its impact on the functional activity of resulting Sr-substituted PBG (PSr). In this study, focusing on the cellular biological response we synthesized and investigated the functional activity of PSr by characterizing its properties and comparing the effect of Sr substitution on cellular bioactivity. Moreover, we benchmarked the optimal composition against 45S5 bioactive glass (BG). Our results showed that PSr groups exhibited a glass structure and phosphate network like that of PBG. The release of Sr and P was most stable for PSr6, which showed favorable cell viability. Furthermore, PSr6 elicited excellent early osteogenic marker expression and inhibition of pro-inflammatory cytokine expression, which was significant compared to BG. In addition, compared to BG, PSr6 had markedly higher expression of osteopontin in immunocytochemistry, higher ALP expression in osteogenic media, and denser alizarin red staining in vitro. We also observed a comparable in vivo regenerative response in a 4-week rabbit calvaria defect model. Therefore, based on the results of this study, PSr6 could be identified as the functionally optimized composition with the potential to be applied as a valuable bioactive component of existing biomaterials used for bone regeneration.

Evaluation of the time-dependent osteogenic activity of glycerol incorporated magnesium oxide nanoparticles in induced calvarial defects

Introduction

Magnesium-based biomaterials have been explored for their potential as bone healing materials, as a result of their outstanding biodegradability and biocompatibility. These characteristics make magnesium oxide nanoparticles (MgO NPs) a promising material for treating bone disorders. The purpose of this investigation is to assess the osteogenic activity of newly-developed locally administered glycerol-incorporated MgO NPs (GIMgO NPs) in rabbits' calvarial defects.

Materials and methods

Characterization of GIMgO was done by X-ray Diffraction (XRD) and Fourier Transform Infrared Spectroscopy (FTIR). Bilateral calvarial defects were created in eighteen New Zealand Rabbits, of which they were divided into 3 groups with time points corresponding to 2, 4, and 6 weeks postoperatively (n = 6). One defect was implanted with absorbable gel foam impregnated with GIMgO NPs while the other was implanted with gel foam soaked with glycerol (the control). The defects were assessed using histological, Micro-Computed Tomography (Micro-CT), and histometric evaluation.

Results

The characterization of the GIMgO nanogel revealed the presence of MgO NPs and glycerol as well as the formation of the crystalline phase of the MgO NPs within the nanogel sample. The histological and micro-CT analysis showed time-dependent improvement of healing activity in the calvarial defects implanted with GIMgO NPs when compared to the control. Furthermore, the histometric analysis demonstrated a marked increase in the total area of new bone, connective tissue, new bone area and volume in the GIMgO NPs implanted site. Statistically, the amount of new bone formation was more significant at 6 weeks than at 2 and 4 weeks postoperatively in the calvarial defects implanted with GIMgO NPs as compared to the control.

Conclusion

The locally applied GIMgO NPs demonstrated efficacy in promoting bone formation, with more significant effects observed over an extended period. These findings suggest its suitability for clinical use as a therapeutic alternative to enhance bone healing.

Effects of glycosaminoglycan content in extracellular matrix of donor cartilage on the functional properties of osteochondral allografts evaluated by micro-CT non-destructive analysis

Osteochondral allograft (OCA) is an important surgical procedure used to repair extensive articular cartilage damage. It is known that chondrocyte viability is crucial for maintaining the biochemical and biomechanical properties of OCA, which is directly related to the clinical success of the operation and is the only standard for preoperative evaluation of OCA. However, there is a lack of systematic research on the effect of the content of cellular matrix in OCA cartilage tissue on the efficacy of transplantation. Therefore, we evaluated the effect of different GAG contents on the success of OCA transplantation in a rabbit animal model. Each rabbit OCA was treated with chondroitinase to regulate glycosaminoglycan (GAG) content in the tissue. Due to the different action times of chondroitinase, they were divided into 4 experimental groups (including control group, 2h, 4h, and 8h groups). The treated OCAs of each group were used for transplantation. In this study, transplant surgery effects were assessed using micro-computed tomography (μCT) and histological analysis. Our results showed that tissue integration at the graft site was poorer in the 4h and 8h groups compared to the control group at 4 and 12 weeks in vivo, as were the compressive modulus, GAG content, and cell density reduced. In conclusion, we evaluated the biochemical composition of OCAs before and after surgery using μCT analysis and demonstrated that the GAG content of the graft decreased, it also decreased during implantation; this resulted in decreased chondrocyte viability after transplantation and ultimately affected the functional success of OCAs.

Bone Regeneration Effect of Nanochitosan with or without Temporally-controlled Release of Dexamethasone

INTRODUCTION

Chitosan is a cationic biopolymer and its modification as a nanoparticle, as well as loading a corticosteroid on it, may enhance its bone regenerative effect. The aim of this study was to investigate the bone regenerative effect of nanochitosan with or without dexamethasone.

METHODS

Under general anesthesia, four cavities were created in the calvarium of 18 rabbits and filled with either nanochitosan, nanochitosan with a temporally-controlled release of dexamethasone (nanochitosan+dexamethasone), an autograft, or left unfilled (control). The defects were then covered with a collagen membrane. The rabbits were randomly divided into 2 groups and were sacrificed at 6 or 12 weeks post-surgery. The new bone type, osteogenesis pattern, foreign body reaction, as well as the type and severity of the inflammatory response were evaluated histologically. The amount of new bone was determined using histomorphometry and cone-beam computed tomography (CBCT). A one-way ANOVA with repeated-measures was performed to compare results between the groups at each interval. A T-test and Chi-square were also conducted to analyze changes in variables between the two intervals.

RESULTS

Nanochitosan and the combination of nanochitosan and dexamethasone significantly increased the combination of woven and lamellar bone (P=0.007). No sample showed a foreign body reaction or any acute or severe inflammation. Chronic inflammation was significantly decreased in number (P=0.002) and severity (P=0.003) over time. There was no significant difference between the extent and pattern of osteogenesis amongst the four groups, as evaluated by histomorphometry and CBCT at each interval.

CONCLUSION

Nanochitosan and nanochitosan+dexamethasone were comparable to the gold standard of autograft regarding the type and severity of inflammation, as well as the level and pattern of osteogenesis, yet they induced more woven and lamellar bone.

Immunomodulatory fibrous hyaluronic acid-Fmoc-diphenylalanine-based hydrogel induces bone regeneration

AIM

To investigate the potential of an ultrashort aromatic peptide hydrogelator integrated with hyaluronic acid (HA) to serve as a scaffold for bone regeneration.

MATERIALS AND METHODS

Fluorenylmethyloxycarbonyl-diphenylalanine (FmocFF)/HA hydrogel was prepared and characterized using microscopy and rheology. Osteogenic differentiation of MC3T3-E1 preosteoblasts was investigated using Alizarin red, alkaline phosphatase and calcium deposition assays. In vivo, 5-mm-diameter calvarial critical-sized defects were prepared in 20 Sprague-Dawley rats and filled with either FmocFF/HA hydrogel, deproteinized bovine bone mineral, FmocFF/Alginate hydrogel or left unfilled. Eight weeks after implantation, histology and micro-computed tomography analyses were performed. Immunohistochemistry was performed in six rats to assess the hydrogel's immunomodulatory effect.

RESULTS

A nanofibrous FmocFF/HA hydrogel with a high storage modulus of 46 KPa was prepared. It supported osteogenic differentiation of MC3T3-E1 preosteoblasts and facilitated calcium deposition. In vivo, the hydrogel implantation resulted in approximately 93% bone restoration. It induced bone deposition not only around the margins, but also generated bony islets along the defect. Elongated M2 macrophages lining at the periosteum-hydrogel interface were observed 1 week after implantation. After 3 weeks, these macrophages were dispersed through the regenerating tissue surrounding the newly formed bone.

CONCLUSIONS

FmocFF/HA hydrogel can serve as a cell-free, biomimetic, immunomodulatory scaffold for bone regeneration.

Laddec® versus Bio-Oss®: The effect on the healing of critical-sized defect - Calvaria rabbit model

The aim of this study was to evaluate the in vivo performance of two different deproteinized bovine bone (DBB) grafting materials: DBBB (Bio-Oss®) and DBBL (Laddec®), for the regeneration of critically sized (8 mm) defects in rabbit's calvaria. Three round-shaped defects were surgically created in the calvaria of 13 New Zealand White rabbits proximal to the coronal suture in the parietal bone. Two of the defects were filled with one of the grafting materials while a third was left empty to serve as a negative control. Bone regeneration properties were evaluated at 4- and 8-weeks after implantation by means of histological and histomorphometrical analyses. Statistical analyses were performed through a mixed model analysis with fixed factors of time and material. Histological evaluation of the control group evidenced a lack of bridging bone formation across the defect sites at both evaluation time points. For the experimental groups, new bone formation was observed around the defect periphery and to progress radially inwards to the center of the defect site, regardless of the grafting material. Histomorphometric analyses at 4 weeks demonstrated higher amount of bone formation through the defect for DBBB group. However, at 8 weeks, DBBL and DBBB demonstrated osteoconductivity and low resorption rates with evidence of statistically similar bone regeneration through the complete boney defect. Finally, DBBB presented lower soft tissue migration within the defect when compared to DBBL at both evaluation time points. DBBB and DBBL presented similar bone regeneration performance and slow resorption rates. Although both materials promoted bone regeneration through the complete defect, DBBB presented lower soft tissue migration within the defects at 4- and 8-weeks.

Rabbit calvarial and mandibular critical-sized bone defects as an experimental model for the evaluation of craniofacial bone tissue regeneration

INTRODUCTION

Many studies have aimed to investigate the regeneration potential of bone substitutes through animal models at different defect sites, where the bone healing mechanism varies due to developmental, structural and functional differences. This study aims to develop a rabbit model with two functionally different (non-load-bearing calvarias and load-bearing mandibular) critical-sized defects (CSD) in one rabbit.

MATERIAL & METHOD

The comparison of the "gold standard" autograft to a sham (no graft) control was undertaken in order to validate this model; at the same time, a 3D-printed biphasic calcium phosphate scaffold was implanted to test its utility in the evaluation of new bone substitute materials. Twenty rabbits were selected with both a 10 mm calvaria defect and a 11 mm bicortical semi-cylindrical mandibular defect. The animals were euthanized at 4 and 12 weeks once surgery, microcomputed tomography and histological analysis had been performed.

RESULTS

In the case of the calvaria, the results for the non-healing sham group compared with the healing of those that had undergone the autograft validated the CSD model. But the mandibular defect was not validated, due to the particularity of mandible high mechanical stress and infectious risk.

DISCUSSION

This study showed for the first time that rabbits have a high tolerance for the bilateral double-site CSD model under consideration; and further studies are essential to modify and improve the design of mandibular CSD.

Three-dimensionally printed biphasic calcium phosphate blocks with different pore diameters for regeneration in rabbit calvarial defects

Background

Biphasic calcium phosphate (BCP) is the most frequently used synthetic bone substitutes, which comprises a combination of hydroxyapatite (HA) and beta-tricalcium phosphate (b-TCP). Thanks to the recent advances in digital dentistry and three-dimensional (3D) printing technology, synthetic block bone substitutes can be customized to fit individual defect morphologies. The diameter of the pores can influence the rate of bone formation and material resorption. The aim of this study was to compare three-dimensionally printed biphasic calcium phosphate (BCP) block bone substitutes with different pore diameters (0.8-, 1.0-, and 1.2- mm) for use in the regeneration of rabbit calvarial defects.

Methods

Four circular defects were formed on the calvaria of ten rabbits. Each defect was randomly allocated to one of the following study groups: (i) control group, (ii) 0.8-mm group, (iii) 1.0-mm group, and (iv) 1.2-mm group. All specimens were postoperatively harvested at 2 and 8 weeks, and radiographic and histomorphometric analyses were performed on the samples.

Results

Histologically, the BCP blocks remained unresorbed up to 8 weeks, and new bone formation occurred within the porous structures of the blocks. After the short healing period of 2 weeks, histomorphometric analysis indicated that new bone formation was significantly greater in the BCP groups compared with the control (p < 0.05). However, there were no significant differences between the groups with different pore diameters (p > 0.05). At 8 weeks, only the 1.0-mm group (3.42 ± 0.48 mm², mean ± standard deviation) presented a significantly larger area of new bone compared with the control (2.26 ± 0.59 mm²) (p < 0.05). Among the BCP groups, the 1.0- and 1.2-mm groups exhibited significantly larger areas of new bone compared with the 0.8-mm group (3.42 ± 0.48 and 3.04 ± 0.66 vs 1.60 ± 0.70 mm², respectively).

Conclusions

Within the limitations of this study, the BCP block bone substitutes can be applied to bone defects for successful bone regeneration. Future studies should investigate more-challenging defect configurations prior to considering clinical applications.

3D Bioprinted Scaffolds for Bone Tissue Engineering: State-Of-The-Art and Emerging Technologies

Treating large bone defects, known as critical-sized defects (CSDs), is challenging because they are not spontaneously healed by the patient’s body. Due to the limitations associated with conventional bone grafts, bone tissue engineering (BTE), based on three-dimensional (3D) bioprinted scaffolds, has emerged as a promising approach for bone reconstitution and treatment. Bioprinting technology allows for incorporation of living cells and/or growth factors into scaffolds aiming to mimic the structure and properties of the native bone. To date, a wide range of biomaterials (either natural or synthetic polymers), as well as various cells and growth factors, have been explored for use in scaffold bioprinting. However, a key challenge that remains is the fabrication of scaffolds that meet structure, mechanical, and osteoconductive requirements of native bone and support vascularization. In this review, we briefly present the latest developments and discoveries of CSD treatment by means of bioprinted scaffolds, with a focus on the biomaterials, cells, and growth factors for formulating bioinks and their bioprinting techniques. Promising state-of-the-art pathways or strategies recently developed for bioprinting bone scaffolds are highlighted, including the incorporation of bioactive ceramics to create composite scaffolds, the use of advanced bioprinting technologies (e.g., core/shell bioprinting) to form hybrid scaffolds or systems, as well as the rigorous design of scaffolds by taking into account of the influence of such parameters as scaffold pore geometry and porosity. We also review in-vitro assays and in-vivo models to track bone regeneration, followed by a discussion of current limitations associated with 3D bioprinting technologies for BTE. We conclude this review with emerging approaches in this field, including the development of gradient scaffolds, four-dimensional (4D) printing technology via smart materials, organoids, and cell aggregates/spheroids along with future avenues for related BTE.

Bilateral double site (calvarial and mandibular) critical-size bone defect model in rabbits for evaluation of a craniofacial tissue engineering constructs

Most existing preclinical models for evaluating the biosafety and bone-regeneration efficacy of innovative bone substitute materials (BSMs) or tissue engineering (TE) constructs only consisted of a single-site defect and the anatomical locations of defect varied drastically. While the compelling evidence showed that the bone healing pattern is location-dependent, owing to developmental, structural, and functional differences of anatomical locations, this is particularly true for the craniofacial region. Taking this into account, the bone healing efficiency of a BSM shown at one anatomical defect location cannot ensure the same impact at another. This prompted us to develop, for the first time, a model of bilateral critical-sized defect (CSD) at two distinctly different locations (non-load-bearing parietal calvaria and load-bearing mandibular body) co-existing in one rabbit to reduce the number of animals needed and avoid the influence of interindividual variability and evaluation bias on comparisons.

24 healthy adult male New Zealand White rabbits were randomly assigned to a group, either control, autograft (considered the “gold standard”) or a clinically relevant BSM (biphasic calcium phosphate granules) (BCPg, Mastergraft®, Medronics). The full-thickness cylindrical calvarial defect (ø10 mm) on frontoparietal region and mandibular composite defect (ø11 mm) on the body of the mandible were created bilaterally using low-speed drilling with saline irrigation. The defect on one side was filled with autograft debris or BCPg, and the other side was no graft (empty). Following the euthanasia of animals at the predetermined intervals (4w and 12w), the defect zones were examined macroscopically and then sampled and processed for microcomputed tomography (microCT) and histological analysis.

All surgeries went uneventfully, and all rabbits recovered slowly but steadily. No symptoms of infection or inflammation associated with the defect were observed during the experiment. At 4w and 12w, macroscopic views of all defect sites were clean without any signs of necrosis or abscess, and no intraoral communication was found. The analysis of microCT and histological findings showed the non-healing nature of the empty defect, thereby both calvaria and mandible CSDs can be validated. The study of the application of BCPg in this defect model highlighted good osteointegration and excellent osteoconductive properties but compromised the osteoinductive properties of this material (compared with autograft).

To conclude, this novel double-site CSD model holds great promise in the application for preclinical evaluation of BSMs, TE construct, etc. With a reduced number of animals in use, and lower interindividual variability and evaluation bias for comparisons.

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A novel rabbit model of bilateral critical-sized defect co-existing at two distinctly different locations was developed.

Magnesium Modified β-Tricalcium Phosphate Induces Cell Osteogenic Differentiation In Vitro and Bone Regeneration In Vivo

In vitro, in vivo, and clinical studies have shown how the physicochemical and biological properties of β-tricalcium phosphate (β-TCP) work in bone regeneration. This study aimed to improve the properties of β-TCP by achieving optimum surface and bulk β-TCP chemical/physical properties through the hydrothermal addition of magnesium (Mg) and to later establish the biocompatibility of β-TCP/Mg for bone grafting and tissue engineering treatments. Multiple in vitro and in vivo analyses were used to complete β-TCP/Mg physicochemical and biological characterization. The addition of MgO brought about a modest rise in the number of β-TCP surface particles, indicating improvements in alkaline phosphatase (ALP) activity on day 21 (p < 0.05) and in the WST-1assay on all days (p < 0.05), with a corresponding increase in the upregulation of ALP and bone sialoprotein. SEM analyses stated that the surfaces of the β-TCP particles were not altered after the addition of Mg. Micro-CT and histomorphometric analysis from rabbit calvaria critical defects resulted in β-TCP/Mg managing to reform more new bone than the control defects and β-TCP control at 2, 6, and 8 weeks (* p ≤ 0.05, ** p ≤ 0.01, *** p ≤ 0.001, and **** p ≤ 0.0001). The hydrothermal addition of MgO to the β-TCP surfaces ameliorated its biocompatibility without altering its surface roughness resulting from the elemental composition while enhancing cell viability and proliferation, inducing more bone regeneration by osteoconduction in vivo and osteoblastic differentiation in vitro.

In vivo efficacy of low-level laser therapy on bone regeneration

PURPOSE

In clinical use of low-level laser therapy for bone regeneration (LLLT), application protocol (dose, duration, and repetitions) has not been established. This study aimed to depict a reliable dosage of LLLT by evaluating the efficacy of different dosing of LLLT (diode) on the healing of rabbit cranial defects.

METHODS

Critical size defects were prepared in calvarias of 26 New Zealand White Rabbits in such each animal containing both test and control groups. Test groups were irradiated with 4 Joule/cm² (j/cm²), 6 j/cm², and 8 j/cm². The rabbits were subjected to six times of laser treatments in 10 days. At the end of the second week, 5 rabbits were sacrificed for histopathological and immunohistochemical analyses. At the 4th and 8th weeks, 20 rabbits (10 each) were sacrificed for micro-CT and histopathological analyses.

RESULTS

Micro-CT evaluation revealed improved new bone formation in all test groups compared to the control group. 6 j/cm² group demonstrated the highest bone formation. The highest bone morphogenic protein -2 levels were found in the 4 j/cm² group. Osteocalcin expression was significantly higher in 4 j/cm² group.

CONCLUSIONS

Our findings indicate that LLLT have a positive effect on new bone formation. The high efficacy of doses of 4 j/cm² and 6 j/cm² is promising to promote early bone healing.

Effect of the size of the bony access window and the collagen barrier over the window in sinus floor elevation: a preclinical investigation in a rabbit sinus model

Purpose

The aim of this study was to investigate the effect of (1) the size of the bony access window and (2) collagen membrane coverage over the window in sinus floor elevation in a rabbit sinus model.

Methods

Small bony access windows (SW; ø 2.8 mm) were made in 6 rabbits and large windows (LW; ø 6 mm) in 6 other rabbits. Both sinuses in each rabbit were allocated to groups with or without coverage of a collagen membrane (CM) on the window, resulting in 4 groups: SW, LW, SW+CM, and LW+CM. After 4 weeks of healing, micro-computed tomographic, histologic, and histomorphometric analyses were performed.

Results

Bony healing in the window area was incomplete in all groups, but most bone graft particles were well confined in the augmented cavity. Histologically, the pattern of new bone formation was similar in all groups. Histomorphometrically, the percentage of newly formed bone was greater in the groups with CM than in the groups without CM, and in the groups with SW than in the groups with LW (12.92%±6.40% in the SW+CM group, 4.21%±7.73% in the SW group, 10.45%±4.81% in the LW+CM group, 11.77%±3.83% in the LW group). The above differences were not statistically significant (P>0.05).

Conclusions

The combination of a small bony access window and the use of a collagen membrane over the window favored new bone formation compared to other groups, but this result should be further investigated due to the limitations of the present animal model.

Comparative evaluation of two collagen-based biomaterials with different compositions used for bone graft: An experimental animal study

A large number of materials with different compositions and shapes have been proposed and studied for the purpose of bone tissue regeneration. Collagen-based materials have shown promising results for this application, with improved physicochemical properties. The aim of the present in vivo animal study was to evaluate and compare two commercially available collagen-based biomaterials for bone regeneration, with these being implanted in circumferential bone defects created in the calvarium of rabbits. Twenty rabbits received bilateral parietal osteotomies, performed with the aid of a 6.5 mm diameter trephine. Two groups were created: the BC group, where the defect was filled with a scaffold composed of 90% bovine bone particles and 10% porcine collagen, and the EG group, where the defect was filled with a scaffold composed of 75% hydroxyapatite particles of bovine origin and 25% bovine collagen. Ten animals were sacrificed at 30 days and another 10 at 45 days after implantation, and the samples were processed and histologically analyzed. In the evaluations of the samples at 30 days, no important differences were found in the results. However, in the samples at 45 days after surgery, the EG group showed better results than the BC group samples, mainly in terms of the amount of bone matrix formation (P < 0.0001) and the volume in area measured in each sample, where the EG group had a value 65% higher than that in the BC group samples. Based on the results obtained, we conclude that the amount of collagen and the particle characteristics present in the composition of the scaffolds can directly influence the amount of neoformation and/or bone regeneration.

The effect of hard-type crosslinked hyaluronic acid with particulate bone substitute on bone regeneration: positive or negative?

Purpose

Methods

Results

Conclusions

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

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.

The Effectiveness of Compartmentalized Bone Graft Sponges Made Using Complementary Bone Graft Materials and Succinylated Chitosan Hydrogels

Bone defects can occur from many causes, including disease or trauma. Bone graft materials (BGMs) have been used to fill damaged areas for the reconstruction of diseased bone tissues since they are cost effective and readily available. However, BGMs quickly disperse around the tissue area, which ultimately leads to it migrating away from the defect after transplantation. We tested chitosan hydrogels as a useful carrier to hold BGMs in the transplantation area. In this study, we synthesized succinylated chitosan (SCS)-based hydrogels with a high decomposition rate and excellent biocompatibility. We confirmed that BGMs were well distributed inside the SCS hydrogel. The SCS-B hydrogel showed a decrease in mechanical properties, such as compressive strength and Young’s modulus, as the succinylation rate increased. SCS-B hydrogels also exhibited a high cell growth rate and bone differentiation rate. Moreover, the in vivo results showed that the SCS hydrogel resorbed into the surrounding tissues while maintaining the BGMs in the transplantation area for up to 6 weeks. These data support the idea that SCS hydrogel can be useful as a bioactive drug carrier for a broad range of biomedical applications.

The effect of 3-D printed polylactic acid scaffold with and without hyaluronic acid on bone regeneration

BACKGROUND

Three- dimensional (3D) technology has been suggested to overcome these limitations in guided bone regeneration (GBR) procedures because 3D-printed scaffolds can be easily molded to patient-specific bone defect site. This study aimed to investigate the effect of 3-D printed polylactic acid (PLA) scaffolds with or without hyaluronic acid (HA) in a rabbit calvaria model.

METHODS

A calvaria defect with a diameter of 15 mm was created in 30 New Zealand white rabbits. The rabbits were randomly allocated into 3 groups including no graft group (control, n = 10) , 3D printed PLA graft group (3D-PLA, n = 10) , and 3D printed PLA with hyaluronic acid graft group (3D-PLA/HA, n = 10) . Five animals in each group were sacrificed at 4 and 12 weeks after surgery. Microcomputed tomography and histologic and histomorphometric analyses were performed.

RESULTS

Over the whole examination period, no significant adverse reactions were observed. There were no statistically significant differences in bone volume (BV) /tissue volume (TV) among the three groups at 4 weeks. However, the highest BV/TV was observed in the 3D-PLA/HA group at 12 weeks. The new bone area for control, 3D-PLA, and 3D-PLA/HA showed no statistical differences at 4 weeks. However, the value was significantly higher in the 3D-PLA and 3D-PLA/HA groups compared to the control group at 12 weeks.

CONCLUSION

The 3D printed PLA scaffolds was biocompatible and integrated well with bone defect margin. They were also provided the proper space for new bone formation. Therefore, 3D printed PLA/HA might be a potential tool to enhance bone augmentation. This article is protected by copyright. All rights reserved.

3D-Printed Barrier Membrane Using Mixture of Polycaprolactone and Beta-Tricalcium Phosphate for Regeneration of Rabbit Calvarial Defects

Background: Polycarprolactone and beta tricalcium phosphate (PCL/β-TCP) are resorbable biomaterials that exhibit ideal mechanical properties as well as high affinity for osteogenic cells. Aim: Objective of this study was to evaluate healing and tissue reaction to the PCL/β-TCP barrier membrane in the rabbit calvaria model for guided bone regeneration. Materials and Methods: The PCL/β-TCP membranes were 3D printed. Three circular defects were created in calvaria of 10 rabbits. The three groups were randomly allocated for each specimen: (i) sham control; (ii) PCL/β-TCP membrane (PCL group); and (iii) PCL/β-TCP membrane with synthetic bone graft (PCL-BG group). The animals were euthanized after two (n = 5) and eight weeks (n = 5) for volumetric and histomorphometric analyses. Results: The greatest augmented volume was achieved by the PCL-BG group at both two and eight weeks (p < 0.01). There was a significant increase in new bone after eight weeks in the PCL group (p = 0.04). The PCL/β-TCP membrane remained intact after eight weeks with slight degradation, and showed good tissue integration. Conclusions: PCL/β-TCP membrane exhibited good biocompatibility, slow degradation, and ability to maintain space over eight weeks. The 3D-printed PCL/β-TCP membrane is a promising biomaterial that could be utilized for reconstruction of critical sized defects.

3D Printed Porous Methacrylate/Silica Hybrid Scaffold for Bone Substitution

Inorganic-organic hybrid biomaterials made with star polymer poly(methyl methacrylate-co-3-(trimethoxysilyl)propyl methacrylate) and silica, which show promising mechanical properties, are 3D printed as bone substitutes for the first time, by direct ink writing of the sol. Three different inorganic:organic ratios of poly(methyl methacrylate-co-3-(trimethoxysilyl)propyl methacrylate)-star-SiO2 hybrid inks are printed with pore channels in the range of 100-200 µm. Mechanical properties of the 3D printed scaffolds fall within the range of trabecular bone, and MC3T3 pre-osteoblast cells are able to adhere to the scaffolds in vitro, regardless of their compositions. Osteogenic and angiogenic properties of the hybrid scaffolds are shown using a rat calvarial defect model. Hybrid scaffolds with 40:60 inorganic:organic composition are able to instigate new vascularized bone formation within its pore channels and polarize macrophages toward M2 phenotype. 3D printing inorganic-organic hybrids with sophisticated polymer structure opens up possibilities to produce novel bone graft materials.

Micro-CT and Histomorphometric Study of Bone Regeneration Effect with Autogenous Tooth Biomaterial Enriched with Platelet-Rich Fibrin in an Animal Model

The aim of this study was to evaluate the potential of tooth biomaterials as bone graft biomaterials for bone healing in rabbits. We prepared tooth biomaterial and platelet-rich fibrin (PRF) to fill the round-shaped defect in the skull of New Zealand white rabbits. These cranial defects were treated with different conditions as follows: group 1, a mixture of tooth biomaterials and platelet-rich fibrin (PRF); group 2, only tooth biomaterials; group 3, only PRF; and group 4, the unfilled control group. Specimens of the filled sites were harvested for analysis with microscopic computerized tomography (micro-CT) and histomorphology at 4 and 8 weeks. As a result of micro-CT, at 4 weeks, the bone volume percentages in groups 1 and 2 were 50.33 ± 6.35 and 57.74 ± 3.13, respectively, and that in the unfilled control group was 42.20 ± 10.53 (p = 0.001). At 8 weeks, the bone volume percentages in groups 1 and 2 were 53.73 ± 9.60 and 54.56 ± 8.44, respectively, and that in the unfilled control group was 37.86 ± 7.66 (p = 0.002). The difference between the experimental group 3 and the unfilled control group was not statistically significant. Histomorphologically, the total new bone was statistically different.

Analysis on Efficacy of Chitosan-Based Gel on Bone Quality and Quantity

Objectives: To assess and compare the quantity and the quality of the newly bone generated when using chitosan-based gel scaffold and osteoprotegerin-chitosan gel scaffold.

Methods: A total of 18 critical-sized defects on New Zealand white rabbit craniums were created. In 12 defects, either chitosan gel or osteoprotegerin-chitosan gel was implanted the last six defects were kept unfilled as a control. Bone formation was examined at 6 and 12 weeks. Bone’s specimens were scanned using the High-resolution peripheral quantitative computed tomography. Histological and histomorphometric analysis were carried out to compare the volume and area of regenerated bone.

Results: The results of the HR-pQCT showed that bone volume and densities in the osteoprotegerin-chitosan gel group were significantly higher than the chitosan gel and control groups whereas, the bone volume density in the chitosan gel group was significantly higher than the control group in both intervals time (p = 0.01, p = 000). No significant difference in bone volume between the chitosan gel and control groups (p = 0.506, p = 0.640) was observed. However, similar findings were shown in the histomorphometric analysis, with the highest new bone formation was observed in the OPG-chitosan gel group followed by the chitosan group. The mean percentage of new bone was greater at 12 weeks compared to 6 weeks in all groups.

Conclusions: Chitosan-based gel demonstrated a significant bone quantity and quality compared to unfilled surgical defects. Consistently, osteoprotegerin enhanced the chitosan gel in bone regeneration.

Animal models in bicompatibility assessments of implants in soft and hard tissues

The ethical dilemmas of using animals as in vivo models in preclinical and clinical examinations have been increasingly present in recent decades. Small laboratory animals (rats, rabbits) will continue to be used because they are cost-effective and permit the formation of statistically testable cohort groups; a task that, for financial, maintenance and care reasons, is almost prohibitive for larger animals. Technological advances in the production of new biomaterials for clinical use are enormous, but screening tests and methods used to assess biocompatibility lag behind these advances. The assessment of biological responses is slow and based on millennial recovery mechanisms in eukaryotic organisms. Therefore, the goal of researchers in this field is to re-evaluate old methods of biocompatibility assessment and introduce new methods of evaluation, especially for in vivo testing. In that sense, a revision of the ISO standards was planned and conducted in 2017, which insisted on cytotoxicity testing in cell lines and produced concrete proposals on how biocompatibility should be quantified. In vivo biocompatibility evaluation of biomaterials used for soft tissue recovery commonly utilises rats. Rabbits are recommended for implants used for hard tissues, because of the rabbit?s size, the possibility of implanting the biomaterials on a larger bone surface, and because of the peculiarities of rabbit bone tissue that favours rapid recovery after bone defects and enables easy reading of the results.

Vertical Guided Bone Regeneration in the Rabbit Calvarium Using Porous Nanohydroxyapatite Block Grafts Coated with rhVEGF165 and Cortical Perforation

Introduction

Vertical bone augmentation without osseous walls to support the stability of clots and bone grafts remains a challenge in dental implantology. The objectives of this study were to confirm that cortical perforation of the recipient bed is necessary and to evaluate whether nanohydroxyapatite (nHA) block grafts coated with recombinant human vascular endothelial growth factor₁₆₅ (rhVEGF₁₆₅) and cortical perforation can improve vertical bone regeneration.

Materials and Methods

We prepared nHA blocks coated with or without rhVEGF₁₆₅ on the rabbit calvarium through cortical perforation, and designated the animals as the nonperforated group (N-nHA), rhVEGF₁₆₅ group (NV-nHA), perforated group (P-nHA) and rhVEGF₁₆₅ on perforated group (PV-nHA). Micro-computed tomography (micro-CT) and fluorescence microscopy were selected to evaluate parameters of vertical bone regeneration at 4 and 6 weeks.

Results

The ratio of the newly formed bone volume to the titanium dome volume (BV/TV) and the bone mineral density (BMD) were significantly higher in the PV-nHA group than in the N-nHA group at 4 and 6 weeks, as determined using micro-CT. The fluorescence analysis showed slightly greater increases in new bone regeneration (NB%) and vertical height (VH%) gains in the P-nHA group than in the N-nHA group. Greater increases in NB% and VH% were observed in groups treated with rhVEGF₁₆₅ and perforation than in the blank groups, with significant differences detected at 4 and 6 weeks (N-nHA compared with PV-nHA, p<0.05). A greater VH% that was observed at the midline of the block in the PV-nHA group than in the other three groups at both time points (0.75±0.53% at 4 weeks and 0.83±0.42% at 6 weeks).

Conclusion

According to the present study, cortical perforation is necessary and nHA blocks coated with rhVEGF₁₆₅ and decoration could work synergistically to improve vertical bone regeneration by directly affecting primary osteoblasts and promoting angiogenesis and osteoinduction.

The Impact of Bioceramic Scaffolds on Bone Regeneration in Preclinical In Vivo Studies: A Systematic Review

Bioceramic scaffolds are appealing for alveolar bone regeneration, because they are emerging as promising alternatives to autogenous and heterogenous bone grafts. The aim of this systematic review is to answer to the focal question: in critical-sized bone defects in experimental animal models, does the use of a bioceramic scaffolds improve new bone formation, compared with leaving the empty defect without grafting materials or using autogenous bone or deproteinized bovine-derived bone substitutes? Electronic databases were searched using specific search terms. A hand search was also undertaken. Only randomized and controlled studies in the English language, published in peer-reviewed journals between 2013 and 2018, using critical-sized bone defect models in non-medically compromised animals, were considered. Risk of bias assessment was performed using the SYRCLE tool. A meta-analysis was planned to synthesize the evidence, if possible. Thirteen studies reporting on small animal models (six studies on rats and seven on rabbits) were included. The calvarial bone defect was the most common experimental site. The empty defect was used as the only control in all studies except one. In all studies the bioceramic materials demonstrated a trend for better outcomes compared to an empty control. Due to heterogeneity in protocols and outcomes among the included studies, no meta-analysis could be performed. Bioceramics can be considered promising grafting materials, though further evidence is needed.

The efficacy of porous hydroxyapatite chips as gap filling in open-wedge high tibial osteotomy in terms of clinical, radiological, and histological criteria

PURPOSE

Hydroxyapatite (HA) does not fully degrade, which raises concerns about poor remodeling and incorporation into the bone after open-wedge high tibial osteotomy (HTO). The purpose of this study was to compare the results between gap filling with allogenous chip bone and HA chip after open-wedge HTO using propensity score matching and to analyze the radiological unabsorbed area of opening gaps histologically in HA using patients.

METHODS

The matched variables were age, body mass index, sex, correction angle, and smoking status. After matching, the allogenous group and HA group included 33 patients each with two years of follow-up. The range of motion (ROM), International Knee Documentation Committee (IKDC) subjective score, Knee Injury and Osteoarthritis Outcome Score (KOOS), mechanical axis (MA), tibial slope, osteoconductivity, and absorbability were evaluated and compared between both groups. Among the HA group, 20 patients underwent bone biopsy and histologically analyzed of the radiological unabsorbed area.

RESULTS

The postoperative ROM, IKDC subjective score, and KOOS were similar in both groups. The osteoconductivities did not differ significantly. The absorbability in the HA group was significantly lower than allogenous group (59.6% vs. 22.6%, P < .001). The histological sections of the radiological unabsorbed area showed mature lamelliform bone tissues were significantly greater than structurally degraded remnant HA (30.4% and 4.2%, P < .001).

CONCLUSION

The HA chips showed an inferior absorbability, however, a mature lamelliform bone was observed in significantly larger amounts than remnant HA in the radiological unabsorbed area. The allogenous bone chips and HA chips showed similar clinical and radiological results after open-wedge HTO.

Enhancement of osteoblast cells osteogenic differentiation and bone regeneration by hydroxyapatite/phosphoester modified poly(amino acid)

Hydroxyapatite/poly(amino acid) (HA/PAA) has been used to treat a variety of long bone and vertebral bony defects, and a further biocompatibility improvement is a key for better application. Phosphoester (PE) contained materials are highly biocompatible but could hardly treat massive bone defects due to its fast-degradation-derived mechanical instability. To address the problems of the two materials, we have incorporated PE molecule into the main chain of PAA by chemical bonding. As a result, the compressive strength of HA/PAA with 1 wt% and 2.5 wt% PE maintained in the range of 80-150 MPa after soaking in PBS for 12 weeks, which could be attributed to the amplified hydrogen-bonding inside composites. Besides, the PE-containing HA/PAAs with increased hydrophilic function groups (O=P-O bonds and O=P-N), created a more favourable surface for cell adhesion. Meanwhile, compared with HA/PAA, the PE-containing HA/PAAs had a fast minerlization speed and promoted cell osteogenic differentiation. Furthermore, the in vivo study indicated that PE-containing HA/PAAs could facilitate bone formation (4 weeks), and form a complete bone bridging (12 weeks) in a rabbit cranial bone defect. In summary, the HA/PE-m-PAAs possessed good mechanical stability, improved cytocompatibility and osteoconductivity, so the composites have a great potential for massive bone defect treatment.

Effect of clopidogrel in bone healing-experimental study in rabbits

BACKGROUND

Clopidogrel is a widely prescribed drug for prevention of myocardial infarction and stroke in patients at risk. It inhibits thrombus formation via inhibition of the P2Y12 purinergic receptor on platelets, which is important in their activation by ADP. However, the P2Y12 receptor has also been found to be expressed in both osteoblasts and osteoclasts. Accumulated evidence suggests that purinergic receptors regulate important functions of bone turnover. Previous studies on the effect of clopidogrel on bone metabolism indicated potential harmful effects, but their results remain conflicting. Thus, clopidogrel treatment may affect bone healing, but it has not yet been studied.

AIM

To evaluate if continuous perioperative clopidogrel treatment has any negative effect on bone healing in the rabbit calvarial defect model.

METHODS

Sixteen male white New Zealand rabbits were randomly assigned in two groups: One group received daily 3 mg/kg of clopidogrel per os and the other group received the vehicle alone for a week prior to the surgical procedures; the treatments were continued for another 6 wk postoperatively. The surgical procedures included generation of two circular calvarial defects 11 mm in diameter in every animal. After the 6-wk period of healing, postmortem radiographic and histomorphometric evaluation of the defects was performed.

RESULTS

Both the surgical procedures and the postoperative period were uneventful and well tolerated by all the animals, without any surgical wound dehiscence, signs of infection or other complication. New bone was formed either inwards from the defect margins or in the central portion of the defect as separated bony islets. While defect healing was still incomplete in both groups, the clopidogrel group had significantly improved radiographic healing scores. Moreover, the histomorphometric analysis showed that bone regeneration (%) was 28.07 ± 7.7 for the clopidogrel group and 19.47 ± 4.9 for the control group, showing a statistically significant difference between them (P = 0.018). Statistically significant difference was also found in the defect bridging (%), i.e. 72.17 ± 21.2 for the clopidogrel group and 41.17 ± 8.5 for the control group, respectively (P = 0.004), whereas there was no statistical difference in bone tissue density between the groups.

CONCLUSION

Our results indicate that maintenance of perioperative clopidogrel treatment does not negatively affect bone healing but rather promotes it. Further research is needed in order to find useful applications of this finding.

Locally administrated single-dose teriparatide affects critical-size rabbit calvarial defects: A histological, histomorphometric and micro-CT study

OBJECTIVE

The aim of this study was to evaluate the effect of teriparatide (PTH 1-34, rhPTH) on a rabbit defect model with local xenogen grafts histomorphometrically and radiologically.

METHODS

For this purpose, two 10 mm diameter critical-size defects were created in the calvaria of 16 rabbits. In the control group, the defect area was filled with a xenogen graft, while in the teriparatide group (PTH 1-34), a xenogen graft combination with 20 mcg teriparatide was used. For both 4 - week and 8 - week study groups, new bone, residual graft, and soft tissue areas were evaluated as well as bone volume histomorphometrically and radiologically.

RESULTS

Histomorphometrically, there was a significant difference in new bone area values at the 8th week (p < 0.05), but there was no significant difference between the 4 - week values (p > 0.05). There was no statistically significant difference between the groups at both 4 and 8 weeks (p > 0.05). In the radiologically measured total bone volume values, PTH1-34 group values were found to be significantly higher for both 4 - and 8 - weeks values compared to the control groups (p < 0.05).

CONCLUSION

In this study, rhPTH, which is used locally in defect areas to be repaired with bone grafts, increases both new bone volume and total bone volume.

Improvement of bone repair with l-PRF and bovine bone in calvaria of rats. histometric and immunohistochemical study

OBJECTIVES

The effect of leucocyte- and platelet-rich fibrin (L-PRF), associated with DBBM (deproteinized bovine bone mineral; Bio-Oss®) was investigated and compared with autogenous bone graft as a standard material for filling bone defects.

MATERIAL AND METHODS

A defect of 5 mm in diameter was performed in 40 calvaria of rats. The animals were divided into 5 groups and received blood clot (CO), autogenous bone (AUT), DBBM (BIO), L-PRF, or DBBM associated with L-PRF (BIO-LPRF). After 4 and 8 weeks, bone regeneration was assessed by histometric and immunohistochemical analyses.

RESULTS

The highest mean percentage of bone formation found at 4 and 8 weeks was observed for the BIO-L-PRF group (54.0% ± 2.8 and 63.6% ± 2.2). The lowest mean percentage at 4 and 8 weeks was observed for the CO group (16.7% ± 2.5 and 20.5% ± 1.0). There was statistical similarity among the AUT, BIO, and L-PRF groups. The expressions OC, RUNX 2, and VEGF showed a favorable aspect in the formation of new bone for BIO-L-PRF. VEGF was the marker with the highest expression because it was related to the initial healing process, promoting the migration and proliferation of endothelial cells in the region of the defect. Even after weeks, VEGF maintained a moderate expression.

CONCLUSIONS

The association of L-PRF with DBBM improved bone repair when these biomaterials were inserted into the defects of the calvaria of rats.

CLINICAL RELEVANCE

This reinforces the good performance of bovine bone and L-PRF as filler materials, especially when associated.

The Application of microRNAs in Biomaterial Scaffold-Based Therapies for Bone Tissue Engineering

In recent years, the application of microRNAs (miRNAs) or anti-microRNAs (anti-miRNAs) that can induce expression of the runt-related transcription factor 2 (RUNX2), a master regulator of osteogenesis, has been investigated as a promising alternative bone tissue engineering strategy. In this review, biomaterial scaffold-based applications that have been used to deliver cells expressing miRNAs or anti-miRNAs that induce expression of RUNX2 for bone tissue engineering are discussed. An overview of the components of the scaffold-based therapies including the miRNAs/anti-miRNAs, cell types, gene delivery vectors, and scaffolds that have been applied are provided. To date, there have been nine miRNAs/anti-miRNAs (i.e., miRNA-26a, anti-miRNA-31, anti-miRNA-34a, miRNA-135, anti-miRNA-138, anti-miRNA-146a, miRNA-148b, anti-miRNA-221, and anti-miRNA-335) that have been incorporated into scaffold-based bone tissue engineering applications and investigated in an in vivo bone critical-sized defect model. For all of the biomaterial scaffold-based miRNA therapies that have been developed thus far, cells that are transfected or transduced with the miRNA/anti-miRNA are loaded into the scaffolds and implanted at the site of interest instead of locally delivering the miRNA/anti-miRNAs directly from the scaffolds. Thus, future work may focus on developing biomaterial scaffolds to deliver miRNAs or anti-miRNAs into cells in vivo.

Influence of in vitro differentiation status on the in vivo bone regeneration of cell/chitosan microspheres using a rat cranial defect model

The aim of this study was to investigate the influence of the in vitro osteogenic differentiation status on the in vivo bone regeneration of cell/chitosan microspheres qualitatively and quantitatively. To this end, rat bone-marrow-derived mesenchymal stromal cells (BMSCs) were seeded onto apatite-coated chitosan microspheres. The constructs were osteogenically differentiated for 0, 7, 14, and 21 days followed by calvarial defect implantation in vivo for up to 8 weeks. In vitro studies showed that BMSCs in the constructs proliferated from day 0 to day 7. The activity and gene expression of alkaline phosphatise increased from day 0 to day 14 and then decreased. The gene expression of collagen type I and osteocalcin peaked at day 21. In vivo, constructs retrieved from day 0 group were filled with fibrous tissues and capillaries, but no bone formation was observed. Constructs retrieved from day 7 and day 21 groups showed progressive bone formation, whereas those retrieved from day 14 group had the highest percentage of bone formation. These data suggested that to generate a substantial amount of bone in vivo, not only the in vitro osteogenic differentiation was necessary, but also the period of pre-differentiation was important for the cell-scaffold constructs. The period of pre-differentiation for 14 days was found to be the most suitable for chitosan microspheres.

Histologic, Histomorphometric, and Osteogenesis Comparative Study of a Novel Fabricated Nanocomposite Membrane Versus Cytoplast Membrane

PURPOSE

The present study compared the in vivo efficacy of a novel synthesized polycaprolactone (PCL)/polyethylene glycol (PEG)/bioactive glass (BG) nanocomposite membrane versus a cytoplast (Cy) membrane in terms of the average percentage of new bone formation and inflammation levels.

MATERIALS AND METHODS

In the present interventional animal study, 12 male New Zealand rabbits were tested. In the parietal bone of the rabbits, 24 defects were prepared (2 defects for each rabbit), which were divided into 3 equal groups (Cy, PCL, and control). Each rabbit's calvarial bone was prepared for the histologic and histomorphometric survey. The amount of regenerated bone (ie, length, area, percentage), necrosis rate, fibrosis (fibrosis plus and percentage), and inflammation in the standard defects of parietal bone in the rabbits were examined and compared after 10 weeks.

RESULTS

A significant difference was found between the Cy and PCL groups regarding the mean area and thickness of the bone. We also found a significant difference in the bone length, area, and percentage formed between PCL and control groups. Also, the rate of fibrous tissue formation was significantly different statistically between the PCL and control groups. The results showed the influence of the PCL membrane in generating more bone and less fibrous tissue. In all 3 groups, negligible inflammation and no necrosis was observed.

CONCLUSIONS

The results of the present study have shown that combining PCL, PEG, and BGs could be promising for bone regeneration in jaw defects, around dental implants, and in oral and maxillofacial defects.

Histological and Histomorphometric Analyses of Two Bovine Bone Blocks Implanted in Rabbit Calvaria

This study compared the osteogenic potential of two types of bovine bone blocks. Blocks were obtained by either sintered or a nonsintered process. Calvaria were surgically exposed in 20 rabbits. In each animal, six 0.5-mm-diameter cortical microperforations were drilled with a carbide bur before grafting to promote graft irrigation. The sintered (group 1) and nonsintered (group 2) bovine bone blocks (6 mm diameter, 5 mm high) were bilaterally screwed onto calvarial bone. Blocks were previously prepared from a larger block using a trephine bur. Rabbits were sacrificed after 6 and 8 weeks for the histological and histomorphometric analyses. Samples were processed using the historesin technique. The quantitative and qualitative analyses of the newly formed bone were undertaken using light microscopy. Both groups showed modest new bone formation and remodeling. At the 8-week follow-up, the sintered group displayed significantly lower bone resorption (average of 10% in group 1 and 25% in group 2) and neo-formation (12.86 ± 1.52%) compared to the nonsintered group (16.10 ± 1.29%) at both follow-ups (p < 0.05). One limitation of the present animal model is that the study demonstrates that variations in the physico-chemical properties of the bone substitute material clearly influence the in vivo behavior.

Leukocyte- and platelet-rich fibrin as graft material improves microRNA-21 expression and decreases oxidative stress in the calvarial defects of diabetic rabbits

OBJECTIVE

Leukocyte- and platelet-rich fibrin (L-PRF) represents a natural, low-cost product which may promote tissue healing by mechanisms not fully elucidated. Diabetes mellitus (DM) disrupts bone healing by inducing inflammation and oxidative stress (OS), mechanisms regulated by microRNAs (miRs). The aim of the present study was to investigate the microRNA-21 (miR-21) involvement in diabetic bone regeneration using L-PRF alone or in combination with a standard grafting material.

DESIGN

After the induction of diabetes (alloxan 100 mg/kg), four cranial osteotomies were made in diabetic (n = 12) and non-diabetic (n = 12) rabbits: one was left empty and the remaining three were grafted with L-PRF, bovine hydroxyapatite (Bio-Oss^®) and L-PRF + Bio-Oss®. Two and eight weeks postoperatively, the samples were harvested for miR-21 expression (Real-time RT-PCR) and enzyme-linked immunosorbent assay analyses.

RESULTS

Diabetic rabbits showed decreased miR-21 and matrix metalloproteinase-9 (MMP-9) protein expression while increased malondialdehyde (MDA) levels two weeks postoperatively; however, there were no significant differences in miR-21 and MMP-9 levels between diabetic and non-diabetic rabbits in samples taken eight weeks postoperatively. Application of L-PRF and L-PRF + Bio-Oss^® improved miR-21 and MMP-9 and decreased MDA levels while Bio-Oss® alone enhanced superoxide dismutase (SOD) activity levels in diabetic rabbits.

CONCLUSION

L-PRF alone or in combination with bovine hydroxyapatite as bone graft could be beneficial in DM since it seems to improve inflammation-modulatory miR-21 expression and decreases oxidative stress.

Effect of Collagen Cross-Link Deficiency on Incorporation of Grafted Bone

Bone matrix collagen, is one of the major contributors to bone quality. No studies have examined how bone quality affects the results of bone transplantation. Collagen cross-links (CCL) are the key factor in collagen properties. The purpose was to investigate the influences of CCL for both grafted bone and recipient site bone on the success of bone augmentation. Four-week-old male Wister rats (n = 54) were divided into control and test groups. Control and test groups equally sub-divided into donors and recipients. An additional six rats were used to characterize bone at day zero. Test groups received 0.2% beta-aminoproperionitrile (BAPN) for 4 weeks as CCL inhibitor. Animals were further divided into donor and recipient groups. The transplanted bone chips integrated with host bone by 25% more in CCL-deficient animals compared to control. However, no difference in cortical thickness among all conditions. CCL-deficient transplanted bone did not show any extra signs of osteocyte apoptosis, while sclerostin expression was comparable to that in control. The host periosteum of CCL-deficient animals showed higher cellular activity, as well as higher bone quantity and osteoclast activity. Collagen cross-links deficiency in host bone might accelerate the incorporation of grafted bone. effect. Incorporation of the bone grafts appears to depend mainly on host condition rather than graft condition.

Bone regeneration using three-dimensional hexahedron channel structured BCP block in rabbit calvarial defects

The purpose of this study is to evaluate the efficacy of bone regeneration and volume maintenance of the three-dimensional (3D) structured biphasic calcium phosphate (BCP) block with porous hexahedron channels in a rabbit calvarial model. In this work, four circular defects (diameter: 8 mm) in calvarium of rabbits were randomly assigned to (1) negative control (control), (2) 3D hexahedron channel structured BCP block, (3) deproteinized bovine bone mineral particle, and (4) deproteinized porcine bone mineral particle. Animals were euthanized at 2 (n = 5) and 8 weeks (n = 5). Outcome measures included micro-computed tomography (CT) and histomorphometrical analysis. Results indicated that in micro-CT, BCP group showed the highest new bone volume with significant difference compared to control (p = 0.008) at 8 weeks. Histomorphometrically, total augmented area of BCP group was the highest with significant difference compared to control (p = 0.008) at 8 weeks. BCP group also maintained total volume of the original defect without collapsing. BCP block with 3D hexahedron channel structure seems to have favorable osteogenic and volume maintaining ability and highly porous structure might attribute to new bone formation. Further studies regarding the optimal internal structure and porosity of the BCP block bone substitute are needed. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 2254-2262, 2019.

Reconstruction of calvarial bone defects using poly(amino acid)/hydroxyapatite/calcium sulfate composite

The aim of this study was to evaluate the thermal properties and in vivo interface performance of poly(amino acid) (PAA) and a composite containing PAA, hydroxyapatite (HA), and calcium sulfate (CS), with respect to their suitability for skull repair. Biocompatibility was evaluated by implantation of materials into muscles of rabbits for eight weeks. Skull repair was assessed by implanting PAA, the compact PAA/HA/CS composite (c-PAA/HA/CS), and a one-side-porous PAA/HA/CS composite (p-PAA/HA/CS) into rabbit calvarial defects. The results showed that the PAA/HA/CS composite possessed good heat resistance and possessed excellent biocompatibility and osteoconductivity. Guided bone regeneration and calvarial repair were observed, with excellent integration between calvarial tissue and implant. The p-PAA/HA/CS composite performed best in terms of stability and bone bonding between implant and host bone tissue. Thus, the present work provides new information for the potential use of osteoconductive PAA/HA/CS composites with a macrostructure in calvarial bone repair.

Comparative Study on Acellular Dermal Graft Versus Propylene Mesh Both Either Loaded or Unloaded with BM-MSCs in Healing of Skull Bone Defect in Rats: Histological and Immunohistochemical Study

Bone defect occurs as a consequence of many conditions. Diseased bones don’t heal properly and defects in face area need proper bone reconstruction to avoid psychological and social problems. Tissue engineering is an emerging new modality of treatment. We thought to study different methods to fill skull bone defect in rats in order to find the most safe and effective method. So, this study was designed to evaluate the efficacy of acellular dermal graft (ADM) versus propylene mesh both either loaded or unloaded with bone marrow derived mesenchymal stem cells (BM-MSCs) in healing of skull bone defect of a 5 mm diameter. The study included 36 adult male Wistar albino rats that were divided into three groups according to the way of filling skull bone defect. Group I: Ia (sham control), Ib (negative control). Group II: IIa (unseeded propylene), IIb (seeded propylene) and Group III: IIIa (unseeded ADM), IIIb (seeded ADM). The trephine operation was done on the left parietal bone. Specimens were collected four weeks postoperative and processed for H&E, osteopontin immunohistochemistry and scanning electron microscope. Morphometric and statistical analysis were also performed. After studying the results of the experiment, we found that propylene mesh and ADM were suitable scaffolds that could support new bone formation in clavarial bone defect. Healing of skull bone defect was better in rats that received seeded scaffolds more than rats with unseeded scaffolds. The seeded ADM showed significant increase in bone forming activity as confirmed by histomorphometric and statistical results.

Effects of Enhanced Hydrophilic Titanium Dioxide-Coated Hydroxyapatite on Bone Regeneration in Rabbit Calvarial Defects

The regeneration of bone defects caused by periodontal disease or trauma is an important goal. Porous hydroxyapatite (HA) is an osteoconductive graft material. However, the hydrophobic properties of HA can be a disadvantage in the initial healing process. HA can be coated with TiO₂ to improve its hydrophilicity, and ultraviolet irradiation (UV) can further increase the hydrophilicity by photofunctionalization. This study was designed to evaluate the effect of 5% TiO₂-coated HA on rabbit calvarial defects and compare it with that of photofunctionalization on new bone in the early stage. The following four study groups were established, negative control, HA, TiO₂-coated HA, and TiO₂-coated HA with UV. The animals were sacrificed and the defects were assessed by radiography as well as histologic and histomorphometric analyses. At 2 and 8 weeks postoperatively, the TiO₂-coated HA with UV group and TiO₂-coated HA group showed significantly higher percentages of new bone than the control group (p < 0.05). UV irradiation increased the extent of new bone formation, and there was a significant difference between the TiO₂-coated HA group and TiO₂-coated HA with UV group. The combination of TiO₂/HA and UV irradiation in bone regeneration appears to induce a favorable response.

Biomimetic characteristics of mussel adhesive protein-loaded collagen membrane in guided bone regeneration of rabbit calvarial defects

Purpose

The aim of the present study was to evaluate the biocompatibility and barrier function of mussel adhesive protein (MAP)-loaded collagen membranes in guided bone regeneration (GBR).

Methods

Eight male New Zealand white rabbits were used. Four circular defects (diameter: 8 mm) were created in the calvarium of each animal. The defects were randomly assigned to 1) a negative control group, 2) a cyanoacrylate (CA)-loaded collagen membrane group (the CA group), 3) a MAP-loaded collagen membrane group (the MAP group), and 4) a group that received a polycaprolactone block with MAP-loaded collagen membrane (the MAP-PCL group). Specimens were harvested at 2 weeks (n=4) and 8 weeks (n=4) postoperatively for observational histology and histometric analysis.

Results

In the histologic analysis, MAP was completely absorbed without any byproducts. In contrast, some of the CA adhesive remained, showing an inflammatory reaction, at 8 weeks. In the MAP-PCL group, the MAP-loaded collagen membranes served as a barrier membrane despite their fast degradation in GBR. No significant difference was found in the amount of new bone between the MAP-PCL and MAP groups (1.82±0.86 mm² and 2.60±0.65 mm², respectively).

Conclusions

The MAP-loaded collagen membrane functioned efficiently in this rabbit calvarial GBR model, with excellent biocompatibility. Further research is needed to assess clinical applications in defect types that are more challenging for GBR than those used in the current model.

Comparative study of new bone formation capability of zirconia bone graft material in rabbit calvarial

PURPOSE

The purpose of this study was to compare the new bone formation capability of zirconia with those of other synthetic bone grafts.

MATERIALS AND METHODS

Twelve rabbits were used and four 6-mm diameter transcortical defects were formed on each calvaria. Each defect was filled with Osteon II (Os), Tigran PTG (Ti), and zirconia (Zi) bone grafts. For the control group, the defects were left unfilled. The rabbits were sacrificed at 2, 4, and 8 weeks. Specimens were analyzed through micro computed tomography (CT) and histomorphometric analysis.

RESULTS

The Ti and Zi groups showed significant differences in the amount of newly formed bone between 2 and 4 weeks and between 2 and 8 weeks (P<.05). The measurements of total bone using micro CT showed significant differences between the Os and Ti groups and between the Os and Zi groups at 2 and 8 weeks (P<.05). Comparing by week in each group, the Ti group showed a significant difference between 4 and 8 weeks. Histomorphometric analysis also showed significant differences in new bone formation between the control group and the experimental groups at 2, 4, and 8 weeks (P<.05). In the comparison of newly formed bone, significant differences were observed between 2 and 4 weeks and between 2 and 8 weeks (P<.05) in all groups.

CONCLUSION

Zirconia bone graft material showed satisfactory results in new bone formation and zirconia could be used as a new synthetic bone graft material.