Biocompatible Customized 3D Bone Scaffolds Treated with CRFP, an Osteogenic Peptide

Background: Currently used synthetic bone graft substitutes (BGS) are either too weak to bear the principal load or if metallic, they can support loading, but can lead to stress shielding and are unable to integrate fully. In this study, we developed biocompatible, 3D printed scaffolds derived from µCT images of the bone that can overcome these issues and support the growth of osteoblasts. Methods: Cylindrical scaffolds were fabricated with acrylonitrile butadiene styrene (ABS) and Stratasys® MED 610 (MED610) materials. The 3D-printed scaffolds were seeded with Mus musculus calvaria cells (MC3T3). After the cells attained confluence, osteogenesis was induced with and without the addition of calcitonin receptor fragment peptide (CRFP) and the bone matrix production was analyzed. Mechanical compression testing was carried out to measure compressive strength, stiffness, and elastic modulus. Results: For the ABS scaffolds, there was a 9.8% increase in compressive strength (p < 0.05) in the scaffolds with no pre-coating and the treatment with CRFP, compared to non-treated scaffolds. Similarly, MED610 scaffolds treated with CRFP showed an 11.9% (polylysine pre-coating) and a 20% (no pre-coating) increase (p < 0.01) in compressive strength compared to non-treated scaffolds. Conclusions: MED610 scaffolds are excellent BGS as they support osteoblast growth and show enhanced bone growth with enhanced compressive strength when augmented with CRFP.

Minimum 10 years clinical and radiological outcomes of acetabular revisions of total hip arthroplasties with tricalcium phosphate/hydroxyapatite bone graft substitute

Background Aseptic loosening is the most frequent indication for revision of total hip arthroplasty. Revision arthroplasty of acetabular component is a challenge for every surgeon because they have to simultaneously deal with the reconstruction of bone defects, adequate implant geometry and stable fixation. Allografts are the most frequently used materials in reconstruction of bone loss during revision surgeries. Because of an increasing number of revision hip arthroplasties and poor availability of allografts, we decided to use bone graft substitutes in acetabular revisions. Methods Between September 2005 and January 2010, 44 revision arthroplasties in 43 patients were performed with the use of bone graft substitutes for acetabular defect reconstruction in revision of total hip arthroplasty. Acetabular bone defects were classified according to Paprosky. Seventeen hips were classified as IIA, 3 hips IIB, 3 hips IIC, 10 hips IIIA and 11 hips IIIB. Acetabular bone defects were reconstructed with tricalcium phosphate/hydroxyapatite bone graft substitute - BoneSave. Clinical and radiological examination was performed after 3 months, 1 year and then annually. Harris hip score was used for clinical evaluation. Survival analysis was performed with Kaplan-Meier method with aseptic loosening as the definition of endpoint. Results The average follow-up period is 12 (range from 10 to 15) years. During the follow-up, three patients died after 24 months because of causes not related to surgery. None of the patients was lost to follow-up. The evaluation of clinical results revealed an increase in pre-operative HHS from average 38.3 (range 25 to 55) points to average 86.3 (range 45 to 95) points at the most recent follow-up. Radiographic evaluation showed the migration of one revision cage 12 months after surgery. Revision arthroplasty performed after 14 months revealed the partial incorporation of bone graft substitute. There were not any cases of loosening of revision acetabular cup at the most recent follow up examination in the remaining 39 patients. Bone graft substitute was not absorbed in all of these patients. The survival after 10 years amounted to 97.56%. Conclusion Bone graft substitute Bone Save may be suitable for acetabular revision surgery, however preoperative bone defect is critical for success and determining of a surgical technique, so this is multifactorial in this challenge surgery.

Polymer Scaffolds-Enhanced Bone Regeneration in Osteonecrosis Therapy

Osteonecrosis without effective early treatment eventually leads to the collapse of the articular surface and causes arthritis. For the early stages of osteonecrosis, core decompression combined with bone grafting, is a procedure worthy of attention and clinical trial. And the study of bone graft substitutes has become a hot topic in the area of osteonecrosis research. In recent years, polymers have received more attention than other materials due to their excellent performance. However, because of the harsh microenvironment in osteonecrosis, pure polymers may not meet the stringent requirements of osteonecrosis research. The combined application of polymers and various other substances makes up for the shortcomings of polymers, and to meet a broad range of requirements for application in osteonecrosis therapy. This review focuses on various applying polymers in osteonecrosis therapy, then discusses the development of biofunctionalized composite polymers based on the polymers combined with different bioactive substances. At the end, we discuss their prospects for translation to clinical practice.

Physicochemical Properties of Torus Mandibularis and Palatinus Indicate a Source of Autogenous Bone Graft

Introduction: There has been extensive research on bone substitutes and autogenous bone; however, little is known about their physical and chemical characteristics of torus mandibularis and palatinus. In the present study, the physical and chemical properties of tori bone and bone graft substitutes were examined. Microbial contamination of torus bone collected during surgery was also investigated. Objective: To investigate the physical and chemical properties of torus mandibularis and torus palatinus, and the microbial contamination of tori bone collected during surgery. Materials and Methods: Torus mandibularis and palatinus were collected from healthy patients by regular surgical procedure via bone collector and a stringent aspiration protocol. Physicochemical properties such as surface structure, elemental components and the crystalline structure of tori and common bone grafting substitutes (OraGRAFT, BioOss, Cerabone) were examined via SEM-EDS, X-Ray Diffractometry analysis, and calcium dissolution assay. The bacterial morphology and gram staining from the torus samples after the surgery were analyzed. Results: The surface structure of tori bone differed greatly from that of bone graft substitutes. An irregular and rough surface structure was found for tori, while bone graft substitutes presented a smooth but dry pattern. Elements found within tori were similar to those within bone graft substitutes; in all cases, carbon, oxygen, sodium, magnesium, phosphate, and calcium were seen. All samples showed high crystallinity, with the highest value in Cerabone, followed by Bio-oss, torus mandibularis, torus palatinus, and Oragraft. Calcium dissolution was highest on the first day in tori samples, whereas it was constantly released until the seventh day in other bone grafts. The microbial contamination was found in all tori samples from the harvesting process, presumably due to saliva contamination. Conclusion: Tori bone was different from bone graft substitutes in terms of surface structure, crystallinity, and calcium release. However, tori bone and bone graft substitutes were similar in terms of elemental composition and crystal compounds, which may positively affect their clinical applications. Taken together, our findings suggest that with an effective decontamination, tori bone should be considered as a viable material for bone grafting, as it is not only practical but also cost-efficient for patients.

Effect of In-Mold Annealing on the Properties of Asymmetric Poly(l-lactide)/Poly(d-lactide) Blends Incorporated with Nanohydroxyapatite

The proper choice of a material system for bioresorbable synthetic bone graft substitutes imposes strict requirements for mechanical properties, bioactivity, biocompatibility, and osteoconductivity. This study aims to characterize the effect of in-mold annealing on the properties of nanocomposite systems based on asymmetric poly(l-lactide) (PLLA)/Poly(d-lactide) (PDLA) blends at 5 wt.% PDLA loading, which was incorporated with nano-hydroxyapatite (HA) at various concentrations (1, 5, 10, 15 wt.%). Samples were melt-blended and injection molded into “cold” mold (50 °C) and hot mold (100 °C). The results showed that the tensile modulus, crystallinity, and thermal-resistance were enhanced with increasing content of HA and blending with 5 wt.% of PDLA. In-mold annealing further improved the properties mentioned above by achieving a higher degree of crystallinity. In-mold annealed PLLA/5PDLA/15HA samples showed an increase of crystallinity by ~59%, tensile modulus by ~28%, and VST by ~44% when compared to neat hot molded PLLA. On the other hand, the % elongation values at break as well as tensile strength of the PLLA and asymmetric nanocomposites were lowered with increasing HA content and in-mold annealing. Moreover, in-mold annealing of asymmetric blends and related nanocomposites caused the embrittlement of material systems. Impact toughness, when compared to neat cold molded PLLA, was improved by ~44% with in-mold annealing of PLLA/1HA. Furthermore, fracture morphology revealed fine dispersion and distribution of HA at 1 wt.% concentration. On the other hand, HA at a high concentration of 15 wt.% show agglomerates that worked as stress concentrators during impact loading.

Bone Graft Substitutes in Maxillofacial Reconstruction - Structural and Biomechanical Perspectives

Reconstruction of a maxillofacial skeletal defect in the recent past has witnessed a paradigm shift in the process of treatment planning. It has now become a collaboration between the surgeon and the bioengineer to provide a customised stable reconstruction. Understanding maxillofacial skeleton from an architectural and biomechanical perspective would not only guide the surgeon in planning a reconstruction but also the bioengineer to select the biomaterial and design an ideal reconstruction. This paper intended to provide an insight into scientific concepts which needed to be considered during the designing of biomaterials for reconstruction of maxillofacial skeletal defects. Any object in the world, from a mechanical perspective is seen only as a material of varying physical and chemical (organic / inorganic) properties dwelling in a dynamic three-dimensional environment. Bone continuously has been re-modelling by adapting to the dynamic loading environment through an established force distribution pattern of equilibrium. 1 Hence, for a patient requiring reconstruction of defects of varying dimensions within the craniomaxillofacial skeleton, its architectural complexity should be seen from both the surgeon’s and bioengineer’s perspective. Such multidisciplinary approach would provide a customized comprehensive reconstructive and rehabilitative solution.