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Abstract

Bone reconstruction is still a matter of concern in middle ear surgery despite the large number of surgical techniques proposed. Combination of biphasic calcium phosphate bioceramics with human fibrin sealant forms a moldable material easy to apply for bone reconstruction. Since 1986, we have been using this composite for reconstruction of mastoid cavities during chronic otitis media surgery. Granules of ceramic provide immediate mechanical stability and later on, promote osseoinduction when fibrin sealant forms a strong bond between granules enhancing the wound healing process. After checking feasibility, efficacy and tolerance through a controlled study on dogs by filling mastoid cavities, we started a clinical series comprising yet 66 mastoid reconstructions. A retrospective data analysis on 63 patients with an average follow up of 42 months including 12 histological controls confirms the stability of bone reconstruction with a remarkable tolerance of the skin in contact. Biopsies confirmed progressive replacement of material by lamellar newly formed bone. Mastoid cavities have a randomed shape making complex bone reconstruction procedure and their filling by the composite constitutes an easy way and represents a highly satisfactory procedure. The authors considered that this should be explored in other indications of bone surgery.

Calcium Phosphate-Based Osteoinductive Materials

“…12,60 Current dental and medical applications of CaP biomaterials include repair of periodontal defects, augmentation of alveolar bone, sinus lifts, tooth replacement, repair of large bone defects caused by tumors, spine fusion, and ear and eye implants. [61][62][63][64][65][66][67][68] CaPs are used as scaffolds in tissue engineering for bone or dentin regeneration [69][70][71][72][73] or delivery systems for drugs [73][74][75][76][77] or antibacterial agents. [78][79][80][81] CaPs are used in the form of injectable cements 17,[82][83][84] or as coatings on titanium and titanium alloy implants [85][86][87][88][89] to combine the bioactivity of the CaP and the strength of the metal.…”

Calcium Orthophosphate-Containing Biocomposites and Hybrid Biomaterials for Biomedical Applications

“…The 3D mesh of fibrin sealant interpenetrates the macro- and micro-porous structure of CaPO 4 ceramics. The physical, chemical and biological properties of CaPO 4 bioceramics and the fibrin glue might be cumulated in biocomposites, suitable for preparation of advanced bone grafts [ 791 , 792 , 793 , 794 , 795 , 796 , 797 ].…”

Biphasic Calcium Phosphate Ceramics for Bone Regeneration and Tissue Engineering Applications

“…BCP ceramics have been considered to be a promising scaffold for use with tissue engineering strategies for large bone defect reconstruction. With the aim of improving their osteogenic potential and mechanical properties, such scaffolds have been mixed with autografts, fibrin, platelet concentrate, several growth factors, cytokines and more recently with expanded cells isolated from several tissues [6,9,17,46,52,53,54,55]. …”

“…Its biocompatibility, safety, predictability, unlimited availability, lower morbidity for the patient and cost effectiveness represent important advantages over autografts and allografts [3,5] and make them a good choice for reconstructive surgery, orthopaedics, dentistry, maxillo and craniofacial surgeries, spinal arthrodesis and neurosurgery [3,5,6,7,8,9,10,11,12,13]. …”