Osteointegration of porous absorbable bone substitutes: A systematic review of the literature

Abstract

Biomaterials’ structural characteristics and the addition of osteoinductors influence the osteointegration capacity of bone substitutes. This study aims to identify the characteristics of porous and resorbable bone substitutes that influence new bone formation. An Internet search for studies reporting new bone formation rates in bone defects filled with porous and resorbable substitutes was performed in duplicate using the PubMed, Web of Science, Scielo, and University of São Paulo Digital Library databases. Metaphyseal or calvarial bone defects 4 to 10 mm in diameter from various animal models were selected. New bone formation rates were collected from the histomorphometry or micro-CT data. The following variables were analyzed: animal model, bone region, defect diameter, follow-up time after implantation, basic substitute material, osteoinductor addition, pore size and porosity. Of 3,266 initially identified articles, 15 articles describing 32 experimental groups met the inclusion criteria. There were no differences between the groups in the experimental model characteristics, except for the follow-up time, which showed a very weak to moderate correlation with the rate of new bone formation. In terms of the biomaterial and structural characteristics, only porosity showed a significant influence on the rate of new bone formation. Higher porosity is related to higher new bone formation rates. The influence of other characteristics could not be identified, possibly due to the large variety of experimental models and methodologies used to estimate new bone formation rates. We suggest the inclusion of standard control groups in future experimental studies to compare biomaterials.

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“…A variety of calcium and ceramic bone graft void fillers have been used to not only promote osseointegration but also as a drug delivery carrier. However, the success of bone graft in osteointegration and antibiotic release can be correlated with the porosity of bone graft substrate [24,25]. Several highly porous CPbased bone void fillers have been shown effective for both in vitro drug release and in vivo infection protection and osseointegration.…”

Bone Xenografts in Trauma and Orthopaedics (Analytical Review)

“…-модификация исходного ксеноматрикса (развитие технологии очистки, изменение структуры и химического состава матрикса кости) [58,59,60,61,62,63,64,65,66,67,68];…”

“…Импрегнация биологически активными веществами Факторы роста [41,42,43,44,45] Антибиотики [46,47] Антибиотики + Факторы роста [48] Бисфосфонаты [49] Плазма, обогащенная тромбоцитами [50] Тканевая инженерия Обогащение ксеноматрикса стволовыми клетками [51,52,53,54,55,56,57] Химическая модификация ксеноматрикса Включение ионов фтора [58] Включение ионов хлора [59] Включение ионов магния [60] Химическая сшивка биополимеров [61] Физическая модификация ксеноматрикса Изменение пористости [62,63] Изменение кристалличности [64] Совершенствование технологии очистки Депротеинизация [65] Извлечение липидов [66] Новые источники ксеноматериала Роговая кость [67] Кролики, лошадь [68] Выполненный анализ показал, что костнопластические материалы ксеногенного происхождения в настоящее время в практической травматологии и ортопедии используются при лечении ограниченного спектра патологий, в отличие от челюстно-лицевой хирургии и стоматологии, где накоплен большой опыт применения этих материалов для замещения костных дефектов, а также сформированы собственные протоколы имплантации. Тем не менее, можно ожидать рост востребованности ксеноматериалов в травматологии и ортопедии, связанный с увеличением клинического спроса на костнопластические материалы, который, в частности, вызван увеличением числа ревизионных операций эндопротезирования, требующих восполнения недостатка костной ткани.…”

Fabrication of carbonate apatite honeycomb and its tissue response

“…An interconnected porous structure is attractive for bone substitutes because bone tissue and cells can penetrate the bone substitute . Furthermore, microporous structure should play an important role in cell growth and differentiation, similar to the niche environment or microenvironment produced by the extracellular matrix .…”

“…An interconnected porous structure is attractive for bone substitutes because bone tissue and cells can penetrate the bone substitute. [17][18][19][20][21][22][23][24][25] Furthermore, microporous structure should play an important role in cell growth and differentiation, similar to the niche environment or microenvironment produced by the extracellular matrix. [26][27][28][29][30][31][32][33] Among many porous structures available, the honeycomb (HC) structure is unique due to its fully interconnected and oriented pores having the same pore size, [34][35][36][37][38][39] and shows high mechanical strength in the direction of the pores.…”