Bone substitutes: a review of their characteristics, clinical use, and perspectives for large bone defects management

Abstract

Bone replacement might have been practiced for centuries with various materials of natural origin, but had rarely met success until the late 19th century. Nowadays, many different bone substitutes can be used. They can be either derived from biological products such as demineralized bone matrix, platelet-rich plasma, hydroxyapatite, adjunction of growth factors (like bone morphogenetic protein) or synthetic such as calcium sulfate, tri-calcium phosphate ceramics, bioactive glasses, or polymer-based substitutes. All these substitutes are not suitable for every clinical use, and they have to be chosen selectively depending on their purpose. Thus, this review aims to highlight the principal characteristics of the most commonly used bone substitutes and to give some directions concerning their clinical use, as spine fusion, open-wedge tibial osteotomy, long bone fracture, oral and maxillofacial surgery, or periodontal treatments. However, the main limitations to bone substitutes use remain the management of large defects and the lack of vascularization in their central part, which is likely to appear following their utilization. In the field of bone tissue engineering, developing porous synthetic substitutes able to support a faster and a wider vascularization within their structure seems to be a promising way of research.

Hydrolytic degradation and cytotoxicity of poly(lactic‐co‐glycolic acid)/multiwalled carbon nanotubes for bone regeneration

“…The rapid advance of tissue engineering has meant that certain biodegradable and biocompatible polymers such as poly( l ‐lactide) (PLLA), polycaprolactone (PCL), poly( l ‐lactide ‐co ‐caprolactone) (PLCL), and poly( l ‐lactide ‐co ‐glycolide) (PLGA) are now used to produce scaffolds for the regeneration of bone tissue . Scaffold production is relatively easy with these polymers using different techniques: thermally induced phase separation (TIPS), particulate‐leaching techniques, and electrospinning, and so on.…”

In vitro and in vivo osteogenic potential of niobium‐doped 45S5 bioactive glass: A comparative study

“…In vivo experiments were performed in order to analyze the properties of osteoconductivity and osteostimulation of Nb‐containing glass. Osteoconductivity is often referred in the biomaterial literature as the capacity of a material to allow bone to grow onto its surface (Fernandez de Grado, Keller, Idoux‐Gillet, et al, ). Despite this definition correctly describing the event, it does not explain exactly how it happens.…”

Cell Attachment and Osteoinductive Properties of Tissue Engineered, Demineralized Bone Fibers for Bone Void Filling Applications

“…This category of graft has typically been manufactured to contain porosity similar to bone, but may lack other desirable surface properties, such as hydrophilicity or a rough surface on which cells can attach. Synthetic bone substitutes have gained popularity due to reduced cost and ready availability; however, they may have mismatched resorption rates compared to bone and generally lack osteogenic and osteoinductive properties [8]. Some synthetics, such as recombinant human BMP-2, depend almost solely upon osteoinductivity and often result in rapid bone formation.…”