Demineralized Bone Matrix Carriers and their Clinical Applications: An Overview

Abstract

Reconstruction of massive bone defects is challenging for orthopaedic clinicians, especially in cases of severe trauma and resection of tumors in various locales. Autologous iliac crest bone graft (ICBG) is the “gold standard” for bone grafting. However, the limited availability and complications at donor sites resulted in seeking other options like allografts and bone graft substitutes. Demineralized bone matrix (DBM) is a form of allograft using acidic solution to remove mineral components, while leaving much of the proteinaceous components native to bone, with small amounts of calcium‐based solids, inorganic phosphates, and some trace cell debris. It is an osteoconductive and osteoinductive biomaterial and is approved as a medical device for use in bone defects and spinal fusion. To pack consistently into the defect sites and stay firmly in the filling parts, DBM products have various forms combined with biocompatible viscous carriers, including sponges, strips, injectable putty, paste, and paste infused with chips. The present review aims to summarize the properties of various kind of viscous carriers and their clinical use combined with DBM in commercially available products. Given DBM'mercially available products. Given DBM;s long clinical track record and commercial accessibility in standard forms, opportunities to further develop and validate DBM as a versatile bone biomaterial in orthopaedic repair and regenerative medicine contexts are attractive.

Recombinant collagen polypeptide as a versatile bone graft biomaterial

“…The interconnecting porosity increases the surface area of these grafting materials and is considered beneficial for bone ingrowth 7 . Demineralized bone allograft is a biodegradable natural polymer primarily composed of bone collagen ECM, which provides a scaffold for cellular migration and tissue regeneration 8 .…”

Caprine demineralized bone matrix (DBMc) in the repair of non-critical bone defects in rabbit tibias. A new bone xenograft

“…Although particulate biomaterial has been used, no standardized granulometry was established, being considered a limitation of this study. The lack of a carrier for the demineralized bone matrix implant made manipulation of the biomaterial difficult during surgical implantation and some tissue may have lost into the marrow cavity 5,23 . Pure particulate biomaterial was used to preserve the characteristics of the demineralized bone matrix, since the addition of carrier substances may alter activity 24 .…”

“…Despite microCT has provided information needed to accomplish the objectives of the present study, a histopathological analysis could have added more accuracy in the assessment of cicatricial process and sensitivity for differentiating tissues, in spite of its two-dimensional feature 36 . Additionally, it is believed that the addition of a carrier and granulometry standardization, could have helped fixing the biomaterial into the receiver bone site and reducing the surface of contact of the biomaterial 5 , 13 , 23 .…”

Decellularized adipose matrix provides an inductive microenvironment for stem cells in tissue regeneration

“…Bone has significant capacity of regeneration, but patients with large-scale bone defects need surgical autogenous bone transplantation, which causes damage and infection of the donor site[ 120 - 122 ]. Artificial composite scaffolds are poorly biocompatible and cannot support vascular regeneration and bone tissue growth[ 122 ], while the source of acellular bone tissue is insufficient to meet clinical needs[ 123 , 124 ]. Mohiuddin et al[ 125 ] used DAM hydrogels to treat C57BL/6 mice for critical size repair of femoral defects.…”