Development of a bioactive implant for repair and potential healing of cranial defects

Engstrand, Thomas; Kihlström, Lars; Neovius, Erik; Skogh, Ann-Charlott Docherty; Lundgren, Ted; Jacobsson, Hans; Bohlin, Jan; Åberg, Jonas; Engqvist, Håkan

doi:10.3171/2013.6.jns1360

Cited by 52 publications

(53 citation statements)

References 25 publications

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“…To overcome unpredictable cranial implant shape, Engstrand et al 28 proposed a calcium phosphate cranial implant reinforced with a titanium mesh. Vital bone inside the mesh was observed 50 months after surgery in a follow-up study in 2 patients.…”

Section: Discussionmentioning

confidence: 99%

BMP-7 Preserves Surface Integrity of Degradable-ceramic Cranioplasty in a Göttingen Minipig Model

Roldán

Schulz

Klünter

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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Background:The aim of the study was to evaluate the integrity of a craniotomy grafted site in a minipig model using different highly porous calcium phosphate ceramic scaffolds either loaded or nonloaded with bone morphogenetic protein-7 (BMP-7).Methods:Four craniotomies with a diameter of 15 mm (critical-size defect) were grafted with different highly porous (92–94 vol%) calcium phosphate ceramics [hydroxyapatite (HA), tricalcium phosphate (TCP), and biphasic calcium phosphate (BCP; a mixture of HA and TCP)] in 10 Göttingen minipigs: (a) group I (n = 5): HA versus BCP; (b) group II (n = 5): TCP versus BCP. One scaffold of each composition was supplied with 250 μg of BMP-7. In vivo computed tomography scan and fluorochrome bone labeling were performed. Specimens were evaluated 14 weeks after surgery by environmental scanning electron microscopy, fluorescence microscopy, and Giemsa staining histology.Results:BMP-7 significantly enhanced bone formation in TCP (P = 0.047). Slightly enhanced bone formation was observed in BCP (P = 0.059) but not in HA implants. BMP-7 enhanced ceramic degradation in TCP (P = 0.05) and BCP (P = 0.05) implants but not in HA implants. Surface integrity of grafted site was observed in all BMP-7-loaded implants after successful creeping substitution by the newly formed bone. In 9 of 10 HA implants without BMP-7, partial collapse of the implant site was observed. All TCP implants without BMP-7 collapsed. Fluorescent labeling showed bone formation at week 1 in BMP-7-stimulated implants.Conclusions:BMP-7 supports bone formation, ceramic degradation, implant integration, and surface integrity of the grafted site.

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Section: Discussionmentioning

confidence: 99%

BMP-7 Preserves Surface Integrity of Degradable-ceramic Cranioplasty in a Göttingen Minipig Model

Roldán

Schulz

Klünter

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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“…Some consider CaP a tissue engineering scaffold and have observed limited resorption and/or support of new cranial bone growth and remodeling, perhaps in children; 39 others, however, have seen no such resorption. 4 In either case, these malleable ceramic alloplastic materials are extremely brittle and are largely used to fill minor gaps in the skull.…”

Section: Advances In Alloplastic Bone Substitutes For Cranial Repairmentioning

confidence: 99%

The Recent Revolution in the Design and Manufacture of Cranial Implants

et al. 2015

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Large format (i.e., > 25 cm2) cranioplasty is a challenging procedure not only from a cosmesis standpoint, but also in terms of ensuring that the patient's brain will be well-protected from direct trauma. Until recently, when a patient's own cranial flap was unavailable, these goals were unattainable. Recent advances in implant Computer Aided Design and 3-D printing are leveraging other advances in regenerative medicine. It is now possible to 3-D-print patient-specific implants from a variety of polymer, ceramic, or metal components. A skull template may be used to design the external shape of an implant that will become well integrated in the skull, while also providing beneficial distribution of mechanical force distribution in the event of trauma. Furthermore, an internal pore geometry can be utilized to facilitate the seeding of banked allograft cells. Implants may be cultured in a bioreactor along with recombinant growth factors to produce implants coated with bone progenitor cells and extracellular matrix that appear to the body as a graft, albeit a tissue-engineered graft. The growth factors would be left behind in the bioreactor and the graft would resorb as new host bone invades the space and is remodeled into strong bone. As we describe in this review, such advancements will lead to optimal replacement of cranial defects that are both patient-specific and regenerative.

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“…Indeed, the incorporation of HA nanoparticles into polymer scaffolds has been shown to increase protein adsorption, cell attachment and migration, and osteogenesis . Building on this, Engstrand et al (2014) described an eloquent computer-aided design method of using a mosaic of calcium phosphate bioceramic tiles supported by titanium wires in the repair of complex cranial defects.…”

Section: Bioactive Ceramics and Glassmentioning

confidence: 99%

Biomaterials for Craniofacial Bone Engineering

et al. 2014

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Conditions such as congenital anomalies, cancers, and trauma can all result in devastating deficits of bone in the craniofacial skeleton. This can lead to significant alteration in function and appearance that may have significant implications for patients. In addition, large bone defects in this area can pose serious clinical dilemmas, which prove difficult to remedy, even with current gold standard surgical treatments. The craniofacial skeleton is complex and serves important functional demands. The necessity to develop new approaches for craniofacial reconstruction arises from the fact that traditional therapeutic modalities, such as autologous bone grafting, present myriad limitations and carry with them the potential for significant complications. While the optimal bone construct for tissue regeneration remains to be elucidated, much progress has been made in the past decade. Advances in tissue engineering have led to innovative scaffold design, complemented by progress in the understanding of stem cell-based therapy and growth factor enhancement of the healing cascade. This review focuses on the role of biomaterials for craniofacial bone engineering, highlighting key advances in scaffold design and development.

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Development of a bioactive implant for repair and potential healing of cranial defects

Cited by 52 publications

References 25 publications

BMP-7 Preserves Surface Integrity of Degradable-ceramic Cranioplasty in a Göttingen Minipig Model

BMP-7 Preserves Surface Integrity of Degradable-ceramic Cranioplasty in a Göttingen Minipig Model

The Recent Revolution in the Design and Manufacture of Cranial Implants

Biomaterials for Craniofacial Bone Engineering

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