Onlay Bone Graft Behaviour After Marrow Exposure of the Recipient Rat Skull Bone

Abstract

This study aimed to evaluate the effects on incorporation of onlay grafts after exposure of the marrow of the skull recipient bed. Tibial or femoral uni- and bicortical bone grafts were positioned subperiosteally or submuscularly in the parietal and temporal region, respectively, of 28 adult rats. The recipient bed was ground to remove the external cortical layer and expose the underlying marrow. The outcome was assessed after four, 12, and 20 weeks by routine histology and immunohistochemical labelling for various bone and cartilage proteins. Marrow exposure resulted in an explosive bone formation, prompt graft incorporation, earlier onset of bone remodelling, but also localized resorption at the host bed due to increased vulnerability to pressure. Graft height loss was similar relative to previous observations by us using the same experimental model but without exposure of the marrow. The investigated proteins were identified at various locations and with different temporal sequences; the technique contributed to a diversified appreciation of graft behaviour. The findings emphasize the essential role of the bone marrow constituents to bone graft incorporation.

Mechanisms of Guided Bone Regeneration: A Review

“…This is called decortication or bone marrow penetration [28]. The rationale may include: (1) to enhance the healing process by promoting bleeding and blood clot formation; (2) to allow progenitor cells and blood vessels to reach the bone graft site [67, 134, 135] which facilitate angiogenesis; and (3) to improve the physical interlocking of grafted bone and a recipient site [136-138]. However, bone marrow penetration may also have some negative effects; additional blood loss, potentially greater postoperative pain, increased bone loss, and increased operative time [139].…”

The Role of Bone Decortication in Enhancing the Results of Guided Bone Regeneration: A Literature Review

“…Perforating the bony cortex also may increase the mechanical interlocking of a bone graft and a recipient site, which may improve its stability and provide firm linking for newly regenerated bone 15,16 . Concerning monocortical bone blocks, it usually takes 4 to 5 months for them to bond with native bone 64 .…”

“…Decortication is done ostensibly to enhance the healing process by promoting bleeding and allowing progenitor cells and blood vessels to reach a bone‐grafted site more readily 6–12 . In addition, decortication may improve the physical bond between grafted bone and a recipient site 15,16 . However, there is controversy in the dental literature with respect to the usefulness of this procedure because its ability to accelerate or increase bone regeneration has not been substantiated in human clinical trials, and there are conflicting results derived from animal studies.…”

Immunohistochemical, tomographic, and histological study on onlay bone graft remodeling. Part III: allografts

“…Several studies on autografts (AUg) have shown the importance of bone microarchitecture, embryonic origin, type of installation (“inlay” or “onlay”), periosteum presence, recipient bed preparation, revascularization rate, and graft fixation methods to assure the success of grafting technique (Alberius et al. ; Stevenson et al. ; Alberius & Gordh ; Ozaki & Buchman ; Buchman & Ozaki ; Tong & Buchman ; Khan et al.…”