The Impact of Bioceramic Scaffolds on Bone Regeneration in Preclinical In Vivo Studies: A Systematic Review

Abstract

Bioceramic scaffolds are appealing for alveolar bone regeneration, because they are emerging as promising alternatives to autogenous and heterogenous bone grafts. The aim of this systematic review is to answer to the focal question: in critical-sized bone defects in experimental animal models, does the use of a bioceramic scaffolds improve new bone formation, compared with leaving the empty defect without grafting materials or using autogenous bone or deproteinized bovine-derived bone substitutes? Electronic databases were searched using specific search terms. A hand search was also undertaken. Only randomized and controlled studies in the English language, published in peer-reviewed journals between 2013 and 2018, using critical-sized bone defect models in non-medically compromised animals, were considered. Risk of bias assessment was performed using the SYRCLE tool. A meta-analysis was planned to synthesize the evidence, if possible. Thirteen studies reporting on small animal models (six studies on rats and seven on rabbits) were included. The calvarial bone defect was the most common experimental site. The empty defect was used as the only control in all studies except one. In all studies the bioceramic materials demonstrated a trend for better outcomes compared to an empty control. Due to heterogeneity in protocols and outcomes among the included studies, no meta-analysis could be performed. Bioceramics can be considered promising grafting materials, though further evidence is needed.

Recent Advances in the Treatment of Bone Metastases and Primary Bone Tumors: An Up-to-Date Review

“…An ideal artificial graft must be biocompatible and biodegradable while supporting osteoconduction, osteoinduction, and osteointegration [3,160]. Additionally, the grafting material should lack carcinogenicity, teratogenicity, be well-tolerated by the organism, bioresorbable, hydrophilic, non-antigenic, non-toxic, affordable, easy to manipulate, sterile or sterilizable, and have excellent biomechanical characteristics [18,161].…”

“…Intensive research has also been directed to scaffolds made of bioceramics and their composites, as they have the necessary properties for biological activity in regard to cell adhesion, migration, and proliferation. Historically, their inherently low fracture toughness and strength limited their use in load-bearing applications, but the currently known variety of bioceramics composition has allowed the adjustment of these materials' mechanical features, bioactivity, and degradation rate [160,161,180,181]. Another possibility of producing scaffolds with tailored properties is developing composites containing different bioceramics and polymers in different ratios [161,178,179].…”

“…The functionalization of the bone replacement with factors is a promising approach for attracting and stimulating cells from the surrounding host tissue after implantation, promoting osteogenic cells' ingrowth, and forming a vascular network within the implant [149]. Growth factors for promoting osteogenesis and angiogenesis can be incorporated in scaffolds, while these structures can also act as stem cell carriers for accelerating bone repair [161]. One of the most potent osteoinductive growth factors (GFs) that can enhance the properties of the bone scaffold is bone morphogenetic proteins (BMPs) [3,176,187].…”

“…One of the most potent osteoinductive growth factors (GFs) that can enhance the properties of the bone scaffold is bone morphogenetic proteins (BMPs) [3,176,187]. Other factors that can be added to bioscaffolds are PDGF, fibroblast GFs, vascular endothelial GFs, insulin-like GFs, TGF-β, IL-1, IL-6, and macrophage colony-stimulating factor [161,188]. The functionalization of the bone replacement with factors is a promising approach for attracting and stimulating cells from the surrounding host tissue after implantation, promoting osteogenic cells' ingrowth, and forming a vascular network within the implant [149].…”

Towards 3D Multi-Layer Scaffolds for Periodontal Tissue Engineering Applications: Addressing Manufacturing and Architectural Challenges

“…At present, the most widely applied biomaterials for bone scaffolds’ production include synthetic polymers (such as polycaprolactone (PCL), polylactic acid (PLA), polyglycolic acid (PGA) and polylactic-co-glycolic acid (PLGA)) [ 14 , 15 , 16 ], as well as bioceramics (such as β-tricalcium phosphate (β-TCP), hydroxyapatite (HA) and its doped alternatives) [ 17 , 18 , 19 , 20 ]. Polymeric materials have showed great promise as 3D substitutes for bone tissues, particularly for their widely demonstrated biocompatibility, biodegradability and easy processability [ 21 , 22 ]; whereas bioceramics have been mainly investigated for their similarity to the inorganic phase of native bone tissue, and thus for their positive outcomes towards osteointegration, osteoinduction and osteoconduction [ 23 ].…”