A Comparison of Mineral Bone Graft Substitutes for Bone Defects

Abstract

Cavitary bone defects are created in the curettage or debridement of benign bone tumors, infections, or low-grade malignancies. In order for new bone to fill these defects, the material that resides within must be osteoconductive, or an appropriate scaffolding that prevents non-osseous (fibrous) tissue infiltration, supports the attachment of new osteoblasts and osteoprogenitor cells, and sustains an interconnected structure through which new cells can migrate and new vessels can form. 1The subsequent substance that develops through this osteoconductive step must also be osteoinductive (facilitate the travel of factors and materials for cellular differentiation) and osteogenic (cause the cellular production of new bone) for new bone to form. 1 Current US consensus dictates that in order for this cascade to develop in a bone defect, a graft must be used. In fact, over 500,000 bone graft procedures are performed annually in the US.2 In order to meet the first and crucial step of osteoconductivity, the graft must fill the void and provide a scaffolding on which stem cells can attach;in order to facilitate the next two critical steps, the graft must be non-inflammatory and non-toxic and resorb at a rate roughly equal to that of bone formation. Prospective randomized clinical trials in the treatment of bone tumors are necessary to properly delineate the real indications for bone grafting and to demonstrate the graft's efficacy in this regard. KeywordsMineral ceramic bone graft substitute, bone defect, bone void Disclosure:The authors have no conflicts of interest to declare.

Use of Calcium Sulfate as a Biomaterial in the Treatment of Bone Fractures in Rabbits – Preliminary Studies

“…Moreover, CS is used as an ingredient in composite biomaterials, whose addition can significantly improve their clinical effectiveness (1, 4, 7 8, 13). Studies of the CS resorption into a bone defect also indicate other beneficial properties, not always displayed by other available biomaterials, such as promotion of angiogenesis (1,12). The biomaterial facilitates the process of osteogenesis and prevents interposition of the connective tissue into the defect area.…”

“…Compared to the previously used type β, the structure of type α gypsum offers better mechanical properties, such as compressive strength and tensile strength. Lower porosity and longer time needed to bond with water result in the lowering of the resorption rate of the type α of CS, which makes it more compatible with the natural rate of the bone consolidation (1,14,16).…”

“…Autogenous bone graft is still regarded as a "gold standard", but due to its limitation, the use of synthetic bone substitutes with properties similar to natural osseous tissue is increasing rapidly (1,2,15). One of the first materials used in the bone reconstruction is calcium sulfate (gypsum, CS), applied in medicine for over 100 years as a resorbable biomaterial for bone grafting.…”

“…Furthermore, CS is a material with high surgical flexibility and its physical properties: hygroscopicity and plasticity allow its easy application in the filling of the bony defect in small animals, without the risk of biomaterial displacement to surrounding soft tissue. These properties make CS a valuable biomaterial in veterinary orthopedics, in both pure form and as a constituent of the composite biomaterials (1,3,4,7). The aim of the study was to evaluate the application of Hartform HF1 gypsum in the treatment of experimental bone fractures in rabbits.…”

Knochenersatzwerkstoffe als lokale Wirkstoffträger

“…However, such a customized addition of antibiotics places the surgeon in a situation of a manufacturer where he assumes liability for the product. Calciumphosphat (CP) 0,5-10 Jahre Hoch [41] Tricalciumphosphat (TCP) 0,5-1,5 Jahre Mittel [2] Hydroxylapatit (HA) amorph 0,5-1 Jahr Hoch [63] Hydroxylapatit (HA) gesintert >10 Jahr Hoch [63] Empfehlenswert ist immer eine vorherige Diskussion mit Mikrobiologen und Apothekern, bevor eine Entscheidung ad hoc in der intraoperativen Situation gefällt wird, welche Wirkstoffe eingesetzt werden sollen. Abb.…”