A New Anorganic Equine Bone Substitute for Oral Surgery: Structural Characterization and Regenerative Potential

Abstract

Different xenogeneic inorganic bone substitutes are currently used as bone grafting materials in oral and maxillo-facial surgery. The aim of the present study was to determine the physicochemical properties and the in vivo performance of an anorganic equine bone (AEB) substitute. AEB is manufactured by applying a process involving heating at >300 °C with the aim of removing all the antigens and the organic components. AEB was structurally characterized by scanning electron microscopy (SEM), X-ray diffraction (XRD), X-ray fluorescence (XRF), and Fourier-transformed infrared (FT-IR) spectroscopy and compared to the anorganic bovine bone (ABB). In order to provide a preliminary evaluation of the in vivo performance of AEB, 18 bone defects were prepared and grafted with AEB (nine sites), or ABB (nine sites) used as a control, in nine Yucatan Minipigs. De novo bone formation, residual bone substitute, as well as local inflammatory and tissue effects were histologically evaluated at 30 and 90 days after implantation. The structural characterization showed that the surface morphology, particle size, chemical composition, and crystalline structure of AEB were similar to cancellous human bone. The histological examination of AEB showed a comparable pattern of newly formed bone and residual biomaterial to that of ABB. Overall, the structural data and pre-clinical evidence reported in the present study suggests that AEB can be effectively used as bone grafting material in oral surgery procedures.

Horizontal GBR with anorganic equine bone combined with a customized titanium mesh

“…Addis et al 4 showed that anorganic equine bone exhibits morpho‐structural characteristics similar to those of bovine anorganic bone. 4 In the study by Poli et al., 33 13 patients undergoing alveolar ridge reconstruction prior to implant placement were treated using a titanium mesh and a combination of autologous bone and deproteinized bovine anorganic bone.…”

“…Addis et al 4 showed that anorganic equine bone exhibits morpho‐structural characteristics similar to those of bovine anorganic bone. 4 In the study by Poli et al., 33 13 patients undergoing alveolar ridge reconstruction prior to implant placement were treated using a titanium mesh and a combination of autologous bone and deproteinized bovine anorganic bone. In 92.30% of the patients, the postoperative course was uneventful, and all patients achieved a sufficient increase in the thickness of the alveolar crest, allowing for proper placement of the planned dental implants.…”

“…GBR involves the use of a grafting material (e.g., autologous bone, heterologous bone substitutes, and synthetic materials) used as scaffold for the regeneration of the missing bone, and membranes acting as physical barriers to the external environment. This barrier prevents the migration of epithelial and/or connective tissues into the bone defect 1 as well as potentially pathogenic agents that could cause infections 2,3 in the newly formed bone 4–6 . Moreover, membranes have the important tasks to contain the grafting material, stabilizing it, and providing a “tent” effect avoiding the premature resorption of the graft due to mechanical stresses 7 .…”

“…This barrier prevents the migration of epithelial and/or connective tissues into the bone defect 1 as well as potentially pathogenic agents that could cause infections 2 , 3 in the newly formed bone. 4 , 5 , 6 Moreover, membranes have the important tasks to contain the grafting material, stabilizing it, and providing a “tent” effect avoiding the premature resorption of the graft due to mechanical stresses. 7 Different types of membranes can be used in GBR, and they can be classified as resorbable or nonresorbable, accordingly to the different materials they are made of.…”

Advanced Materials for Oral Application

“…Anorganic equine bone has been recently introduced as an alternative for bone grafting, used in oral surgery for volume preservation and for augmentation purposes. The aim of the study performed by Addis et al [ 5 ] was to assess the physicochemical and structural properties of anorganic equine bone and its in vivo performance in mandibular bony defects. The study confirmed that its structural and physicochemical properties match the typical features of heat-treated xenogeneic bone substitutes, and its use as a grafting material yielded bone formation with no presence of inflammatory cell infiltrate [ 5 ].…”