Comparison of two β-tricalcium phosphate  composite grafts used for reconstruction of  mandibular critical size bone defects

M. C. Nolff; N.-C. Gellrich; G. Hauschild; M. Fehr; K.-H. Bormann; K. Rohn; S. Spalthoff; M. Rücker; H. Kokemüller

doi:10.3415/VCOT-08-04-0038

Veterinary and Comparative Orthopaedics and Traumatology, Table of Contents

Vet Comp Orthop Traumatol 2009; 22(02): 96-102
DOI: 10.3415/VCOT-08-04-0038

Original Research

Schattauer GmbH

Comparison of two β-tricalcium phosphate composite grafts used for reconstruction of mandibular critical size bone defects

M. C. Nolff

¹Department of Oral and Maxillofacial Surgery, Hanover Medical School, Hanover, Germany

²Small Animal Clinic, University of Veterinary Medicine Hanover, Germany

,

N.-C. Gellrich

¹Department of Oral and Maxillofacial Surgery, Hanover Medical School, Hanover, Germany

,

G. Hauschild

²Small Animal Clinic, University of Veterinary Medicine Hanover, Germany

³Department of Orthopedics, University of Muenster, Muenster, Germany

,

M. Fehr

²Small Animal Clinic, University of Veterinary Medicine Hanover, Germany

,

K.-H. Bormann

¹Department of Oral and Maxillofacial Surgery, Hanover Medical School, Hanover, Germany

,

K. Rohn

⁴Department of Biometry, Epidemiology and Information Processing; University of Veterinary Medicine Hanover, Hanover, Germany

,

S. Spalthoff

¹Department of Oral and Maxillofacial Surgery, Hanover Medical School, Hanover, Germany

,

M. Rücker

¹Department of Oral and Maxillofacial Surgery, Hanover Medical School, Hanover, Germany

,

H. Kokemüller

¹Department of Oral and Maxillofacial Surgery, Hanover Medical School, Hanover, Germany

› Author Affiliations

Abstract

Summary

Objective: The aim was to compare osseointegration of blood perfused β-tricalcium phosphate cylinders (β-TCPB) with similar composites that were additionally loaded with cancellous bone and bone marrow (β-TCPB/BM/CB) for mandibular reconstruction.

Methods: Twelve German Black-Headed sheep with an average weight of 72.5 ± 10 kg underwent segmental re-section of the right hemi-mandible. The animals that were assigned to group A (n=6) were reconstructed using β-TCPB while the sheep that were assigned to group B received β-TCPB/BM/CB grafts. Tissue quality was histologically assessed and bone-, scaffold-, cartilage- and fibrous-tissue area were estimated using semiautomated histomorphometrical software.

Results: Composite grafts that were loaded with bone marrow and cancellous bone (β-TCPB/BM/CB) exhibited significant (p<0.01) higher amounts of bone formation than β-TCPB. The patients that were assigned to group B achieved defect union and a high grade of bone maturation. Residual ceramic remnants were rare and disconnected. Bone maturity within group A was inferior and none of the specimens showed defect union. The defect centre was still occupied by a ceramic core.

Clinical significance: Bone and bone marrow augmented β-tricalcium phosphate composites may qualify as a promising alternative to autograft bone for mandibular reconstruction in human and veterinary medicine.

Keywords

Mandibular continuity resection - β-tricalcium phosphate composite - bone marrow - bone graft substitute - sheep

Full Text

References

References
1 Cornell CN. Osteoconductive materials and their role as substitutes for autogenous bone grafts. Orthop Clin North Am 1999; 30: 591-598.
2 Den Boer FC, Patka P, Bakker FC. et al. Current concepts of fracture healing, delayed unions, and nonunions. Osteo Trauma Care 2002; 10: 1-7.
3 Rodriguez-Merchan EC, Forriol F. Nonunion: general principles and experimental data. Clin Orthop Relat Res 2004; 419: 4-12.
4 Rueger JM. [Bone substitution materials. Current status and prospects]. Orthopade 1998; 27: 72-79.
5 Banwart JC, Asher MA, Hassanein RS. Iliac crest bone graft harvest donor site morbidity. A statistical evaluation. Spine 1995; 20: 1055-1060.
6 Younger EM, Chapman MW. Morbidity at bone graft donor sites. J Orthop Trauma 1989; 3: 192-195.
7 Bauer TW, Muschler GF. Bone graft materials. An overview of the basic science. Clin Orthop Relat Res 2000; (371) 10-27.
8 Einhorn TA. Clinically applied models of bone regeneration in tissue engineering research. Clin Orthop Relat Res 1999; 367 (Suppl) S59-67.
9 Caplan AI, Bruder SP. Mesenchymal stem cells: building blocks for molecular medicine in the 21^stcentury. Trends Mol Med 2001; 7: 259-264.
10 Khan SN, Bostrom MP, Lane JM. Bone growth factors. Orthop Clin North Am 2000; 31: 375-388.
11 Vacanti CA, Vacanti JP. The science of tissue engineering. Orthop Clin North Am 2000; 31: 351-356.
12 Bruder SP, Fox BS. Tissue engineering of bone. Cell based strategies. Clin Orthop Relat Res 1999; 367 (Suppl) S68-83.
13 Connolly JF, Guse R, Tiedeman J. et al. Autologous marrow injection as a substitute for operative grafting of tibial nonunions. Clin Orthop Relat Res 1991; 266: 259-270.
14 Muschler GF, Nitto H, Matsukura Y. et al. Spine fusion using cell matrix composites enriched in bone marrow-derived cells. Clin Orthop Relat Res 2003; 407: 102-118.
15 Kon E, Muraglia A, Corsi A. et al. Autologous bone marrow stromal cells loaded onto porous hydro-xyapatite ceramic accelerate bone repair in critical-size defects of sheep long bones. J Biomed Mater Res 2000; 49: 328-337.
16 Bruder SP, Kurth AA, Shea M. et al. Bone regeneration by implantation of purified, culture-expanded human mesenchymal stem cells. J Orthop Res 1998; 16: 155-162.
17 Ohgushi H, Kitamura S, Kotobuki N. et al. Clinical application of marrow mesenchymal stem cells for hard tissue repair. Yonsei Med J 2004; 45 (Suppl) S61-67.
18 Lane JM, Tomin E, Bostrom MP. Biosynthetic bone grafting. Clin Orthop Relat Res 1999; 367 (Suppl) S107-117.
19 Kirker-Head CA, Gerhart TN, Schelling SH. et al. Long-term healing of bone using recombinant human bone morphogenetic protein 2. Clin Orthop Relat Res 1995; (318) 222-230.
20 Sipe JD, Kelley CA, McNicol LA. National Institutes of Health (U.S.). Bioengineering Consortium. Reparative medicine: growing tissues and organs New York: New York Academy of Sciences; 2002
21 Harlan DM, Karp CL, Matzinger P. et al. Immuno-logical concerns with bioengineering approaches. Ann N Y Acad Sci 2002; 961: 323-330.
22 Seeherman H. The influence of delivery vehicles and their properties on the repair of segmental defects and fractures with osteogenic factors. J Bone Joint Surg Am 2001; 83>–A Suppl 1(Pt 2): S79-81.
23 Tay BK, Patel VV, Bradford DS. Calcium sulfateand calcium phosphate-based bone substitutes. Mimicry of the mineral phase of bone. Orthop Clin North Am 1999; 30: 615-623.
24 Perry CR. Bone repair techniques, bone graft, and bone graft substitutes. Clin Orthop Relat Res 1999; (360) 71-86.
25 Bloemers FW, Patka P, Bakker FC. et al. The use of calcium phosphates as a bone substitute material in trauma surgery. Osteo Trauma Care 2002; 10: 33-37.
26 Ayoub AF, Richardson W, Koppel D. et al. Segmental mandibular reconstruction by microincre-mental automatic distraction osteogenesis: an animal study. Br J Oral Maxillofac Surg 2001; 39: 356-364.
27 Schmitz JP, Hollinger JO. The critical size defect as an experimental model for craniomandibulofacial nonunions. Clin Orthop Relat Res 1986; (205) 299-308.
28 Fleming Jr. JE, Cornell CN, Muschler GF. Bone cells and matrices in orthopedic tissue engineering. Orthop Clin North Am 2000; 31: 357-374.
29 Goldstein SA. Tissue engineering: functional assessment and clinical outcome. Ann N Y Acad Sci 2002; 961: 183-192.
30 Connolly JF, Guse R, Tiedeman J. et al. Autologous marrow injection for delayed unions of the tibia: a preliminary report. J Orthop Trauma 1989; 3: 276-282.
31 Caplan AI. Tissue engineering designs for the future: new logics, old molecules. Tissue Eng 2000; 6: 1-8.
32 Jaiswal N, Haynesworth SE, Caplan AI. et al. Osteogenic differentiation of purified, culture-expanded human mesenchymal stem cells in vitro. J Cell Biochem 1997; 64: 295-312.
33 Bruder SP, Jaiswal N, Ricalton NS. et al. Mesenchymal stem cells in osteobiology and applied bone regeneration. Clin Orthop Relat Res 1998; (Suppl. 355) S247-256.
34 Bucholz RW. Clinical experience with bone graft substitutes. J Orthop Trauma 1987; 1: 260-262.
35 Cornell CN, Lane JM. Current understanding of osteoconduction in bone regeneration. Clin Orthop Relat Res 1998; (Suppl. 355) S267-273.
36 Damien CJ, Ricci JL, Christel P. et al. Formation of a calcium phosphate-rich layer on absorbable calcium carbonate bone graft substitutes. Calcif Tissue Int 1994; 55: 151-158.
37 Delloye C, Verhelpen M, d'Hemricourt J. et al. Morphometric and physical investigations of segmental cortical bone autografts and allografts in canine ulnar defects. Clin Orthop Relat Res 1992; (282) 273-292.
38 Eggli PS, Muller W, Schenk RK. Porous hydro-xyapatite and tricalcium phosphate cylinders with two different pore size ranges implanted in the cancellous bone of rabbits. A comparative histomorphometric and histologic study of bony in-growth and implant substitution. Clin Orthop Relat Res 1988; (232) 127-138.
39 Jensen SS, Broggini N, Hjorting-Hansen E. et al. Bone healing and graft resorption of autograft, an-organic bovine bone and beta-tricalcium phosphate. A histologic and histomorphometric study in the mandibles of minipigs. Clin Oral Implants Res 2006; 17: 237-243.