The application of bone graft substitutes for alveolar ridge preservation after orthodontic extractions and for augmentation of residual cleft defects

The use of bone substitute materials in orthodontics is to be considered prior to orthodontic space closure after tooth extraction during the treatment of marked crowding as well as for treatment of residual defects in cleft-lip-and-palate children. In both cases the common objective is structure preservation or augmentation of the alveolar ridge. The demands to be made on the synthetic bone graft substitute comprise not just complication-free and safe use but also the chance of early tooth movement into the treated defect area with sufficient stability of the new tooth position

Bone graft substitutes in periodontal and peri-implant bone regeneration

Regenerative medicine provides different therapy alternatives alongside gold standard autogenous grafts for the treatment of periodontal or peri-implant osseous defects. Continuing progress in the field of alloplastic bone substitutes has yielded promising solutions to the appropriate indications with the membrane technique either alone or in combination with enamel matrix derivatives. Their clinical outcomes, however, still require critical discussion

The clinical application of a new synthetic bone grafting material in oral and maxillofacial surgery

A novel bone formation material based on hydroxyapatite-xerogel is presented. With the use of the innovative sol-gel technology this material is produced in the low-temperature range by the addition of silicon dioxide; in its structure it mimics to a great extent the natural bone matrix. This results in high osteoconductivity and an osteoprotective effect as well as in complete biodegradation corresponding to bone formation in the course of natural bone remodelling. Two case reports are presented

The manufacture of synthetic non-sintered and degradable bone grafting substitutes

A new synthetic bone grafting substitute (NanoBone®, ARTOSS GmbH, Germany) is presented. This is produced by a new technique, the sol-gel-method. This bone grafting substitute consists of nanocrystalline hydroxyapatite (HA) and nanostructured silica (SiO2). By achieving a highly porous structure good osteoconductivity can be seen. In addition, the material will be completely biodegraded and new own bone is formed. It has been demonstrated that NanoBone® is biodegraded by osteoclasts in a manner comparable to the natural bone remodelling process

The biodegradation of hydroxyapatite bone graft substitutes in vivo

Hydroxyapatite (HA) ceramics are widely used for bone reconstruction. They are osteoconductive and serve as structural scaffolds for the deposition of new bone. Generally, scaffold materials should be degradable as they affect the mechanical properties of the reconstructed bone negatively. Degradation by osteoclasts during the bone remodelling process is desirable but often does not take place. In the current study we analysed by light microscopy the degradation of two granular HA implants in critically sized defects in the mandibula of Goettingen mini-pigs five weeks after implantation. Bio-Oss® consists of sintered bovine bone and NanoBone® is a synthetic HA produced in a sol-gel process in the presence of SiO2. We found that both biomaterials were degraded by osteoclasts with ruffled borders and acid phosphatase activity. The osteoclasts created resorption lacunae and resorptive trails and contained mineral particles. Frequently, resorption surfaces were in direct contact with bone formative surfaces on one granule. Granules, especially of NanoBone®, were also covered by osteoclasts if located in vascularised connective tissue distant from bone tissue. However, this usually occurred without the creation of resorption lacunae. The former defect margins consisted of newly formed bone often without remnants of bone substitutes. Our results show that the degradation of both biomaterials corresponds to the natural bone degradation processes and suggest the possibility of complete resorption during bone remodelling

Bone functions and the requirements for bone grafts and substitutes in the orofacial region

Bone is the largest calcium storage, has distinctive plasticity and adaptability and is part of the supporting tissue. An adequate composition is thus necessary. The bone matrix consists of organic and anorganic structures. Osteoblasts, osteoclasts and osteocytes are responsible for bone formation, resorption and metabolism. The periosteum, endosteum and bone tissue are a functional unit and provide protection, nutrition and growth. Bone is subject to continuous remodelling

Wound management after the application of bone grafting substitutes in the orofacial region

Surgical dressing after the application of bone grafting material depends on the type and size of the defect. A complete and tension-free wound closure has proved to be successful. In this context the infection problem needs special attention. Bone graft substitutes with an adequate surface structure, porosity and chemical properties, in combination with sufficient blood circulation, hold osteoconductive potential. They serve as a guide rail for the osteoblast-induced formation of new bone tissue, which at best may lead to complete replacement of the grafting material

Critical considerations on the diagnostic appraisal, adaptation and remodelling of bone graft substitutes

The diagnostic assessment of skeletal defects has a long-standing tradition. As a result of the development of new bone grafting materials, the demands on diagnostic assessment have also increased. The mode and quality of diagnostic appraisal are crucial to further clinical use and outcome prediction. Alongside traditional clinical and biological techniques, molecular biological methods have gained a broad scope of application and will be used even more frequently in the future

The influence of procarbazine and thiocyanate on embryonic bone maturation

The substance procarbazine (Natulan®) is a teratogen known to induce cleft palates in rats on day 14 post-conception. The application of thiocyanate (SCN-) alone to rats on day 10 and 14 of pregnancy had no effects on fetal bone maturation. However, when procarbazine was used, the maturation and growth of fetal bones was delayed. Upon additional application of thiocyanate, the effects of procarbazine (Natulan¿) were increased. Thus, no antiteratogenic effect of thiocyanate occurs. We propose that charge and metabolites of teratogenic agents play a key role in developing the effects of thiocyanate