Clinical application of osteoinductive implants in craniofacial surgery

Abstract

Autolyzed, antigen-extracted, allogeneic bone (AAA bone) is prepared from cortical bones of human organ donors. AAA bone possesses osteoinductive properties as it delivers BMPs from its bone matrix. Within a prospective study, 37 cranial defects were reconstructed using AAA bone implants over a period of more than 7 years. The patients were followed-up at standardized intervals. Roentgenographic assessments and bone scintigraphies revealed osseous integration and remodelling of the AAA bone implants. In one quarter of the cases re-entry was performed 10 to 18 months after the cranioplasty (removal of osteosynthesis material, recurrence of tumor). All nine AAA bone reconstructions showed bleeding surfaces and bony integrations. A bone biopsy was taken from the center of one of these AAA bone implants and this showed new bone formation originating from the surface of the implant. In one case an AAA bone implant was lost due to infection. This is noteworthy as in approximately one third of the cases the bone implants were in direct contact with the frontal sinus. The clinical results clearly emphasize the therapeutical benefit of AAA bone for cranioplasties. Large AAA bone chips from human skull bones facilitate the reconstruction of the skull's convexity, especially when sterolithography-based operation planning is performed.