Abstract
In the last twenty years, due to an increasing medical and market demand for orthopaedic implants, several grafting options have been developed. However, when alternative bone augmentation materials mimicking autografts are searched on the market, commercially available products may be grouped into three main categories: cellular bone matrices, growth factor enhanced bone grafts, and peptide enhanced xeno-hybrid bone grafts. Firstly, to obtain data for this review, the search engines Google and Bing were employed to acquire information from reports or website portfolios of important competitors in the global bone graft market. Secondly, bibliographic databases such as Medline/PubMed, Web of Science, and Scopus were also employed to analyse data from preclinical/clinical studies performed to evaluate the safety and efficacy of each product released on the market. Here, we discuss several products in terms of osteogenic/osteoinductive/osteoconductive properties, safety, efficacy, and side effects, as well as regulatory issues and costs. Although both positive and negative results were reported in clinical applications for each class of products, to date, peptide enhanced xeno-hybrid bone grafts may represent the best choice in terms of risk/benefit ratio. Nevertheless, more prospective and controlled studies are needed before approval for routine clinical use.
Highlights
Cellular bone matrices (CBMs) or cellular allografts are obtained by proprietary processing techniques that remove all immune-responsive signals generated by bone marrow components
Such components are hematopoietic cells, retaining bone-forming cells within the cancellous bone matrix. Apart from this feature common to all products, cellular bone matrices (CBMs) differ in some critical variables, such as cell type, cell amount, cell viability after thawing, bone tissue processing and subsequent formulation, and cryoprotectant agents
The market offers a wide variety of products for clinical use, this range is significantly reduced to three main categories of products when searching for alternative bone augmentation materials mimicking autografts: (i) cellular bone matrices (CBMs), (ii) growth factor enhanced bone grafts, and (iii) peptide enhanced xeno-hybrid bone grafts
Summary
Many clinical conditions, such as arthritis, tumours, traumas, infections (e.g., osteomyelitis, periodontitis), and teeth extraction, may result in bone loss requiring a surgical intervention to replace or restore the lost tissue [1,2]. The ageing population, poised to become one of the most significant social transformations, explains the increasing number of bone graft procedures performed every year. Several clinical procedures and material options were investigated for defect repair and bone regeneration [3,4]. To date, autologous bone is still considered the ideal source for graft procedures since it provides all the three elements necessary for bone healing: (i) an osteoconductive scaffold for cell attachment promotion, (ii) extracellular growth factors for cell proliferation and differentiation, and (iii) viable cells with osteogenic potential [5]
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