Abstract
Resorbable polymeric implants and surface coatings are an emerging technology to treat bone defects and increase bone formation. This approach is of special interest in anatomical regions like the calvaria since adults lose the capacity to heal large calvarial defects. The present study assesses the potential of extracellular matrix inspired, embroidered polycaprolactone-co-lactide (PCL) scaffolds for the treatment of 13 mm full thickness calvarial bone defects in rabbits. Moreover the influence of a collagen/chondroitin sulfate (coll I/cs) coating of PCL scaffolds was evaluated. Defect areas filled with autologous bone and empty defects served as reference. The healing process was monitored over 6 months by combining a novel ultrasonographic method, radiographic imaging, biomechanical testing, and histology. The PCL coll I/cs treated group reached 68% new bone volume compared to the autologous group (100%) and the biomechanical stability of the defect area was similar to that of the gold standard. Histological investigations revealed a significantly more homogenous bone distribution over the whole defect area in the PCL coll I/cs group compared to the noncoated group. The bioactive, coll I/cs coated, highly porous, 3-dimensional PCL scaffold acted as a guide rail for new skull bone formation along and into the implant.
Highlights
The majority of cranial bone defects are caused by trauma, congenital deformity, or tumor resection
Defect areas filled with autologous bone and empty defects served as reference
Regarding the relative stiffness of the reconstructed area, the results demonstrate the significant influence of the biomaterial and its coating to achieve a bone like stability
Summary
The majority of cranial bone defects are caused by trauma, congenital deformity, or tumor resection. Since successful spontaneous healing only occurs in infants younger than two years, a variety of materials have been proposed to repair such defects, including autologous or allogeneic bone grafts, alloplastic materials, and tissue engineered bone scaffolds optionally seeded with cells or growth factors [2, 4]. Autologous bone grafts are the gold standard, but their clinical use is limited by donor site morbidity, availability, additional surgery, bone resorption at the recipient site, and difficulties with three-dimensional contouring [3, 4]. The most commonly used alloplastic materials are metals (e.g., stainless steel, titanium, gold, and aluminum), polymers (e.g., polymethyl methacrylate), and ceramics based on hydroxyapatite (HA). Most ceramics, and many polymers are not considered to be biodegradable and cannot be fully replaced by host bone tissue [5]. The large amount of methods reflects that each technique has its own advantages and disadvantages as well as the need for new and improved treatment options [2]
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