Abstract
Osteoinductive properties of β-TCP remain unknown in humans. It is important to improve the bone grafts which have been the standard treatment for bone defect due to their biocompatibility and bone-healing properties. The purpose of this study was to radiologically clarify the bone forming property of β-TCP by evaluating the replacement of β-TCP by newly formed bone in the defect after fibular resection and to examine the histological features of a β-TCP specimen three months after grafting. Radiographs of 17 patients who underwent β-TCP grafting were evaluated. Osteoinductive and osteoconductive properties were assessed by examining bone formation from the remnant fibula, periosteum, and β-TCP alone. In one case, β-TCP was removed later because of postoperative complications and was evaluated histologically. Twenty two of 34 sites between the remnant fibula and β-TCP had achieved good bone regeneration. Five of 14 sites between the periosteum and β-TCP had achieved good bone regeneration. We found immature but evident bone formation in three cases with no osseous and periosteal sites. Histological analysis revealed bone formation on the outer macropore surface of β-TCP. Some blood vessels formed in the macropores expressed CD31 and CD34, while a few lymphatic vessels expressed CD34 and podoplanin. Thus, the osteoinductive ability of β-TCP alone was demonstrated in humans radiographically for the first time. The histological morphology of β-TCP was demonstrated at an early stage after grafting in humans.
Highlights
Bioactive ceramics have gained popularity for filling bone defect secondary to trauma or tumor resection [1] [2] [3] [4] [5]
Autogenic periosteum could increase the bioactivity of ceramics in heterosites and improve bone formation in porous calcium phosphate ceramics [27]
We previously investigated the process of osteoinduction in porous β-TCP in canine dorsal muscles, which suggested that the micropores on the macropore surfaces are critical for this process [10] [11]
Summary
Bioactive ceramics have gained popularity for filling bone defect secondary to trauma or tumor resection [1] [2] [3] [4] [5]. Autogenous bone grafts have been the standard treatment for bone loss due to their biocompatibility and bone-healing properties [6]. The amount of bone that can be harvested from a patient’s bone is a limitation. Bioactive ceramic substitutes are a suitable option for filling large bone defects. A variety of synthetic ceramic substitutes have been developed to fill bone defects [7]. Hydroxyapatite (Ca10(PO4)6(OH)2), beta-tricalcium phosphate (β-TCP) (Ca3(PO4)2), and their derivatives and combinations are the most commonly used ceramic materials in bone surgeries [8]
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