The Use of Bone Substitutes in the Treatment of Bone Defects – the Clinical View and History

Abstract

AbstractSummary: Bone has the ability to regenerate and remodel itself. In the clinic circumstances appear when bone defects do not heal spontaneously. These situations frequently result from trauma, congenital abnormities, infection or tumor resection. Hence, filling of the resulting defect by bone transplantation is a common practise with an increasing value in the re‐establishment of the musculoskeletal system to promote bone healing. Since decades, efforts have been put to improve the effectiveness of bone substitutes. Conventional approaches with the use of ivory, animal and also human bone were not satisfactory. Negative effects like allergic reactions, rejection reactions, inflammations and other problems occurred. These led to implant failure, non union and amputation, to only mention a few. The introduction of bone banks and the development of standards in bone transplantation brought up the false hope to find a final solution for the treatment of bone loss. Disease transmissions (HIV) by allografts caused critical discussions. Despite all efforts, transplantation of autogenous cancellous bone is still the “gold standard” to induce bone healing. However, autografts are only limited available and are accompanied with high morbidity and mortality during the harvest. The problems associated with autologous and allogenous bone grafts promoted the development of multiple organic and inorganic bone substitutes. Well established substitutes at the present are demineralised bone matrix (DBM), composites and calcium phosphates (hydroxyl apatite and tri‐calcium phosphate). These osteoconductive substances have shown to improve new bone formation. Nevertheless, clinical application of these materials is merely successful in a good bony environment but does not induce large progress in critical bone defects.