Allograft Material Research Articles

Evaluation of low-crystallinity apatite as a novel synthetic bone graft material: In vivo and in vitro analysis.

To overcome the shortcomings of sintered bone graft materials, low-crystallinity apatite (LCA) was developed using a non-heated approach to enhance resorption and integration during bone regeneration. This study aimed to evaluate the efficacy of LCA as a synthetic bone graft material for bone reconstruction. LCA was compared to three conventional synthetic bone graft materials: biphasic calcium phosphate (BCP) 37, BCP 64, and octacalcium phosphate (OCP). Crystalline structure and surface morphology were examined using X-ray diffraction (XRD) and scanning electron microscopy (SEM). In vivo testing was conducted using a rabbit calvarial augmentation model, in which the grafts were placed into standardized defects. Bone formation and graft resorption were analyzed using micro-computed tomography (micro-CT) and histomorphometric analyses at three and six weeks post-implantation. LCA exhibited structural similarities to the allograft material and enhanced surface properties. Micro-CT and histomorphometric evaluations at three and six weeks post-implantation demonstrated higher rates of bone formation and substantial volumetric changes with LCA, indicating efficient graft resorption and bone regeneration. LCA exhibited superior integration, osteoconductivity, and biodegradability compared to other synthetic grafts, suggesting the potential for improved clinical outcomes with its use. Although the efficacy of LCA has been validated, further studies in diverse biological environments are necessary to confirm its safety and effectiveness for broader clinical use. LCA, which mimics natural bone structure and has superior integration and osteoconductivity, has the potential for clinical applications requiring rapid and effective bone healing.

Systematic Review Regarding the Clinical Implications of Allograft and Alloplastic Bone Substituents Used for Periodontal Regenerative Therapy

Background/Objectives: Regenerative periodontal therapy is a treatment method that focuses on restoring the periodontium affected by chronic inflammatory disease or injury. It involves using different biomaterials and techniques to completely restore the periodontal structures. The main objective was to identify and critically evaluate relevant studies comparing the clinical efficacy of allograft and alloplastic materials in regenerative periodontal therapy. Methods: For evaluation, a systematic review based on PRISMA guidelines was conducted. Data were extracted using only specific types of study designs, which included randomized controlled trials, cohort studies, and case-control studies. Target patients with periodontal disease or periodontal lesions undergoing periodontal therapy using allograft or alloplastic materials were selected. Periodontal parameters such as clinical attachment level, probing pocket depth, radiographic bone fill, or patient-reported outcomes were analyzed. Results: The results showed that allograft and alloplastic materials offered reduced pocket depth, a gain in clinical attachment, and bone repairment. The variation observed indicated that allografts showed a slightly more significant clinical attachment gain and a superior bone fill than alloplastic ones, suggesting that allografts enhance osteogenesis and provide a greater capacity for repair in periodontal defects. Conclusions: The results of the present study suggest that allograft and alloplastic materials offered reduced pocket depth, a gain in clinical attachment, and bone repairment, with both methods having similar clinical efficacy.

Preoperative Planning of Craniectomy and Reconstruction using 3D Printed Cranioplasty for Treatment of Calvarial Lesion

There is a number of diseases which causes calvarial lesion. Fibrous dysplasia, intraosseous meningioma, osteoma is to name a few. Treatment of these lesions necessitates removal of part of the skull or craniectomy to decompress the brain and neural elements. The ensuing skull defect needs to be repaired to protect the brain. Previously used allograft and alloplastic materials have been replaced with newer PEEK material, which is more resistant, biocompatible and can be 3D printed. In this series we describe 4 cases in which skull lesions are removed and reconstructed in the same sitting using 3D printed PEEK implant designed preoperatively using high resolution CT data. The results are superior and complication rates are low. All the cases were done in different government hospitals. The technical process was developed indigenously, and the methods are the first in our country. Bang. J Neurosurgery 2024; 13(2): 64-69

In Vivo Evaluation of Demineralized Bone Matrix with Cancellous Bone Putty Formed Using Hydroxyethyl Cellulose as an Allograft Material in a Canine Tibial Defect Model.

Demineralized bone matrix (DBM) is a widely used allograft material for bone repair, but its handling properties and retention at defect sites can be challenging. Hydroxyethyl cellulose (HEC) has shown promise as a biocompatible carrier for bone graft materials. This study aimed to evaluate the efficacy of DBM combined with cancellous bone putty formed using HEC as an allograft material for bone regeneration in a canine tibial defect model. Experiments were conducted using dogs with proximal tibial defects. Four groups were compared: empty (control group), DBM + HEC (DH), DBM + cancellous bone + HEC (DCH), and DBM + cancellous bone + calcium phosphate + HEC (DCCH). Radiographic, micro-computed tomography (CT), and histomorphometric evaluations were performed 4 and 8 weeks postoperatively to assess bone regeneration. The Empty group consistently exhibited the lowest levels of bone regeneration throughout the study period, indicating that DBM and cancellous bone with HEC significantly enhanced bone regeneration. At week 4, the DCCH group showed the fastest bone regeneration on radiography and micro-computed tomography. By week 8, the DCH group showed the highest area ratio of new bone among all experimental areas, followed by the DH and DCCH groups. This study demonstrated that HEC significantly enhances the handling, mechanical properties, and osteogenic potential of DBM and cancellous bone grafts, making it a promising carrier for clinical applications in canine allograft models. When mixed with allograft cancellous bone, which has high porosity and mechanical strength, it becomes a promising material offering a more effective and reliable option for bone repair and regeneration.

Microarchitectural properties of compacted cancellous bone allografts: A morphology micro-computed tomography analysis

Massive bone loss poses a significant challenge in defect reconstruction. The use of compacted allografts is a valuable technique to reconstruct bone stock. This study aimed to assess the impact of compression on the microstructure of native cancellous bone chips with a micro-CT analysis. Bone samples were harvested from 15 femoral heads donated by patients who underwent total hip arthroplasty. Bone chips were prepared using a bone mill. All samples with the same weight were compressed by 25% and 50% of their original volume and subsequently scanned with a micro-CT scanner to determine the microarchitectural morphology of the bone chips. Uniaxial compression test was carried out before and after a standardized compaction procedure. Comparing the samples without compaction to 50%, the number of trabeculae doubled, the volume ratio doubled, and the trabeculae spacing was reduced, showing voids of 800μm on average. The number of interlocking possibilities tripled, while no differences were seen in the trabeculae morphology. Uniaxial compression test showed a yield limit after compaction of 0.125MPa. Interlocking might occur three times more with a denser material than in a non-compacted sample. The increase in density comparable to manual intraoperative compaction did not lead to significant fragmentation of the allograft material. The assessed microarchitecture should, therefore, reassemble the intraoperative situation during a manual bone impaction procedure.

Cranioplasty Approaches for Cranial Defects: A Case Series

Cranial defects are commonly caused due to road traffic accidents, tumor, postneurosurgery, or congenital deformities. Protection of the cranial structures, maintaining cerebrospinal fluid dynamics, and esthetics are some of the prime considerations while restoration of such defects. The use of autograft or allograft materials such as bone from a self or another donor site from ribs, ilium, tibia, scapula, and fascia and procedures such as split-thickness cranioplasty were carried out in the past. However, in larger defects, alloplastic materials such as celluloids, methyl methacrylate, hydroxyapatite, polyethylene, silicone, and metals such as titanium, aluminum, and stainless steel, were used for restoration. Irrespective of the material of choice, it is desirable of the prosthetic material to demonstrate low thermal conductivity, optimal strength, low infection rate, longevity, close adaptation to the defect, and fixability with plates to adjacent bone. Before digital imaging, conventional impressions were made, and approximations were done to fabricate cranial plates. With the advent of digital technology and bone imaging techniques with alongside the development of printed and milled materials, accurate cranial prosthesis can be fabricated. We cannot disregard conventional techniques as these are still used in places where access to digital technology is limited and also for patients who cannot afford the cost incurred with digital technology. The case series presents one case, which was fabricated with a conventional method, and two cases with two different approaches using digital technology. The paper aims to present various advantages, limitations, and nuances needed while the fabrication of such a prosthesis with these three methods.

Establishing a bone bank within a hospital setting in India: early insights from a tertiary care center in Northern India-a review article.

When addressing bone defects resulting from trauma, infection, or tumors, the use of allogenic bone is often necessary. While autografts are considered the standard, they have limitations and can lead to donor site morbidity. Consequently, there has been exploration into the feasibility of utilizing allogenic bone and bone graft replacements. Allogenic bone transplants are acquired from donors following rigorous procurement, sterile processing, and donor screening procedures. To ensure the safe storage and effective utilization of allograft material, a bone banking system is employed. Establishing and managing an orthopedic bone bank, entails navigating complex legal and medical organizational aspects. This paper examines the establishment and operation of bone banks in India, drawing upon our first-hand experience in managing one at a tertiary care center in Northern India.Level of evidence: Level IV.

Comparative Evaluation of Effectiveness of Demineralized Freeze-dried Bone Allograft and Other Regenerative Materials for the Treatment of Intrabony Periodontal Defects: A Systematic Review and Meta-analysis

ABSTRACT The aim of this systematic review and meta-analysis is to evaluate and compare the effectiveness of demineralized freeze-dried bone allograft (DFDBA) and other regenerative materials for the treatment of intrabony periodontal defects. Randomized controlled trials (RCTs) and non-randomized controlled trials (Non-RCTs) reporting on clinical and/or radiographic outcome parameters of periodontal regenerative procedures OF DFDBA with other regenerative materials with a follow-up of more than 3 months were systematically assessed. PRISMA checklist was followed and electronic and hand search was done to identify the studies. Outcome variables were pocket probing depth and pocket depth reduction (PDR), clinical attachment level and clinical attachment gain (CAG), gingival recession (GR), bone fill and percentage (%) of bone fill. Meta-analysis was carried out with possible RCT studies using the DerSimonian–Laird estimator of variance. As sensitivity analysis, fixed-effect meta-analysis was performed using the Mantel–Haenszel method. The search resulted in 1235 published studies. After removal of duplicates and full-text analysis, 10 RCTs and 4 non-RCTs were selected. Overall, the result demonstrated the promising regenerative capacity of DFDBA with other graft materials for the treatment of intabony periodontal defect. Within the limitations of the present systematic review and meta-analysis, the use of DFDBA gives better results in terms of PDR, GR, bone fill, and percentage of bone fill when compared to other regenerative materials in treatment of intrabony periodontal defects, except CAG.

Prognosis recovery score of apical surgery Guided Bone Regeneration using cone beam computed tomography and digital bioinformatics

Guided Bone Regeneration (GBR) is a dental surgical procedure that uses barrier membranes to prevent soft tissue invasion and conduct new bone growth. This study aimed to define a Prognosis Recovery score (PR score) to objectively classify post-surgery responders from non-responder patients who underwent GBR using Cone Beam Computed Tomography (CBCT). This prospective-observational-longitudinal-cohort study recruited 250 individuals who were assigned to: Conventional-Apical-Surgery (CAS, n=39), Apical-Surgery using human fascia lata Membrane placement (ASM, n=42), and Apical-Surgery using human fascia lata Membrane placement and lyophilized allograft Bone powder (ASMB, n=39); and Apical-Surgery using collagen membrane Porcine origin and Bovine Bone-matrix (ASPBB, n=130), an independent external validation cohort. Surgery was performed, and evolution was monitored by CBCTs at 0, 6-, 12-, 18-, and 24 months post-surgery. Normalized lesion volumes were calculated, and non-linear time evolution morphology curves were characterized. The three-time evolution bone growth patterns were: a linear tendency (PR0), "S'' shaped log-logistic (PR1), and "C" cellular growth (PR2). The treatment success rates were PR2-46%, PR2-88%, and PR2-95%/PR1-5% for CAS, ASM, and ASMB groups. The xenograft ASPBB counterpart achieved PR2-92% and PR1-8%. The score PR had a sensitivity, specificity, and accuracy of 100%. Patients' treatment success can be quantitatively, objectively, and precisely predicted with the Prognosis Recovery score (using only two CBCTs), according to their biological response to allograft or xenograft materials (time-evolution bone growth curves), reducing cost and radiation exposure. Through digital imaging and bioinformatic analysis of bone regeneration observed in CBCTs, we defined a Prognosis Recovery (PR) score using only two CBCT volume assessments (0 and 6 months). The PR score allowed us to define three time-evolution curves depending on the biomaterials used and to classify patients in a quantitative, objective, and accurate way.

Efficacy of sintered Zinc-doped fluorapatite scaffold as an antimicrobial regenerative bone filler for dental applications

The objective of this study was to assess whether zinc-doped fluorapatite (ZnFA) could serve as an effective antimicrobial dental bone filler for bone regeneration compared to autografts. FA and 2 % zinc-doped FA (2ZnFA) were synthesized and characterized in-house. Compressed and sintered FA and 2ZnFA disks were incubated with bacteria to assess antimicrobial properties. Adipose-derived stem cells were cultured on these discs to evaluate the surfaces' ability to support cell growth and promote osteogenic differentiation. Surfaces exhibiting the highest expressions of the bone markers osteopontin and osteocalcin were selected for an in vivo study in a rat mandibular defect model. Twenty rats were divided into 5 groups, equally, and a 5 mm surgical defect of the jaw was left untreated or filled with 2ZnFA, FA, autograft, or demineralized bone matrix (DBM). At 12 weeks, the defects and surrounding tissues were harvested and subjected to microCT and histological evaluations. Standard techniques such as FTIR, ICP-MS, fluoride probe, and XRD revealed the sintered FA and ZnFA's chemical compositions and structures. Bacterial studies revealed no significant differences in surface bacterial adhesion properties between FA and 2ZnFA, but significantly fewer bacterial loads than control titanium discs (p < 0.05). Cell culture data confirmed that both surfaces could support cell growth and promote the osteogenic differentiation of stem cells. MicroCT analysis confirmed statistical similarities in bone regeneration within FA, 2ZnFA, and autograft groups. The data suggests that both FA and 2ZnFA could serve as alternatives to autograft materials, which are the current gold standard. Moreover, these bone fillers outperformed DBM, an allograft material commonly used as a dental bone void filler. The use of FA or 2ZnFA for treating mandibular defects led to bone regeneration statistically similar to autograft repair and significantly outperformed the widely used dental bone filler, DBM. Additional translational research may confirm FA-based materials as superior substitutes for existing synthetic bone fillers, ultimately enhancing patient outcomes.

EFFECTIVENESS OF SOCKET PRESERVATION IN MAINTAINING ALVEOLAR BONE VOLUME: A SYSTEMATIC REVIEW

Introduction: Alveolar bone undergoes dimensional changes due to resorption after tooth extraction, which can make it difficult to place a denture or implant. Preservation socket procedures are performed at the time of tooth extraction with the aim of minimizing alveolar bone resorption. The purpose of this systematic review is to analyze the effectiveness of socket preservation in preserving alveolar bone. Review: This systematic review was conducted through an electronic literature search in PubMed, Wiley, and Sciencedirect, which was used to obtain a number of Randomized Clinical Trial (RCT) articles on the effectiveness of socket preservation with graft material versus no socket preservation. This systematic review was conducted following the Preferred Reporting Items for Systematic reviews (PRISMA) guidelines. Based on the 417 articles screened, there were 24 duplicates, and after the articles were included by the criteria of: RCT, human study, publication in English, within the last five years and focusing on the methods and outcomes of socket preservation, 5 articles were found to be relevant. Conclusion: Of the five studies reviewed, one study using allograft material and four studies using xenograft material, the results were that socket preservation can reduce alveolar bone resorption and can maintain the horizontal and vertical dimensions of alveolar bone compared to no socket preservation

PERIODONTAL INFRABONY DEFECT GRAFTING WITH AND WITHOUT BIOCOMPATIBLE GRAFT MATERIAL DFDBA IN IMMEDIATE IMPLANT PLACEMENT AT EXTRACTION SITE

Background: Immediate implant placement in contrast to delayed placement of implant may be advantageous butpresence of jumping gap, morphology of the site, presence of interdental crater or intrabony 2-3 walled defect complicates the placement of immediate implant at extraction site. To overcome these complicating factors bone substitute material ie DFDBA within the fixture-socket gap preserves alveolarridge volume by minimizing socket remodeling and encouraging de-novo bone formation. Aim:To compare the hard tissue dimensions in immediately placed implants with and without biocompatible allograft material DFDBA at extraction site. Material And Methods:A total number of 20 patients selected randomly from the Outpatient Department of Periodontology were categorized in two groupsCONTROL AND TEST GROUP. Experimental GROUP A:- Immediate implant placement without DFDBA Bone Graft in fresh extraction socketin 10 patients.(Control Group) Experimental GROUP B:Immediate implant placement with DFDBA Bone Graft in fresh extraction socket in10 patients.(Test Group) Statistical Analysis:The data for the present study was entered in the Microsoft Excel 2007 and analyzed using the SPSS statistical software 23.0 Version. Result: Test group showed increased bone dimensions post operatively after 6 months as compared to control group showing decreased bone resorption and encouraging de- novo bone formation property of DFDBA. Conclusion:With guided bone regeneration by DFDBA for insertion of immediate dental implant displayed the predictable results when proper case selection and careful surgery was performed.

Resorbable magnesium metal membrane for sinus lift procedures: a case series

BackgroundThe purpose of this case series was to demonstrate the use of a magnesium membrane for repairing the perforated membrane in both direct and indirect approaches, as well as its application in instances where there has been a tear of the Schneiderian membrane.Case presentationThe case series included four individual cases, each demonstrating the application of a magnesium membrane followed by bone augmentation using a mixture of xenograft and allograft material in the sinus cavity. In the first three cases, rupture of Schneiderian membrane occurred as a result of tooth extraction, positioning of the dental implant, or as a complication during the procedure. In the fourth case, Schneiderian membrane was perforated as a result of the need to aspirate a polyp in the maxillary sinus. In case one, 10 mm of newly formed bone is visible four months after graft placement. Other cases showed between 15 and 20 mm of newly formed alveolar bone. No residual magnesium membrane was seen on clinical inspection. The vertical and horizontal augmentations proved stable and the dental implants were placed in the previously grafted sites.ConclusionWithin the limitations of this case series, postoperative clinical examination, and panoramic and CBCT images demonstrated that resorbable magnesium membrane is a viable material for sinus lift and Schneiderian membrane repair. The case series showed successful healing and formation of new alveolar bone with separation of the oral cavity and maxillary sinus in four patients.

Radiographic texture analysis of the hard tissue changes following socket preservation with allograft and xenograft materials for dental implantation: a randomized clinical trial.

This study aimed to assess the hard tissue changes following socket preservation with allograft and xenograft materials for dental implantation by texture analysis (TA) using cone-beam computed tomography (CBCT). This prospective clinical trial was conducted on 25 patients who required the extraction of carious mandibular posterior teeth and their subsequent replacement with dental implants. The patients were categorized into three groups: (I) no socket preservation, (II) socket preservation with xenograft material, and (III) socket preservation with allograft material. Four months after tooth extraction, the patients were recalled for preoperative assessment before dental implantation, and CBCT scans were obtained (Kvp:110, mA:1.94, S:3.6). MaZda software was used to compare homogeneity, contrast, and texture complexity on axial CBCT sections among the three groups. Significant differences existed among the three groups in all parameters (P < 0.05) except for the mean correlation parameter (P > 0.05). The results showed no significant difference between the no graft and xenograft groups regarding contrast and differential (dif.) entropy (P > 0.05). Also, no significant difference was found between the xenograft and allograft groups regarding the dif. variance and also between the no graft and allograft groups regarding the inverse difference moment(InvDfMom) and dif. variance parameters (P > 0.05). All other pairwise comparisons revealed significant differences (P < 0.05). TA can be used for the quantification of radiographic changes of bone following socket preservation and potentially accelerate the process of decision-making for dental implant treatment.

Evaluation of amnion chorion membrane for socket preservation after the extraction of maxillary single rooted teeth: A randomized controlled clinical trial

Introduction: The aim of this study was to assess the efficiency of using dehydrated de-epithelial ized amnion chorion membrane (ddACM) on socket preservation in the anterior region, clinically and radiographically. Methods: 26 unrestorable maxillary anterior or single rooted premolars, with buccal fenestration, were selected. The socket was filled with allograft material and covered with ddACM for the test group, and allograft material with a collagen membrane for the control group divided equally. Clinical parameters including gingival healing and tissue thickness was assessed. Volumetric bone change was measured 4 months later using a CBCT. Results: Test group showed clinical statistically significant results than the control group (P-value = 0.020, effect size = 0.574) along with a radiographic higher mean bone width measurement than control group after four months (P-value = 0.372, Effect size = 0.357). Conclusion: As compared to collagen membrane, intentionally exposed ACM is similarly successful in ridge preservation. Moreover, the use of ACM may help to reduce postoperative VAS ratings and may result in excellent bone quality available for implant placement.

Sustainability and Release Pattern of Growth Factors from Bone Grafts Prepared with Platelet-Rich Fibrin.

Platelet-rich fibrin (PRF) is used to prepare "sticky bone" by combining it with bone graft material. The present study investigated the ability of different bone grafts to absorb growth factors from the PRF and release them over time. Human blood was collected from 10 healthy volunteers for liquid PRF preparation. Bovine bone, allograft (mineralized and demineralized), and synthetic bone were each mixed with the PRF to prepare a sticky bone. All sticky bone samples were incubated for up to 4 days. The absorption and release pattern kinetics of two selective growth factors within the PRF-platelet-derived growth factor (PDGF) and bone morphogenetic protein-2 (BMP-2)-were quantified with immunofluorescence staining and enzyme-linked immunoassay (ELISA) testing. All bone graft materials adsorbed the examined growth factors from the PRF. β-TCP showed the highest adsorption levels, followed by the xenograft, and the allografts showed the lowest adsorption levels. Furthermore, PDGF showed a fast-release pattern from the grafts, whereas BMP-2 was released at a later stage. Similar to the adsorption pattern, the β-TCP and xenograft were better able to sustain the release of the PRF growth factors from the graft than the allografts. The adsorption of PDGF and BMP-2 differ between graft materials, with superior results for β-TCP, followed by xenograft, then allograft materials.

Orbitalization of Ethmoidal Sinus With Stacked Cross-linked Acellular Dermal Matrix: A New Strategy to Reconstruct Medial Orbital Wall Fracture.

The use of an acellular dermal matrix (ADM) has not been reported in medial orbital wall fracture reconstruction previously. This study aimed to share our early experience with the cross-linked ADM as an allograft material for medial orbital wall reconstruction. In this study, the author evaluated the medical records and serial facial computed tomography scans of 27 patients with pure medial orbital wall fractures reconstructed by a single surgeon between May 2021 and March 2023. The author routinely approached the medial orbital wall with a retrocaruncular incision. Five out of 27 patients were reconstructed with trimmed, multiple folded, 1.0-mm-thick cross-linked ADM (MegaDerm; L&C Bio, South Korea). All cases reconstructed with cross-linked ADM improved clinically and radiologically without complications. The serial computed tomography findings revealed that implanted cross-linked ADM successfully covered the defect while providing a significant volumizing effect. This is the first study to show the efficacy of cross-linked ADM for orbital medial wall fracture reconstruction. Our strategy of orbitalization of ethmoidal sinus with stacked cross-linked ADM would be an excellent surgical option.

An Immunological and Biomechanical Comparison of PEEK-Zeolite and PEEK Interbody Fusion Devices.

A laboratory study comparing PEEK-zeolite and PEEK spinal implants in an ovine model. This study challenges a conventional spinal implant material, PEEK, to PEEK-zeolite using a non-plated cervical ovine model. Although widely used for spinal implants due to its material properties, polyether ether ketone (PEEK) is hydrophobic, resulting in poor osseointegration, and elicits a mild non-specific foreign body response. Zeolites are negatively-charged aluminosilicate materials that are hypothesized to reduce this pro-inflammatory response when used as a compounding material with PEEK. Fourteen skeletally mature sheep were each implanted with one PEEK-zeolite interbody device and one PEEK interbody device. Both devices were packed with autograft and allograft material and randomly assigned to one of two cervical disc levels. The study involved two survival timepoints (12 and 26wk) and biomechanical, radiographic, and immunological endpoints. One sheep expired from complications not related to the device or procedure. Biomechanical evaluation was based on measures of segmental flexibility, using a six-degrees-of-freedom pneumatic spine tester. Radiographic evaluation was performed using microCT scans in a blinded manner by three physicians. Levels of the pro-inflammatory cytokines interleukin-1β, interleukin-6, and tumor necrosis factor alpha at the implant were quantified using immunohistochemistry. PEEK-zeolite and PEEK exhibited equivalent range of motion in flexion extension, lateral bending and axial torsion. Motion was significant reduced for implanted devices at both time points as compared to native segments. Radiographic assessments of fusion and bone formation were similar for both devices. PEEK-zeolite exhibited lower levels of interleukin-1β (P=0.0003) and interleukin-6 (P=0.0300). PEEK-zeolite interbody fusion devices provide initial fixation substantially equivalent to PEEK implants but exhibit a reduced pro-inflammatory response. PEEK-zeolite devices may reduce the chronic inflammation and fibrosis previously observed with PEEK devices.

Effectiveness of Cross-Linked Acellular Dermal Matrix to Correct Post-Traumatic Enophthalmos.

The use of an acellular dermal matrix is rarely reported in orbital wall fracture reconstruction. This study aimed to share the author's experience with the cross-linked acellular dermal matrix as an allograft material for enophthalmos correction. In this retrospective study, the author evaluated the medical records and 3-dimensional facial computed tomography scans of patients with enophthalmos caused by neglected orbital fractures between May 2021 and June 2022. Facial computed tomography scans confirmed the clinical diagnosis of enophthalmos. A single surgeon performed all surgical operations. In all patients, the author accessed the orbital floor via subciliary incision while approaching the medial wall with a retrocaruncular incision. After fully exposing the lesion, the author used a 1.0-mm-thick cross-linked acellular dermal matrix (ADM) (MegaDerm; L&C Bio, South Korea). After trimming the cross-linked ADM to a proper size, the author implanted the ADM into the lesion. During May 2021 and June 2022, 3 cases of enophthalmos were successfully corrected with cross-linked ADM at the author's hospital. All patients were improved clinically and radiologically. This is the first study to show the effectiveness of cross-linked ADM for the correction of enophthalmos.

Osteoregenerative Potential of 3D-Printed Poly ε-Caprolactone Tissue Scaffolds In Vitro Using Minimally Manipulative Expansion of Primary Human Bone Marrow Stem Cells.

The repair of orthopedic and maxillofacial defects in modern medicine currently relies heavily on the use of autograft, allograft, void fillers, or other structural material composites. This study examines the in vitro osteo regenerative potential of polycaprolactone (PCL) tissue scaffolding, fabricated via a three-dimensional (3D) additive manufacturing technology, i.e., a pneumatic micro extrusion (PME) process. The objectives of this study were: (i) To examine the innate osteoinductive and osteoconductive potential of 3D-printed PCL tissue scaffolding and (ii) To perform a direct in vitro comparison of 3D-printed PCL scaffolding with allograft Allowash® cancellous bone cubes with regards to cell-scaffold interactions and biocompatibility with three primary human bone marrow (hBM) stem cell lines. This study specifically examined cell survival, cell integration, intra-scaffold cell proliferation, and differentiation of progenitor cells to investigate the potential of 3D-printed PCL scaffolds as an alternative to allograft bone material for the repair of orthopedic injuries. We found that mechanically robust PCL bone scaffolds can be fabricated via the PME process and the resulting material did not elicit detectable cytotoxicity. When the widely used osteogenic model SAOS-2 was cultured in PCL extract medium, no detectable effect was observed on cell viability or proliferation with multiple test groups showing viability ranges of 92.2% to 100% relative to a control group with a standard deviation of ±10%. In addition, we found that the honeycomb infill pattern of the 3D-printed PCL scaffold allowed for superior mesenchymal stem-cell integration, proliferation, and biomass increase. When healthy and active primary hBM cell lines, having documented in vitro growth rates with doubling times of 23.9, 24.67, and 30.94 h, were cultured directly into 3D-printed PCL scaffolds, impressive biomass increase values were observed. It was found that the PCL scaffolding material allowed for biomass increase values of 17.17%, 17.14%, and 18.18%, compared to values of 4.29% for allograph material cultured under identical parameters. It was also found that the honeycomb scaffold infill pattern was superior to the cubic and rectangular matrix structures, and provided a superior microenvironment for osteogenic and hematopoietic progenitor cell activity and auto-differentiation of primary hBM stem cells. Histological and immunohistochemical studies performed in this work confirmed the regenerative potential of PCL matrices in the orthopedic setting by displaying the integration, self-organization, and auto-differentiation of hBM progenitor cells within the matrix. Differentiation products including mineralization, self-organizing "proto-osteon" structures, and in vitro erythropoiesis were observed in conjunction with the documented expression of expected bone marrow differentiative markers including CD-99 (>70%), CD-71 (>60%), and CD-61 (>5%). All of the studies were conducted without the addition of any exogenous chemical or hormonal stimulation and exclusively utilized the abiotic and inert material polycaprolactone; setting this work apart from the vast majority of contemporary investigations into synthetic bone scaffold fabrication In summary, this study demonstrates the unique clinical potential of 3D-printed PCL scaffolds for stem cell expansion and incorporation into advanced microstructures created via PME manufacturing to generate a physiologically inert temporary bony defect graft with significant autograft features for enhanced end-stage healing.