Bone Graft Material Research Articles

Enhanced Osteogenic Activity and Bone Repair Ability of PLGA/MBG Scaffolds Doped with ZIF-8 Nanoparticles Loaded with BMP-2.

Tissue engineering scaffolds are porous and can be loaded with growth factors to promote osteogenesis and bone repair, which can solve the problem of clinical bone defects. The direct loading of growth factors on scaffolds is hindered by the disadvantages of low loading capacities, and uncontrollable burst release. Zeolitic imidazolate framework-8 (ZIF-8) has osteoinductive activity and drug-loading potential and can be loaded with growth factors to achieve sustained release. In this study, we aimed to establish a sustained release system of composite scaffolds loaded with growth factors to achieve the goal of slow controlled release and effective bone repair. ZIF‑8 nanoparticles loaded with bone morphogenetic protein-2 (BMP-2) were incorporated into poly-(lactide-co-glycolide)/mesoporous bioactive glass (PLGA/MBG) porous scaffolds by a 3D-printing method. The surface morphology, chemical properties and BMP-2 release of the prepared scaffold were investigated. The osteoblast adhesion, proliferation, spreading, and osteogenic differentiation in vitro and the bone repair ability in vivo of the PLGA/MBG/ZIF-8/BMP-2 (PMZB) scaffold were evaluated, and compared with those of PLGA/MBG (PM) and PLGA/MBG/ZIF-8 (PMZ) scaffolds. The results showed that the PMZB scaffold exhibited a slow and continuous BMP-2 release pattern, enhanced osteoblast adhesion, proliferation, spreading and osteogenic differentiation in vitro, and promoted new bone formation and bone repair in vivo. The PLGA/MBG/ZIF-8/BMP-2 porous scaffold could continuously and slowly release BMP-2, enhance osteogenic activity, and promote new bone formation and bone repair at bone defects. The PMZB scaffold can be used as a bone graft material to repair bone defect at non-weight-bearing sites.

Bilateral sinus augmentation using Hydrodynamics for Functional and Esthetic maxillary rehabilitation

Edentulism is a prevalent oral health issue that negatively impacts the quality of life of the patient on a social and psychological level. For the treatment of edentulism, implant-supported prosthesis replacement is the most successful and supported treatment plan. Placement of an implant in the maxillary arch exposes a clinician to various complications like the quality of bone, pneumatization of the maxillary sinus, atrophic ridge, etc. This issue can be addressed with bone augmentation techniques using various bone graft materials which can improve the quality of bone and can also protect the sinus membrane. Current concepts in implant dentistry rely on techniques that are minimally invasive. Elevation of the sinus membrane can be performed by a minimally invasive procedure with the help of DASK kits. This case report discusses the full mouth maxillary rehabilitation with immediate implant placement after extraction of hopeless teeth in the anterior region followed by bone augmentation, indirect sinus lift and delayed implant placement in the maxillary molar region using a hydraulic sinus lift DASK kit. The patient has been reviewed periodically and the maxillary arch was later restored using a malo-bridge.

Clinical success of guided tissue regeneration for treating vertical bone and furcation defects in dogs.

This study evaluated the clinical success rate of guided tissue regeneration (GTR) for treating advanced periodontal disease in a large canine cohort. A total of 112 GTR procedures performed from 2003-2021 were retrospectively evaluated, including pre- and post-treatment (3-12 months) periodontal probing depths of 104 treated teeth, dental radiographs of 73 treated teeth, and both diagnostic modalities in 64 treated teeth. Probing depth, radiographically apparent bone height, bone graft material, barrier membrane material, and tooth extraction adjacent to the GTR site were investigated as factors affecting success. Vertical bone defects were evaluated separately from furcation defects. GTR was clinically successful, defined as objective improvement in probing depth, objective decrease in radiographic vertical bone defect, and subjective radiographic gain in bone height in 90.3% of vertical bone defects. Success was significantly associated with the magnitude of initial probing depth and the type of barrier membrane used. GTR was clinically successful, defined as objective improvement in furcation probing and subjective radiographic improvement of the bone in the furcation in 22.2% of furcation defects. When F3 lesions were excluded, GTR was successful in 64.3% of furcation defects. GTR is an appropriate treatment to maintain teeth in the oral cavity of dogs with proper client counseling and patient selection, but it is most likely to be successful in vertical defects.

Journey of Mineral Precursors in Bone Mineralization: Evolution and Inspiration for Biomimetic Design.

Bone mineralization is a ubiquitous process among vertebrates that involves a dynamic physical/chemical interplay between the organic and inorganic components of bone tissues. It is now well documented that carbonated apatite, an inorganic component of bone, is proceeded through transient amorphous mineral precursors that transforms into the crystalline mineral phase. Here, the evolution on mineral precursors from their sources to the terminus in the bone mineralization process is reviewed. How organisms tightly control each step of mineralization to drive the formation, stabilization, and phase transformation of amorphous mineral precursors in the right place, at the right time, and rate are highlighted. The paradigm shifts in biomineralization and biomaterial design strategies are intertwined, which promotes breakthroughs in biomineralization-inspired material. The design principles and implementation methods of mineral precursor-based biomaterials in bone graft materials such as implant coatings, bone cements, hydrogels, and nanoparticles are detailed in the present manuscript. The biologically controlled mineralization mechanisms will hold promise for overcoming the barriers to the application of biomineralization-inspired biomaterials.

Bicalcium Phosphate as an Asset in Regenerative Therapy.

After a loss of a tooth, alveolarbone resorption is immutable, leaving the area devoid of sufficient bone quality and mass for a successful and satisfactory implant or any other dental treatment. To treat this problem of irreversible bone loss, bone grafting is the primary solution and a well-accepted technique. The use of bone grafting procedures has increased in recent years. This review is about the various bone grafting techniques and best-situated material available currently along with their trump cards and limitations. In the thorough discussion regarding bone grafting materials and their substitutes, one alloplastic material has shown unbeaten and the most satisfactory properties than any other material, "bicalcium phosphate" (BCP). BCP is a mixture of hydroxyapatite (HA) and beta-tricalcium phosphate (B-TCP) usually obtained through sintering calcium-deficient apatite (CDA) at or above 700°C or by other methods such as hydrolysis or precipitation. The review also shows comparative studies done to understand the effect, most adequate balance, and impact of ratios of HA/B-TCP on the properties, structure, and success rate of this material. The objective of the review is to enlighten the principal characteristic of the most likely used bone graft material presently, i.e., BCP. The most impeccable characteristic of BCP is its capability to osteointegrate, which results in a superior interface. This interface depicts a dynamic process that includes physicochemical reactions, crystal-protein interactions, cell and tissue colonization, and bone remodeling. BCP has certain essential properties that could be put forth as its advantage over any other substitute. These properties include bioactivity, osteointegration, osteoinduction, osteogenesis, and biodegradation, which are mostly governed by modifying the HA/B-TCP ratio. Other applications of BCP are feasible, such as in drug administration and scaffolds for tissue engineering.

Efficiency of antiseptic agents for treatment of autogenous dentinal blocks

BACKGROUND: Autogenous material is currently one of the most common and effective materials used for bone grafting. In recent years, materials based on extracted teeth have attracted attention. When analyzing modern articles, all authors agree that before using autogenous dentinal material, it is necessary to carry out antiseptic treatment to prevent possible complications.
 AIM: A comparison was made of various antiseptic agents for the treatment of autogenous dentinal blocks with subsequent osteoplastic operations in the pre-implantation period.
 MATERIALS AND METHODS: At the Department of Maxillofacial and Plastic Surgery of the Moscow State University of Medicine and Dentistry named after A.I. Evdokimov, 43 teeth were removed for orthodontic indications, the teeth were processed mechanically and fragmented into 125 autogenous dentinal blocks. Then they were treated with antiseptic agents (0.01% Miramistin solution, 95% ethyl alcohol solution, 0.05% and 2% chlorhexidine solution) for 15 min and were sent to the Department of Microbiology, Virology, Immunology of the Moscow State University of Medicine and Dentistry named after A.I. Evdokimov for the isolation of microbial cultures.
 RESULTS: The use of antiseptic agents showed a significant reduction in microbial contamination compared with the control group, which did not undergo antiseptic treatment, which indicates the effectiveness of the treatment of extracted teeth before using it as an osteoplastic material for bone grafting.
 CONCLUSION: Autogenous dentinal blocks must be processed before being used as an osteoplastic material.

Polymer-ceramic composites for bone challenging applications: Materials and manufacturing processes

The continuous advancement of bone restoration technologies is crucial for the creation of innovative materials that possess enhanced functional and technological capabilities. One promising area of research focuses on the development of composite materials combining polymers and ceramics for bone regeneration. These materials offer several advantages over traditional bone grafting materials, including the ability to be customized to meet the specific needs of individual patients and a reduced risk of disease transmission. In recent years, significant progress has been made in the development of polymer-ceramic biomaterials with improved capacities for bone regeneration. This progress has primarily concentrated on enhancing mechanical properties, biodegradability, and biocompatibility. The objective of this overview is to present the latest advancements in composite ceramic polymers used for bone regeneration, encompassing the corresponding manufacturing processes as well as the materials employed in these biomaterials.

Bibliometric analysis of the 100 most cited articles on bone grafting in dentistry.

This bibliometric study analyzed the characteristics of the 100 most cited articles on bone grafts in dentistry. A database search was performed on the Web of Science Core Collection using a specific search strategy. Scopus and Google Scholar were also consulted for citation comparisons. Data extracted included: title, citation metrics, publication year, journal, study design, graft material, surgical technique, authors, institution, and country. Bibliometric networks were generated using VOSviewer. The identified articles were published between 1991 and 2019. Citation counts ranged from 120 to 1161 (mean: 240, 30). Clinical Oral Implants Research was the most cited journal (5175 citations; 25/100). Xenogeneic bone graft material was the most frequently used (5130 citations; 22/100). Europe had 62 articles (14,604 citations), and the United States was the most prominent country (5209 citations; 22/100). The University of Bern had the highest number of citations (2565 citations; 13/100), with Buser D as the author with the largest number of articles (2648 citations; 12/100). This study shows the scientific progress on bone grafts in dentistry. The use of xenogeneic grafts for horizontal and/or vertical ridge augmentation was the most prominent trend.

Revision Clavicle Fracture ORIF with Bone Graft from the Distal Clavicle Utilizing BioBrace

Introduction Clavicle fractures are among the most common fractures. Nonunion fracture of the clavicle has traditionally been treated with autograft from the iliac crest, although it has been proposed that distal clavicle autograft would have less morbidities associated. Case Report Patient presented with a left midshaft clavicle fracture with broken hardware from previous open reduction internal fixation (ORIF). This was treated with removal of broken hardware, revision ORIF, and autograft bone from distal clavicle. Healing was augmented with bone marrow aspirate from the ipsilateral proximal humerus as well as with BioBrace (CONMED Corporation, Largo, FL) collagen strips to reestablish periosteal sleeve and retain bone graft material. Conclusion Distal clavicle autograft augmented with BioBrace is presented as a novel method to treat nonunion clavicle fracture and may be associated with less morbidities.

Bone grafting techniques and materials for implant dentistry.

Bone quality, volume, height and width all play a pivotal role in dental implant stability, success and survival. A lack of adequate bone can be overcome with various bone grafting procedures. Dependent on many factors, including the amount of bone required, the site of implant placement, patient preferences and clinician factors; the type of bone grafting material and procedure undertaken can vary. Supplemental bone can be sourced from a variety of sources, including autogenous, allogenous and xenograft bone. Dependent on the source of the bone, it will have different properties in aiding bone formation, as well as being presented in different formulations, such as bone particles or bone blocks.The aim of this paper is to provide an overview of bone grafting indications, materials and types of bone grafting techniques that can be utilised to aid dental implant provision. It also discusses the properties needed to ensure optimal success of guided bone regeneration techniques.

Research Hotspots and Trends of Bone Xenograft in Clinical Procedures: A Bibliometric and Visual Analysis of the Past Decade.

Bone defect therapy is a common clinical challenge for orthopedic and clinical physicians worldwide, and the therapeutic effect affects the physiological function and healthy life quality of millions of patients. Compared with traditional autogenous bone transplants, bone xenografts are attracting attention due to their advantages of unlimited availability and avoidance of secondary damage. However, there is currently a lack of bibliometric analysis on bone xenograft. This study aimed to use bibliometric methods to analyze the literature on bone xenograft from 2013 to 2023, to explore the current status, hotspots, and future trends of research in this field, and to promote its development and progress. Using the Web of Science Core Collection database, we retrieved and collected publication data related to xenogeneic bone grafting materials worldwide from January 2013 to March 2023. Origin (2021), CiteSpace (6.2.R2 standard), and an online bibliometric platform were used for bibliometric analysis and data visualization. A total of 3395 documents were retrieved, and 686 eligible papers were selected. The country and institutions with the highest number of publications and centrality were the United States (125 papers, centrality = 0.44) and the University of Zurich (29 papers, centrality = 0.28), respectively. The most cited author was Araujo MG (163 times), and the author with the most significant centrality was Froum SJ (centrality = 0.09). The main keyword clusters were "tissue engineering", "sinus floor elevation", "dental implants", "tooth extraction", and "bone substitutes". The most significant bursting keywords in the last three years were "platelet rich fibrin". Research on bone xenograft is steadily growing and will continue to rise. Currently, research hotspots and directions are mainly focused on dental implants related to bone-augmentation techniques and bone tissue engineering. In the future, research hotspots and directions may focus on decellularization technology and investigations involving platelet-rich fibrin.

Correlations between Dental Implant Infectious Pathologies and Maxillary Sinusitis: A Review Article.

(1) Background: The demands of patients for aesthetic and functional rehabilitation of edentulous areas led to the use of dental implants as therapeutic means on an increasingly large scale. This aspect determined the appearance of some infectious pathologies with a peri-implant starting point that can be complicated by various sinus diseases. The purpose of this review article is to synthesize the existing information in the specialized literature regarding the existing correlations between peri-implant and maxillary sinusitis. (2) Methods: The articles published in five databases were researched using different combinations of search terms. We selected 12 articles from the 250 found, by applying the inclusion and exclusion criteria and removing duplicates. (3) Results: We analyzed the included studies and we found that all of them reported a positive correlation between maxillary sinusitis and peri-implant infectious diseases. There are also reported other pathologies with a peri-implant infectious disease as a starting point such as abscesses, oro-antral communications, or foreign body reactions due to implant or bone graft materials migration. (4) Conclusions: This scoping review highlighted the existence of correlations between peri-implant and sinus pathology and the importance of preventing peri-implant diseases of an infectious nature to avoid the occurrence of these complications.

Hydrothermally Synthesized Hydroxyapatite-Silica Composites with Enhanced Mechanical Properties for Bone Graft Applications

The demand for synthetic bone grafts has increased in recent years. Hydroxyapatite (HA) is one of the highly suitable candidates as a bone graft material due to its excellent biocompatibility and high osteoconductive properties with low toxicity. HA has disadvantageous mechanical strength showing relatively fragile and brittle behavior due to its high hygroscopic properties. This leads to improper mechanical properties for such grafting applications. Therefore, HA should be combined with another material with similar biocompatibility and high hardness, such as SiO2. In this work, HA/SiO2 (HAS) composite material was prepared via a hydrothermal method to obtain the high purities of HA with a particle size of approximately 35 nm and around 50% crystallinity. It was found that the addition of SiO2 stimulated the composite system by forming an orthosilicic acid complex that can reduce the overall solution’s pH, thus contributing to the integrity and stability of the HAS composite. Therefore, higher SiO2 contents in the HAS composite can enhance its mechanical stability when immersed in simulated body fluid (SBF). Our work demonstrated that HAS can highly improve HA material’s hardness and mechanical stability under immersion of SBF. The Vickers test showed that the 0.05 GPa hardness in 10% SiO2 increased to 0.35 GPa hardness with the addition of 20% SiO2. The crystal structures of HAS were analyzed using X-ray diffraction, and the morphology of the HAS composites was observed under electron microscopy.

Analysis of risk factors for non-fusion of bone graft in anterior cervical discectomy and fusion: A clinical retrospective study

BackgroundBone graft fusion is a major concern among surgeons after Anterior Cervical Discectomy and Fusion (ACDF) surgery as non-fusion may lead to further physical and drug therapies. MethodsThe related risk elements of non-fusion of bone graft in ACDF surgery were retrospectively assessed. Patients receiving ACDF operation in our hospital from January 2015 to December 2019 were retrospectively analyzed. According to the criteria, 107 study subjects were recruited with a total of 164 surgical segments. The general information of patients, bone graft materials, imaging parameters, and clinical efficacy was recorded. T-test, chi-square test and binary logistic regression evaluation were employed to explore the risk factors of bone graft nonunion. ResultsLow housefield unit (HU) value, diabetes, allogeneic bone, and hydroxyapatite (HA) artificial bone could be risk factors for bone graft fusion in ACDF surgery. Further multivariate analysis was performed and confirmed those related factors of bone graft non-fusion including low HU value (non-fusion rate: 32.53% [27/83], OR = 5.024, p = 0.025), diabetes (non-fusion rate: 53.33% [8/15], OR = 4.776, p = 0.031), allogeneic bone (18.57% [13/70], OR = 3.964, p = 0.046), and artificial bone (68.29% [28/41], OR = 50.550, p < 0.01). ConclusionBy looking at bone graft fusion, selecting autologous iliac bone is an ideal selection to avoid non-fusion of bone graft in ACDF. Diabetes was more important predictor of bone graft nonunion than low HU value. Larger sample size and longer follow-up are required to further confirm these findings in the future.

Efficacy of 3D-printed customized titanium implants and its clinical validation in foot and ankle surgery

&amp;nbsp;In foot and ankle surgery, internal fixation was crucial to maintain the stability of bony structure, and bone grafting material is commonly used to treat bone defects. With rapid development of three-dimensional (3D) printing technology, new advances were made in these two aspects. In this study, digital image correlation method (DICM) data of the patient&amp;rsquo;s ankle via computed tomography (CT) examination were obtained and imported into a series of software. The engineer cooperated with the surgeon to design the customized implants. Ti-6Al-4V spherical metal powder was chosen as raw material and fused together by selective electron beam melting (SEBM), a type of 3D printing technology, to prepare the implant. The implants were sterilized with ethylene oxide. The customized 3D-printed implants were successfully utilized in tibiotalocalcaneal (TTC) arthrodesis to maintain the bony structures at the functional position. In another case, the 3D-printed fusion cage was applied in subtalar arthrodesis to treat bone defects. In these clinical cases, 3D-printed customized titanium implants helped improve the surgical operation flow, and no obvious tissue reaction was observed. The successful implementation suggested that the application of 3D printing technology to prepare customized titanium implants would play an important role in future foot and ankle surgery.

Osteogenic differentiation and reconstruction of mandible defects using a novel resorbable membrane: An in vitro and in vivo experimental study.

To evaluate the cellular response of both an intact fish skin membrane and a porcine-derived collagen membrane and investigate the bone healing response of these membranes using a translational, preclinical, guided-bone regeneration (GBR) canine model. Two different naturally sourced membranes were evaluated in this study: (i) an intact fish skin membrane (Kerecis Oral®, Kerecis) and (ii) a porcine derived collagen (Mucograft®, Geistlich) membrane, positive control. For the in vitro experiments, human osteoprogenitor (hOP) cells were used to assess the cellular viability and proliferation at 24, 48, 72, and 168 h. ALPL, COL1A1, BMP2, and RUNX2 expression levels were analyzed by real-time PCR at 7 and 14 days. The preclinical component was designed to mimic a GBR model in canines (n = 12). The first step was the extraction of premolars (P1-P4) and the 1st molars bilaterally, thereby creating four three-wall box type defects per mandible (two per side). Each defect site was filled with bone grafting material, which was then covered with one of the two membranes (Kerecis Oral® or Mucograft®). The groups were nested within the mandibles of each subject and membranes randomly allocated among the defects to minimize potential site bias. Samples were harvested at 30-, 60-, and 90-days and subjected to computerized microtomography (μCT) for three-dimensional reconstruction to quantify bone formation and graft degradation, in addition to histological processing to qualitatively analyze bone regeneration. Neither the intact fish skin membrane nor porcine-based collagen membrane presented cytotoxic effects. An increase in cell proliferation rate was observed for both membranes, with the Kerecis Oral® outperforming the Mucograft® at the 48- and 168-hour time points. Kerecis Oral® yielded higher ALPL expression relative to Mucograft® at both 7- and 14-day points. Additionally, higher COL1A1 expression was observed for the Kerecis Oral® membrane after 7 days but no differences were detected at 14 days. The membranes yielded similar BMP2 and RUNX2 expression at 7 and 14 days. Volumetric reconstructions and histologic micrographs indicated gradual bone ingrowth along with the presence of particulate bone grafts bridging the defect walls for both Kerecis Oral® and Mucograft® membranes, which allowed for the reestablishment of the mandible shape after 90 days. New bone formation significantly increased from 30 to 60 days, and from 60 to 90 days in vivo, without significant differences between membranes. The amount of bovine grafting material (%) within the defects significantly decreased from 30 to 90 days. Collagen membranes led to an upregulation of cellular proliferation and adhesion along with increased expression of genes associated with bone healing, particularly the intact fish skin membrane. Despite an increase in the bone formation rate in the defect over time, there was no significant difference between the membranes.

Topology Optimization of Spinal Cage Designs for Improved Stress Distribution and Bone Graft Window

Interbody fusion is utilized as a treatment for spinal degenerative diseases. Spinal cages, also known as intervertebral cages or interbody fusion devices, are implants employed in spinal surgery to address these conditions and promote spinal stability. These cages are inserted into the intervertebral space between adjacent vertebrae, replacing the damaged or degenerated disc. Spinal cages aid in the distribution of loads and stress at the fusion site and often incorporate a dedicated area for bone graft material. In this study, a topology optimization approach was employed to develop distinct spinal cages featuring a bone graft window. The mechanical behavior of the spinal cages under loading conditions was simulated and evaluated using finite element analysis. Following optimization, a finite element model analysis estimated the maximum stresses and compared them to the initial model. For topology optimization, reductions of 30%, 50%, and 70% in mass were defined. Both the 50% and 70% mass-reduced designs, featuring an open window, are deemed suitable for bone graft placement and stress distribution.

Comparison of Xenograft and Alloplast Bone Grafts for Infrabony Bone Defect: Literature Review

Restoring supporting tissues to a healthy state is a critical area that provides a much more appealing beside prevention, initial therapy, and corrective procedure. Infrabony defects can be found in the interalveolar and marginal bone caused by periodontal disease as a result of local factors. Nowadays, various surgical therapies are available for treating infrabony defects such as bone graft. However, many considerations in selecting the best option of bone graft materials. To compare the effectiveness of Xenograft and Alloplast bonegraft in infrabony defect therapy. The allograft presented a significantly higher amount of newly formed bone than the xenograft. There were no differences in the percentage of newly formed bone between the allograft and the alloplastic graft, and between the alloplastic graft and the xenograft. Between the three types of grafts, there were no discernible changes in the percentage of remaining particles. All bone substitute materials shown favorable properties for use in bone regeneration treatments. Local factors such as oral hygiene and controlled chronic disease are the main point of successful bone graft therapy. The present study concludes that both Alloplast and Xenograft have equal potential in infrabony bone defect therapy.

Minimally invasive techniques for lateral maxillary sinus floor elevation: small lateral window and one-stage surgery—a 2–5-year retrospective study

This study aimed to introduce a minimally invasive technique for maxillary sinus floor elevation using the lateral approach (lSFE) and to determine the factors that influence the stability of the grafted area in the sinus cavity. Thirty patients (30 implants) treated with lSFE using minimally invasive techniques from 2015 to 2019 were included in the study. Five aspects of the implant (central, mesial, distal, buccal, and palatal bone heights [BHs]) were measured using cone-beam computed tomography (CBCT) before implant surgery, immediately after surgery (T0), 6 months after surgery (T1), and at the last follow-up visit (T2). Patients’ characteristics were collected. A small bone window (height, (4.40 ± 0.74) mm; length, (6.26 ± 1.03) mm) was prepared. No implant failed during the follow-up period (3.67 ± 1.75) years. Three of the 30 implants exhibited perforations. Changes in BH of the five aspects of implants showed strong correlations with each other and BH decreased dramatically before second-stage surgery. Residual bone height (RBH) did not significantly influence BH changes, whereas smoking status and type of bone graft materials were the potentially influential factors. During the approximate three-year observation period, lSFE with a minimally invasive technique demonstrated high implant survival rate and limited bone reduction in grafted area. In conclusion, lSFE using minimally invasive techniques was a viable treatment option. Patients who were nonsmokers and whose sinus cavity was filled with deproteinized bovine bone mineral (DBBM) had significantly limited bone resorption in grafted area.

In Vitro and In Vivo Bone Regeneration Assessment of Titanium-Doped Waste Eggshell-Derived Hydroxyapatite in the Animal Model.

In this work, a titanium-doped hydroxyapatite (HAp) scaffold was produced from two different sources (natural eggshell and laboratory-grade reagents) to compare the efficacy of natural and synthetic resources of HAp materials on new bone regeneration. This comparative study also reports the effect of Ti doping on the physical, mechanical, and in vitro as well as in vivo biological properties of the HAp scaffold. Pellets were prepared in the conventional powder metallurgy route, compacted, and sintered at 900 °C, showing sufficient porosity for bony ingrowth. The physical-mechanical characterizations were performed by density, porosity evaluation, XRD, FTIR, SEM analysis, and hardness measurement. In vitro interactions were evaluated by bactericidal assay, hemolysis, MTT assay, and interaction with simulated body fluid. All categories of pellets showed absolute nonhemolytic and nontoxic character. Furthermore, significant apatite formation was observed on the Ti-doped HAp samples in the simulated body fluid immersion study. The developed porous pellets were implanted to assess the bone defect healing in the femoral condyle of healthy rabbits. A 2 month study after implantation showed no marked inflammatory reaction for any samples. Radiological analysis, histological analysis, SEM analysis, and oxytetracycline labeling studies depicted better invasion of mature osseous tissue in the pores of doped eggshell-derived HAp scaffolds as compared to the undoped HAp, and laboratory-made samples. Quantification using oxytetracycline labeling depicted 59.31 ± 1.89% new bone formation for Ti-doped eggshell HAp as compared to Ti-doped pure HAp (54.41 ± 1.93) and other undoped samples. Histological studies showed the presence of abundant osteoblastic and osteoclastic cells in Ti-doped eggshell HAp in contrast to other samples. Radiological and SEM data also showed similar results. The results indicated that Ti-doped biosourced HAp samples have good biocompatibility, new bone-forming ability, and could be used as a bone grafting material in orthopedic surgery.