Bone Regeneration Research Articles

Polytrauma impairs fracture healing accompanied by increased persistence of innate inflammatory stimuli and reduced adaptive response.

The field of bone regeneration has primarily focused on investigating fracture healing and nonunion in isolated musculoskeletal injuries. Compared to isolated fractures, which frequently heal well, fractures in patients with multiple bodily injuries (polytrauma) may exhibit impaired healing. While some papers have reported the overall cytokine response to polytrauma conditions, significant gaps in our understanding remain in how fractures heal differently in polytrauma patients. We aimed to characterize fracture healing and the temporal local and systemic immune responses to polytrauma in a murine model of polytrauma composed of a femur fracture combined with isolated chest trauma. We collected serum, bone marrow from the uninjured limb, femur fracture tissue, and lung tissue over 3 weeks to study the local and systemic immune responses and cytokine expression after injury. Immune cell distribution was assessed by flow cytometry. Fracture healing was characterized using microcomputed tomography (microCT), histological staining, immunohistochemistry, mechanical testing, and small angle X-ray scattering. We detected more innate immune cells in the polytrauma group, both locally at the fracture site and systemically, compared to other groups. The percentage of B and T cells was dramatically reduced in the polytrauma group 6 h after injury and remained low throughout the study duration. Fracture healing in the polytrauma group was impaired, evidenced by the formation of a poorly mineralized and dysregulated fracture callus. Our data confirm the early, dysregulated inflammatory state in polytrauma that correlates with disorganized and impaired fracture healing.

3D Printing Hierarchical Porous Nanofibrous Scaffold for Bone Regeneration.

Current limitations in 3D printing pose significant challenges for the fabrication of hierarchical 3D scaffolds with nanofibrous structures that simulate the natural bone extracellular matrix (ECM) for enhanced bone regeneration. This study presents an innovative approach to 3D printing customized hierarchical porous scaffolds with nanofiber structures using biodegradable nanofibrous microspheres as the bio-ink. In vitro investigations demonstrate that the hierarchical porous architecture substantially enhances cell infiltration and proliferation rates, while the nanofiber topology provides physical cues to guide osteogenic differentiation and ECM deposition. When serving as a cell carrier, the 3D-printed nanofibrous scaffold promotes bone tissue regeneration and integration in vivo. Additionally, the facile and versatile chemical modification facilitates the precise tailoring of the scaffold's functionality. Using nanofibrous microspheres with highly biomimetic and versatile modification properties as the foundational constituent in this universal 3D printing methodology enables comprehensive manipulation of scaffolding biological properties, spanning from macroscopic external morphology to molecular-scale biochemical kinetics, thereby addressing a diverse spectrum of clinical requisites.

Biomaterial Cues for Regulation of Osteoclast Differentiation and Function in Bone Regeneration

AbstractTissue regeneration involves dynamic dialogue between and among different cells and their surrounding matrices. Bone regeneration is specifically governed by reciprocity between osteoblasts and osteoclasts within the bone microenvironment. Osteoclast‐directed resorption and osteoblast‐directed formation of bone are essential to bone remodeling, and the crosstalk between these cells is vital to curating a sequence of events that culminate in the creation of bone tissue. Among bone biomaterial strategies, many have investigated the use of different material cues to direct the development and activity of osteoblasts. However, less attention has been given to exploring features that similarly target osteoclast formation and activity, with even fewer strategies demonstrating or integrating biomaterial‐directed modulation of osteoblast‐osteoclast coupling. This review aims to describe various biomaterial cues demonstrated to influence osteoclastogenesis and osteoclast function, emphasizing those that enhance a material construct's ability to achieve bone healing and regeneration. Additionally discussed are approaches that influence the communication between osteoclasts and osteoblasts, particularly in a manner that takes advantage of their coupling. Deepening the understanding of how biomaterial cues may dictate osteoclast differentiation, function, and influence on the microenvironment may enable the realization of bone‐replacement interventions with enhanced integrative and regenerative capacities.

Advancements and clinical applications of extended platelet-rich fibrin (E-PRF)

Extended platelet-rich fibrin (E-PRF) has emerged as a potent biological agent in regenerative medicine and dentistry. It leverages the natural healing capacities of growth factors and cytokines from platelets and leukocytes to promote tissue repair. This systematic review explores the role of E-PRF in various clinical applications, including wound healing, bone regeneration, and periodontal therapy. The findings indicate that E-PRF provides an enhanced bioactive matrix, supporting superior clinical outcomes compared to conventional treatments. Future studies should focus on optimizing E-PRF protocols and investigating its long-term effectiveness.

Connective Tissue Graft May Compensate for Residual Bone Defect of the Implant in the Esthetic Zone: A Case Report with 7-year Follow-up

The present case report aimed to demonstrate the case using a connective tissue graft (CTG) to compensate for a residual defect after guided bone regeneration (GBR) in the anterior maxillary area. An extensive number of studies have reported successful outcomes of horizontal bone augmentation, but it was also demonstrated that a complete resolution of the defect may not be achieved in all cases. In the present case report, the patient underwent implant placement simultaneously with GBR at the anterior maxillary area. After 4 months, partial regeneration of the initial defect was observed. To compensate for such residual defect, a CTG was applied. Other expectations by the CTG were to enhance tissue volume and phenotype. The final prosthesis was delivered after 3 months. Up to 7 years, favorable radiographic and clinical situations were observed. In conclusion, a CTG may compensate for residual bone defect of the implant in the esthetic zone.

Peri-implant bone regeneration in pigs.

To review the current literature to answer the focused question: in the experimental pig model (population), which types of peri-implant bone defects (exposure) have been used evaluate different modes of therapy and what is their capacity for spontaneous healing and regeneration (outcome)? Following PRISMA guidelines, electronic databases were searched for studies reporting peri-implant bone defects in the maxillae or mandibles of pigs. Those studies which reported a control group of untreated defects with assessment of spontaneous regeneration [new bone area (BA)] and/or re-osseointegration [new bone-to-implant contact (BIC)] via quantitative radiography or histomorphometry were included in a random effects meta-analysis for the outcomes BA and BIC. Overall, 21 studies, mostly performed in the mandibles of minipigs, were included. Most studies reported 'acute' intrabony (circumferential and/or dehiscence; n = 12) or supra-alveolar defects (horizontal; n = 4). Five studies attempted to induce 'chronic' peri-implantitis lesions using ligatures with conflicting results. Meta-analyses revealed pooled estimates (with 95% confidence intervals) of 48.07% BIC (30.14-66%) and 64.31% BA (42.71-85.91%) in intrabony defects, and 52.09% BIC (41.83-62.35%) and 28.62% BA (12.97-44.28%) in supra-alveolar defects. Heterogeneity in the meta-analysis was high (I2 > 90%). Current evidence for peri-implant bone regeneration in pigs is mainly based on acute intrabony defects, which demonstrate a high capacity for spontaneous regeneration and re-osseointegration. The evidence for chronic peri-implantitis is limited and does not clearly indicate a spontaneous progression of the disease in this animal model.

The Punch Graft Technique: A Simplified Protocol for Three-Dimensional Peri-Implant Soft and/or Hard Tissue Augmentation in a Single Step.

This article describes a clinical protocol utilizing soft tissue augmentation alone or in combination with guided bone regeneration (GBR), introducing simultaneous application of the one abutment one time concept for three-dimensional reconstruction of the deficient ridge. Soft and hard tissue quality and dimensions are fundamental elements for long lasting results in implant dentistry. Different techniques have been described for soft and hard tissue augmentation at time of implant placement presenting favorable results. However, multiple abutment disconnections during the prosthetic phase of treatment can compromise the results achieved during surgery. The purpose of this article is to present a surgical protocol that allows three-dimensional ridge reconstruction involving soft tissue augmentation alone, or in combination with hard tissue augmentation in one single step with the use of an one-time intermediate abutment as an anchorage device for the regenerative materials. Two clinical cases utilizing the proposed protocol are also presented, demonstrating favorable results. The application of the proposed protocol simplifies the surgical phase of treatment, protects the achieved result and enables a favorable outcome in decreased time. Utilising an intermediate abutment as an anchorage device at time of surgery can be proven an easy to apply and biologically favorable alternative way to other methods of soft tissue graft stabilization proposed in the past.

LncRNA CASC11 regulates the progress of delayed fracture healing via sponging miR-150-3p.

Long non-coding RNA (lncRNA) plays a pivotal role in bone regeneration by interaction with microRNAs (miRNAs) and constructing a lncRNA-miRNA regulatory network. This research aimed to elucidate the role of lncRNA CASC11 in the delayed healing process of tibial fractures and to explore its potential regulatory mechanisms. The expression levels of CASC11 and miR-150-3p in serum samples were detected and the predictive capability of CASC11 regarding delayed healing in fracture patients. Furthermore, the study confirmed the accuracy of the binding sites between CASC11 and miR-150-3p. Subsequently, overexpression/interference plasmids of CASC11, along with overexpression plasmids co-transfected with both CASC11 and miR-150-3p, were systematically introduced into MC3T3-E1 cells to investigate their effects on the expression of osteogenic marker genes, as well as their influence on cellular proliferation and apoptosis. The expression levels of CASC11 were significantly elevated, while miR-150-3p levels were markedly decreased in individuals exhibiting delayed fracture healing (P < 0.001). CASC11 was observed to suppress the expression of osteogenic marker genes, inhibit the proliferation of MC3T3-E1 cells, and promote cell apoptosis (P < 0.05). Furthermore, the overexpression of miR-150-3p effectively countered the inhibitory impact of CASC11 on osteogenic differentiation and the promoting effect on cell apoptosis (P < 0.05). The sponging effect of CASC11 on miR-150-3p led to delayed fracture healing. CASC11 emerges as a potential target for treating delayed fracture healing.

Biocooperative Regenerative Materials by Harnessing Blood-Clotting and Peptide Self-Assembly.

The immune system has evolved to heal small ruptures and fractures with remarkable efficacy through regulation of the regenerative hematoma (RH); a rich and dynamic environment that coordinates numerous molecular and cellular processes to achieve complete repair. Here, a biocooperative approach that harnesses endogenous molecules and natural healing to engineer personalized regenerative materials is presented. Peptide amphiphiles (PAs) are co-assembled with blood components during coagulation to engineer a living material that exhibits key compositional and structural properties of the RH. By exploiting non-selective and selective PA-blood interactions, the material can be immediately manipulated, mechanically-tuned, and 3D printed. The material preserves normal platelet behavior, generates and provides a continuous source of growth factors, and promotes in vitro growth of mesenchymal stromal cells, endothelial cells, and fibroblasts. Furthermore, using a personalized autologous approach to convert whole blood into PA-blood gel implants, bone regeneration is shown in a critical-sized rat calvarial defect. This study provides proof-of-concept for a biocooperative approach that goes beyond biomimicry by using mechanisms that Nature has evolved to heal as tools to engineer accessible, personalized, and regenerative biomaterials that can be readily formed at point of use.

Effectiveness of cold atmospheric plasma in decontaminating enterococcus faecalis colonized collagen and PTFE membranes used in guided bone regeneration: a comparative in vitro investigation.

Wound healing disorders caused by bacterial infections in dental surgery, especially where membranes are used, are a common issue in oral surgery. Cold atmospheric plasma (CAP) offers a non-invasive solution for surface decontamination, including dental implants. The aim of this study was to evaluate the antibacterial effectiveness of CAP on various clinically applied membranes made of collagen and polytetrafluoroethylene (PTFE). To assess the antibacterial properties of CAP, enterococcus faecalis were seeded on different membranes: Memlock (collagen), Memlock Pliable (collagen), Agronaut (collagen), and PermaPro (PTFE); n = 4. After in vitro cultivation for 6days, CAP using a kINPen® MED with an output of 5 W was applied 5min and 10min. Bacterial colony-forming units (CFU) were quantified to detect decontamination effectiveness. In addition, live and dead staining as well as scanning electron microscopy (SEM) of membranes was performed for validation and surface texture analysis. Bacterial colonization was highest on collagen-based membranes (CFU Memlock: 14.38 ± 8.91). The results showed that CAP significantly reduced bacterial colonization on all membrane types after 10min application of CAP; Memlock (CFU after 10min 0.22 ± 0.16^106; p = 0.0256), Argonaut (CFU after 10min 0.02 ± 0.01^106; p = 0.0129) and PermaPro (complete bacterial decontamination; p = 0.0058). This was paralleled by fluorescence and scanning electron microscopy. CAP was most effective on smooth membrane surfaces as SEM revealed. CAP thus offers a non-invasive, cost-effective method to reduce bacterial infections in guided bone regeneration using membranes.

Framework Nucleic Acid-Based Selective Cell Catcher for Endogenous Stem Cell Recruitment.

Cell-surface engineering holds great promise in boosting endogenous stem cell attraction for tissue regeneration. However, challenges such as cellular internalization of ligand and the dynamic nature of cell membranes often complicate ligand-receptor interactions. The aim of this study is to harness the innovative potential of programmable tetrahedral framework nucleic acid (tFNA) to enable precise, tunable ligand-receptor interactions, thereby improving stem cell recruitment efficiency. This approach involves experimental screening and theoretical analysis using dissipative particle dynamics. The results demonstrate that altering the flexibility and topology of ligands on tFNA changes their cellular internalization and membrane binding efficiency. Furthermore, optimizing the distribution of the mesenchymal stem cell (MSC)-binding aptamer 19S (Apt19S) on the tFNA enhances the stem cell capture efficiency. Following successful in vitro MSC capture, Apt19S-modified tFNA is chemically linked to a hyaluronic acid hydrogel, forming an efficient "stem cell catcher" system. Subsequent in vivo experiments demonstrate that this system effectively promotes early stem cell recruitment and accelerates bone regeneration in different bone healing scenarios, including cranial and maxillary defects.

Dental pulp stem cell‑derived extracellular vesicles loaded with hydrogels promote osteogenesis in rats with alveolar bone defects.

Alveolar bone defects caused by inflammation, trauma and tumors adversely affect periodontal health, causing tooth loosening or dentition defects, thus affecting denture or implant repair. Advancements in tissue engineering technology and stem cell biology have significantly improved the regenerative reconstruction of alveolar bone defects. The multiple trophic activities of extracellular vesicles (EVs) produced by mesenchymal stem cells play important roles in exerting their therapeutic effects. Several studies have reported the role of dental pulp stem cells (DPSCs) in bone regeneration, but the regenerative effects of DPSC‑EVs on alveolar bone defects are unclear. In the present study, the osteogenic effects of DPSC‑EVs on Hertwig's epithelial root sheath (HERS) cells in vitro and their osteoinductive effects in an alveolar bone defect rat model were investigated. The results showed that DPSC‑EVs significantly promoted the expression of osteogenic genes, such as runt‑related transcription factor 2 and alkaline phosphatase, and increased the osteogenic differentiation capability of HERS. These findings suggested that transforming growth factor β1 inhibition decreased DPSC‑EV‑induced Smad, MAPK and ERK phosphorylation in HERS. In vivo, DPSC‑EV‑loaded hydrogels were transplanted into the alveolar sockets of Sprague‑Dawley rats and observed for eight weeks. The new bone grew concentrically in the DPSC‑EV or DPSC‑EV‑loaded hydrogel group, with greater bone mass than that in the control group, and the bone volume/total volume increased notably. The results confirmed the osteogenic and osteoinductive effects of DPSC‑EVs and DPSC‑Exo‑loaded hydrogels on alveolar bone defects. Due to their low immunogenicity, high stability, good biocompatibility and osteogenic propensity, DPSC‑EV‑loaded hydrogels are a safe cell‑free therapeutic approach for defective alveolar bone regeneration.

The Effect of Platelet-Rich Fibrin (PRF) in Accelerating Periodontal Regeneration: A Randomized Controlled Clinical Trial

ABSTRACT Background: Regeneration of periodontal tissues is an essential component in treating periodontal disease, and there is an increasing focus on biological agents that might improve the healing process. Materials and Methods: The randomized controlled clinical study included a cohort of 60 individuals diagnosed with chronic periodontitis. Each participant was randomly allocated to one of two groups: the experimental group (n = 30), which underwent PRF in combination with traditional open flap debridement (OFD), and the control group (n = 30), which received OFD alone. Clinical criteria such as probing pocket depth (PPD), clinical attachment level (CAL), and bone fill percentage were assessed at baseline and after 6 months. Furthermore, cone-beam computed tomography (CBCT) was used to evaluate bone regrowth radiographically. Results: Following a period of 6 months, the experimental group had a notable decrease in postpartum depression (mean decrease of 4.2 mm) and an increase in central artery ligation (mean increase of 3.5 mm) compared to the control group, which had a mean decrease in postpartum depression of 2.8 mm and a mean increase in central artery ligation of 2.1 mm. The test group had a notably greater proportion of bone fill (45%) in comparison to the control group (30%). Further radiographic study verified enhanced bone regeneration in the areas treated with PRF. Conclusion: The use of Platelet-Rich Fibrin (PRF) in combination with traditional periodontal surgery greatly expedites the process of periodontal regeneration, as shown by notable enhancements in clinical indicators and bone regeneration.

A novel multifunctional nanocomposite hydrogel orchestrates the macrophage reprogramming-osteogenesis crosstalk to boost bone defect repair.

Repairing bone defects is a complex cascade reaction process, as immune system regulation, vascular growth, and osteogenic differentiation are essential. Thus, developing a tissue-engineered biomaterial that caters to the complex healing process of bone regeneration remains a major clinical challenge. In the study, Ca2+-TA-rGO (CTAG)/GelMA hydrogels were synthesized by binding Ca2+ using metal chelation to graphene oxide (GO) nanosheets reduced by tannic acid (TA-rGO) and doping them into gelatin methacrylate (GelMA) hydrogels. TA and rGO exhibited biocompatibility and immunomodulatory properties in this composite, while Ca2+ promoted bone formation and angiogenesis. This novel nanocomposite hydrogel demonstrated good mechanical properties, degradability, and conductivity, and it could achieve slow Ca2+ release during bone regeneration. Both in vitro and in vivo experiments revealed that CTAG/GelMA hydrogel modulated macrophage reprogramming and induced a shift from macrophages to healing-promoting M2 macrophages during the inflammatory phase, promoted vascular neovascularization, and facilitated osteoblast differentiation during bone formation. Moreover, CTAG/GelMA hydrogel could downregulate the NF-κB signaling pathway, offering new insights into regulating macrophage reprogramming-osteogenic crosstalk. Conclusively, this novel multifunctional nanocomposite hydrogel provides a multistage treatment for bone and orchestrates macrophage reprogramming-osteogenic crosstalk to boost bone repair.

Improvement of osteogenic differentiation potential of placenta-derived mesenchymal stem cells by metformin via AMPK pathway activation.

Placenta-derived human mesenchymal stem cells (PL-MSCs) have gained a lot of attention in the field of regenerative medicine due to their availability and bone-forming capacity. However, the osteogenic differentiation capacity of these cells remains inconsistent and could be improved to achieve greater efficiency. Although metformin, a widely used oral hypoglycemic agent, has been shown to increase bone formation in various cell types, its effect on osteogenic differentiation of PL-MSCs has not yet been investigated. Therefore, the objective of this study was to examine the effect of metformin on the osteogenic differentiation capacity of PL-MSCs and the underlying mechanisms. The PL-MSCs were treated with 0.5 to 640µM metformin and their osteogenic differentiation capacity was examined by an alkaline phosphatase (ALP) activity assay, Alizarin red S staining and expression levels of osteogenic genes. The role of adenosine 5'-monophosphate-activated protein kinase (AMPK) signaling in mediating the effect of metformin on the osteogenic differentiation capacity of PL-MSCs was also investigated by determining levels of phosphorylated AMPK(pAMPK)/AMPK ratio and by using compound C, an AMPK inhibitor. The results showed that 10-160µM metformin significantly increased the viability of PL-MSCs in a dose- and time-dependent manner. Furthermore, 80-320µM metformin also increased ALP activity, matrix mineralization, and expression levels of osteogenic genes, runt-related transcription factor 2 (RUNX2), osterix (OSX), osteocalcin (OCN) and collagen I (COL1), in PL-MSCs. Metformin increases osteogenic differentiation of PL-MSCs, at least in part, through the AMPK signaling pathway, since the administration of compound C inhibited its enhancing effects on ALP activity, matrix mineralization, and osteogenic gene expression of PL-MSCs. This study demonstrated that metformin at concentrations of 80-320μM significantly enhanced osteogenic differentiation of PL-MSCs in a dose- and time-dependent manner, primarily through activation of the AMPK signaling pathway. This finding suggests that metformin could be used with other conventional drugs to induce bone regeneration in various bone diseases. Additionally, this study provides valuable insights for future osteoporosis treatment by highlighting the potential of modulating the AMPK pathway to improve bone regeneration.

Repairing alveolar bone defect using demineralized dentin grafts: a meta-analysis of randomized controlled trials.

The alveolar bone defect often was hardly healed naturally by the body's repair mechanism. Implant placement was the most favored option for replacing a missing tooth in the current times, and the preservation of alveolar bone was vital. Tooth components, especially dentin, were very similar to alveolar bone components and could be used for promoting the alveolar bone regeneration process in reconstructive dentistry. We exhaustively scoured multiple literature databases, such as PubMed and Embase, from inception to September 2024. The protocol for this meta-analysis was officially registered with PROSPERO (CRD42023400591). Randomized clinical trials (RCTs) that reported alveolar bone preservation through demineralized dentin grafts were chosen from the studies. We extracted both qualitative and quantitative data and evaluated statistical heterogeneity using the I2 test. The potential for publication bias was evaluated using both qualitative and quantitative methods. A visual evaluation of the funnel plot was used for the qualitative assessment, with the Begg's test and the Egger's test were used for quantitative analysis. Ultimately, 7 studies met the inclusion criteria, comprising 230 participants who were adults without systemic diseases and free from caries or peri-apical infections. Compared with the control group, the demineralized dentin matrix (DDM) group was not statistically significant for improving radiographic ridge width change (SMD - 0.09, 95% CI -0.39 to 0.22) and ISQ values (SMD 0.06, 95% CI -2.39 to 2.51). These results indicate that DDM performs comparably to the control, suggesting that it can be considered an effective alternative in achieving similar outcomes in these specific measures. The DDM grafts appear to be a feasible alternative to other biomaterials used for alveolar bone preservation. Not applicable. This study is a meta-analysis and does not involve a clinical trial. Therefore, no clinical trial number has been assigned.

Nanotechnology-Enhanced Orthopaedic Surgery

Nanomaterials hold significant promise for the future of orthopaedic implants due to their ability to mimic the nanoscale components of the bone, such as collagen fibrils and hydroxyapatite. Nanomaterials can regulate cell behaviour while offering mechanical strength and biocompatibility, making them ideal for bone repair and tissue regeneration. This comprehensive review explores the key existing and potential applications of nanotechnology in orthopaedics, including bone tissue engineering, drug delivery systems, systems combatting implant-related infections, and the surface preparation of implants to enhance osseointegration. These innovations are poised to revolutionise orthopaedic care by improving implant durability, reducing infection risks, and promoting bone regeneration to deliver personalised treatment and create better patient outcomes.

Three-Dimensional Semiconductor Network as Regulators of Energy Metabolism Drives Angiogenesis in Bone Regeneration.

Insufficient vascularization is a primary cause of bone implantation failure. The management of energy metabolism is crucial for the achievement of vascularized osseointegration. In light of the bone semiconductor property and the electric property of semiconductor heterojunctions, a three-dimensional semiconductor heterojunction network (3D-NTBH) implant has been devised with the objective of regulating cellular energy metabolism, thereby driving angiogenesis for bone regeneration. The three-dimensional heterojunction interfaces facilitate electron transfer and establish internal electric fields at the nanoscale interfaces. The 3D-NTBH was found to noticeably accelerate glycolysis in endothelial cells, thereby rapidly providing energy to support cellular metabolic activities and ultimately driving angiogenesis within the bone tissue. Molecular dynamic simulations have demonstrated that the 3D-NTBH facilitates the exposure of fibronectin's Arg-Gly-Asp peptide binding site, thereby regulating the glycolysis of endothelial cells. Further evidence suggests that 3D-NTBH promotes early vascular network reconstruction and bone regeneration in vivo. The findings of this research offer a promising research perspective for the design of vascularizing implants.

PREVENÇÃO E TRATAMENTO DA COMUNICAÇÃO BUCO-SINUSAL EM PROCEDIMENTOS ODONTOLÓGICOS: REVISÃO DE TÉCNICAS CIRÚRGICAS E BIOMATERIAIS

Oroantral communication (OAC) is a frequent complication in dental procedures, especially in extractions of upper posterior teeth due to the anatomical proximity to the maxillary sinus. This review addresses the main surgical techniques and the use of biomaterials in the treatment of OAC, based on articles published between 2010 and 2024, found in databases such as PubMed and Scielo. Risk factors like the proximity of dental roots to the floor of the maxillary sinus and advanced age increase the likelihood of OAC, with cone-beam computed tomography (CBCT) being an effective tool in preoperative evaluation. Minimally invasive surgical techniques, such as controlled osteotomy and piezosurgery, have been effective in preventing perforations, while biomaterials like collagen membranes and bone grafts are widely used in treating larger perforations, promoting bone regeneration and healing. The combination of appropriate sutures and biomaterials is essential to avoid postoperative complications such as chronic sinusitis and fistulas. The review concludes that despite advances in surgical techniques and the use of biomaterials, gaps remain in the literature regarding the management of complex perforations, highlighting the need for more comparative studies to optimize OAC treatment. An integrated approach—including preoperative evaluation, appropriate surgical techniques, and postoperative follow-up—is crucial for treatment success and the reduction of long-term complications.

Advances in Bioceramics for Bone Regeneration: A Narrative Review

Large osseous defects resulting from trauma, tumor resection, or fracture render the inherent ability of the body to repair inadequate and necessitate the use of bone grafts to facilitate the recovery of both form and function of the bony defect sites. In the United States alone, a large number of bone graft procedures are performed yearly, making it an essential area of investigation and research. Synthetic grafts represent a potential alterative to autografts due to their patient-specific customizability, but currently lack widespread acceptance in the clinical space. Early in their development, non-autologous bone grafts composed of metals such as stainless steel and titanium alloys were favorable due to their biocompatibility, resistance to corrosion, mechanical strength, and durability. However, since their inception, bioceramics have also evolved as viable alternatives. This review aims to present an overview of the fundamental prerequisites for tissue engineering devices using bioceramics as well as to provide a comprehensive account of their historical usage and significant advancements over time. This review includes a summary of commonly used manufacturing techniques and an evaluation of their use as drug carriers and bioactive coatings—for therapeutic ion/drug release, and potential avenues to further enhance hard tissue regeneration.