Periosteal Distraction Osteogenesis Research Articles

Pumping the Periosteum: A Feasibility Study.

Gradual elevation of periosteum from the bone surface is known to promote the adaptation of soft tissues and the formation of hard tissues. The aim of our study was to estimate the benefit of periosteal distraction osteogenesis (PDO) on de novo bone formation in a rat model. After device placement, animals were allowed for a latency period of 7 days. Animals in the PDO group were subjected to distraction at a rate of 0.1 mm/d for 10 days. In the periosteal pumping (PP) group, the animals were subjected to distraction at a rate of 0.1 mm/d. The direction of distraction was alternated every 2 days. The animals were euthanized at 17, 31, and 45 days after surgery, and the samples were analyzed histologically and by microcomputed tomography. In both groups, the new bone was characterized as primary woven bone that was located at the leading edge of bone apposition. Bone volumes significantly increased throughout the observation period both in the PP group ( P = 0.018) and in the PDO group ( P < 0.001). The new bone was denser and more mature in the PP group than in the PDO group, and the difference was significant at the 31-day time point ( P = 0.024). However, the volume of the new bone was higher in the PDO at the 45-day time point ( P < 0.001). We propose that the PP may be applied to enhance the osteogenic capacity of periosteum without plate elevation. Because this is only a proof-of-principle study, the alternated protocol of periosteal distraction warrants evaluation in the future studies.

Regeneration of Craniofacial Bone Induced by Periosteal Pumping.

A variety of surgical techniques and tissue engineering strategies utilizing osteogenic potential of the periosteum have been developed for the repair of extended bone deficiencies. The aim of the present study was to assess the impact of an alternating protocol of periosteal distraction osteogenesis (PDO) on bone regeneration in an intraoral model. Eight adult, male Beagle dogs were used for the study. Two distraction devices were placed on each side of the mandible. After a 7-day latency period, distraction devices in all animals were manipulated at the rate of 0.5 mm for a total of 8 days. The pumping protocol in two test groups proceeded twice daily by alternating activation with relaxation. In the periosteal pumping/distraction (PPDO) group, the distraction screws were activated two times (at 12 and 24 h) and then turned back (at 36 h), and in the periosteal pumping (PP) group repeatedly activated and turned back (at 12 h). In the PDO group, only activation was performed once daily (positive control). Devices were left inactivated in the negative control (NC) group. The samples were harvested after 8 weeks of consolidation period and investigated by micro-CT and histological analysis. New mature, lamellar bone was formed over the pristine bone in all groups. PPDO and PDO groups showed more new bone area (NBA) compared to the PP (p < 0.001 and p < 0.001, respectively) and to the NC group (p = 0.032 and p = 0.031, respectively). Furthermore, greater NBA was found in the PP group than the NC group (p = 0.006). PDO demonstrated higher relative connective tissue area than the PPDO group (p = 0.005) and lower relative new bone volume than the NC group (p = 0.025). Pumping protocol of periosteal distraction may successfully induce the endogenous regeneration of the mandibular bone in dogs. Impact Statement Repair of extended bone defects impose a significant challenge to oral and maxillofacial surgeons. In this article, a principle of distraction osteogenesis was applied to stimulate bone regeneration in the mandible. A periosteum-based regeneration approach may represent a valuable step toward creating a significant volume of hard and soft tissues, without need for autogenous bone harvesting or application of biomaterials.

Systematic Review and Quality Evaluation Using ARRIVE 2.0 Guidelines on Animal Models Used for Periosteal Distraction Osteogenesis.

Simple SummaryPeriosteal distraction osteogenesis (PDO) is a promising new technique for bone regeneration, as it avoids some of the complications that other techniques present. In this review, were examined the animal models used in preclinical studies carried out so far, as well as the quality of the studies using the ARRIVE guidelines (Animal Research: Reporting of In Vivo Experiments). The models that have shown the best results in terms of handling and fewer complications are the rabbit and the rat. The minipig is not recommended due to its difficult oral hygiene and handling. The quality of the studies has increased since the implementation of the ARRIVE guidelines in 2010. Future studies shall be improved in terms of transparency, comparability, and reproducibility.The objective of this systematic review was to synthesize all the preclinical studies carried out in periosteal distraction osteogenesis (PDO) in order to evaluate the quality using the ARRIVE guidelines. The animal models used, and the influence of the complications, were analysed in order to establish the most appropriate models for this technique. The PRISMA statements have been followed. Bibliographic sources have been consulted manually by two reviewers. Risk of bias was evaluated using the SYRCLE tool for animal studies, and the quality of the studies with the ARRIVE 2.0 guidelines. The selection criteria established by expert researchers were applied to decide which studies should be included in the review, that resulted in twenty-four studies. Only one achieved the maximum score according to the ARRIVE 2.0 guidelines. The rabbit as an animal model has presented good results in PDO, both for calvaria and jaw. Rats have shown good results for PDO in calvaria. The minipig should not be recommended as an animal model in PDO. Despite the increase in the quality of the studies since the implementation of the ARRIVE 2.0 guidelines, it would be necessary to improve the quality of the studies to facilitate the transparency, comparison, and reproducibility of future works.

Three-Dimensional-Printed Poly-L-Lactic Acid Scaffolds with Different Pore Sizes Influence Periosteal Distraction Osteogenesis of a Rabbit Skull.

The repair of bone defects is a big challenge in reconstructive surgery. Periosteal distraction osteogenesis (PDO), as a promising technique used for bone regeneration, forms a space between the periosteum and bone cortex to regenerate the new bone merely by distracting the periosteum. In order to investigate the influence of distractor framework on the PDO, we utilized three-dimensional (3D) printing technology to fabricate three kinds of poly-L-lactic acid (PLLA) scaffolds with different pore sizes in this study. The in vitro experiments showed that the customized PLLA scaffolds had different-sized microchannels with low toxicity, good biocompatibility, and enough mechanical strength. Then, we built up an in vivo bioreactor under the skull periosteum of New Zealand white rabbits. The distractors with different pore sizes all could satisfy the demand of periosteal distraction in the animal experiments. After 8 weeks of consolidation period, the quality and quantity of the newly formed bone were improved with the increasing pore sizes of the distractors. Moreover, the newly formed bone also displayed an increasing degree of vascularization. In conclusion, 3D printing technology could promote the innovation of PDO devices and fabricate optimized scaffolds with appropriate pore sizes, shapes, and structures. It would help us regenerate more functional tissue-engineered bone and provide new ideas for further clinical application of the PDO technique.

Periosteal distraction osteogenesis versus immediate periosteal elevation in a rat model: Histological and micro-CT analysis

PurposeThe aim of the present study was to compare periosteal distraction osteogenesis (PDO) to immediate periosteal elevation (IPE) in terms of de novo bone formation. Material and methodsAnimals of PDO Group were subjected to a 7-day latency period and a 10-day distraction period. Distraction device in IPE Group were activated for 1 mm at placement. Both groups of animals were euthanized at 17, 31 and 45-day following surgery and the samples analyzed histologically and by micro-CT. Total gap region (TG) was divided in two subregions, less than 0.5 mm (LG) and over 0.5 mm of the gap height (HG). ResultsBone formation in PDO Group was observed in the distal region of the distraction gap, whereas in IPE Group proximally and distally from the distraction gap. Bone volume increased in both groups in LG, HG and TG (p < 0.001), while bone mineral density only in HG (p = 0.001). More new bone was observed in PDO than in IPE Group in HG (p = 0.017) and in TG (p < 0.001), without differences found in bone mineral density. ConclusionsThe function of immediately elevated periosteum is limited to the distance to the underlying bone. PDO may be successfully applied to maintain the osteogenic capacity of elevated periosteum.

Effects of collagen membrane application and cortical bone perforation on de novo bone formation in periosteal distraction: an experimental study in a rabbit calvaria

The aim of the present study was to assess the impact of collagen membrane application and cortical bone perforations in periosteal distraction osteogenesis. A total of 32 New Zealand rabbits were randomized into four experimental groups, considering two treatment modalities. Calvarial bone was perforated or left intact (P+/-). In half the animals, the distraction mesh was covered with a collagen membrane (M+/-). All animals were subjected to a 7-day latency period and a 10-day distraction period. The samples were harvested after 4-week and 8-week consolidation periods and analyzed histologically and by means of micro-computed tomography. Primary, woven bone observed at the 4-week consolidation period was gradually replaced by lamellar bone at the 8-week consolidation period. Significant increase in bone volume was found in all groups (P<.001) and in bone mineral density in groups I (P-/M-; P<.001), III (P+/M-; P<.001), and IV (P+/M+; P=.013). Group III (P+/M-) showed significantly more new bone at the 8-week consolidation period compared with the other three groups (P=.001), with no differences observed in bone mineral density between groups at a given time-point. In the present model, cortical bone perforations have more impact on the osteogenic process compared with the application of a collagen membrane.

Periosteum-Induced Bone Formation by Distraction Osteogenesis: Histologic and Microcomputed Tomography Analysis

Strains tending to pull the periosteum away from the bone are typically osteogenic. The aim of this study was to assess the influence of periosteum on de novo bone formation in a rat calvaria model of distraction osteogenesis. A total of 28 rats were randomized in four experimental groups considering two treatment modalities. Periosteum was either left intact or completely excised. In half of the animals, the distraction plate was covered with a collagen membrane. All animals were subjected to a 7-day latency period and a 10-day distraction period. The samples were harvested after a 2-week consolidation period and analyzed histologically and by means of microcomputed tomography (micro-CT). New bone in all animals originated from the original bone surface. Two groups of animals with periosteum, with membrane (24.56 ± 5.26) and without membrane (21.83 ± 14.04), showed significantly more bone volume compared with groups without periosteum, with membrane (2.72 ± 1.08, P = .003) and without membrane (4.25 ± 2.33, P = .014). There were no significant differences between the four groups in bone mineral density. Groups pooled together for the presence of periosteum demonstrated significantly more bone volume (P < .001) and bone mineral density (P = .028) than groups without periosteum. No differences were found for groups pooled for the barrier membrane application. The periosteum plays an indispensable, but indirect role in the osteogenic process during periosteal distraction osteogenesis.

Periosteal Distraction Osteogenesis: An Effective Method for Bone Regeneration.

The treatment of bone defects is challenging and controversial. As a new technology, periosteal distraction osteogenesis (PDO) uses the osteogenicity of periosteum, which creates an artificial space between the bone surface and periosteum to generate new bone by gradually expanding the periosteum with no need for corticotomy. Using the newly formed bone of PDO to treat bone defects is effective, which can not only avoid the occurrence of immune-related complications, but also solve the problem of insufficient donor. This review elucidates the availability of PDO in the aspects of mechanisms, devices, strategies, and measures. Moreover, we also focus on the future prospects of PDO and hope that PDO will be applied to the clinical treatment of bone defects in the future.

Effects of local simvastatin on periosteal distraction osteogenesis in rabbits

Our aim was to evaluate the effect of local simvastatin on the formation of new bone using a new design of periosteal distractor. The distractors were placed between the periosteum and bone at the inferior border of the mandible of 20 New Zealand rabbits. In the first group (n=10) simvastatin was applied locally to the distraction zone. The other 10 rabbits served as controls. The formation of new bone was evaluated with digital direct radiography, computed tomography (CT), and histomorphometric analyses. New bone formed in all rabbits, but more formed in the experimental group according to histomorphometric variables. However, other measurements did not differ significantly between the groups. The new design of the periosteal distraction device was successful in causing new bone to form. Local simvastatin made no significant contribution to the procedure.

Relative Contributions of Osteogenic Tissues to New Bone Formation in Periosteal Distraction Osteogenesis: Histological and Histomorphometrical Evaluation in a Rat Calvaria

The relative contributions of different, potential factors to new bone formation in periosteal distraction osteogenesis are unknown. The aim of the present study was to assess the influence of original bone and periosteum on bone formation during periosteal distraction osteogenesis in a rat calvarial model by means of histology and histomorphometry. A total of 48 rats were used for the experiment. The contribution of the periosteum was assessed by either intact or incised periosteum or an occlusive versus a perforated distraction plate. The cortical bone was either left intact or perforated. Animals were divided in eight experimental groups considering the three possible treatment modalities. All animals were subjected to a 7-day latency period, a 10-day distraction period and a 7-day consolidation period. The newly formed bone was analyzed histologically and histomorphometrically. New, mainly woven bone was found in all groups. Differences in the maximum height of new bone were observed and depended on location. Under the distraction plate, statistically significant differences in maximum bone height were found between the group with perforations in both cortical bone and distraction plate and the group without such perforations. If the marrow cavities were not opened, the contribution to new bone formation was dominant from the periosteum. If the bone perforations opened the marrow cavities, a significant contribution to new bone formation originated from the native bone.

Histomorphometric analysis of different latency periods effect on new bone obtained by periosteal distraction: an experimental study in the rabbit model

The aim of this study was to evaluate the effects of latency period on the bone formation after periosteal distraction. For this purpose, a rabbit model was developed and histologic and histomorphometric analyses were conducted. Periosteal distractors were custom designed and built from stainless steel. Rabbits were divided into 2 groups of 18 each according to the duration of latency period. In group 1, the latency period was 7 days, and in group 2 it was 1 day. Distraction was performed by activating the distractor 0.25 mm twice per day. A periosteal distraction of 7.0 mm was achieved after a distraction period of 10 days. Both groups were divided to 3 subgroups according to the rabbits being killed on the 15th, 30th, or 60th day of the consolidation period. Histologic and histomorphometric analyses were performed to evaluate the bone formation. In the histologic evaluation, new bone formation was observed on the lateral side of the mandible of all the rabbits. Histomorphometric measurements revealed that the mean area of newly formed bone formation was 2.62 cm(2) in group 1 and 3.26 cm(2) in group 2. Periosteal distraction osteogenesis is a viable method in acquired and congenital alveolar ridge defects, resulting in new bone formation. Newly formed bone can be obtained by periosteal distraction osteogenesis applying different latency periods.

Periosteal distraction osteogenesis: Preliminary experimental evaluation in rabbits and dogs

The aim of this project was to evaluate the potential of bone formation by the distraction of periosteum. Distraction of calvarial bone in 12 rabbits at 0.25 mm a day caused formation of bone in 3 animals, and distraction at 0.5 mm a day caused formation of bone in 2. A second trial of alveolar distraction in four dogs using a specifically-designed distraction device showed lack of stability of the device.

Histomorphometrically analysis of new bones obtained by distraction osteogenesis and periosteal distraction osteogenesis in rabbits

Histomorphometrically analysis of new bones obtained by distraction osteogenesis and periosteal distraction osteogenesis in rabbits