가토의 상악골에 자가 골막, 연골막, 근막으로서 싸서 첨부한 coral의 생물학적 양태

조승제,손대구,강진성 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.6

In the last decade various biomaterials have come into widespread use in clinical practice. Hydroxyapatite (HA) is one of the more extensively studied materials recently developed as a bone graft substitute. As an onlay bone graft substitute, however, there are disadvantages, including difficulty in secure fixation, soft-tissue thinning over the implant, and the potential for late exposure. Because of their high density and hardness, synthetic HA substance can lead to nonanatomic remodeling, with bone loss in some areas and densification in others. Coral (Biocoral, Inoteb B,P., Saint Gonnery, France) is a biomaterial derived from natural corals, and is used as a bone graft substitute. After harvesting, the natural coral is transformed into a biomaterial by a series of preparation, purification, shaping, and sterilization processes. It is composed of 99% calcium carbonate and 1% amino acids. Its physical architecture is similar to bone with mean pore diameter of 150㎛. Unlike HA, resorption occurs in coral in the tissues. Resorbable coral has the advantage of being replaced by newly formed bone. The resorbability of the bone substitute can be advantageous, particularly for substance whose longterm presence could jeopardize the function of surrounding tissue. In animal studies coral appeared to be a satisfactory bone graft substitute, and successful clinical applications were reported. In this study we implanted coral blocks wrapped totally with autogenous periosteum, perichondrium, and fascia on the maxilla of the rabbit. The purpose of this study is to investigate the role of the periosteum, fascia, and perichondrium in bone and cartilage induction. Fifteen rabbits were used. Five samples of periosteum-wrapped, fascia-wrapped, perichondrium-wrapped, and non-wrapped coral implants, respectively were collected at 4, 8 and 12 weeks postoperatively. They were carefully examined grossly and microscopically. There was no morbidity or mortality among the rabbits in the study. No implant infection or movement was seen. At 4 weeks, there were foci of new bone formation in periosteum-wrapped, fascia-wrapped, and perichordrium-wrapped groups. In all sections we observed fibroconnective tissue and capillary infiltration into holes of the entire block. At 8 weeks, all the periosteum-wrapped implants demonstrated significantly greater amounts of woven bone formation, some of which was lamellating. Other groups formed only woven bone formation without maturation. At 12 weeks, all periosteum-wrapped implants contained predominantly mature lamellar bone, and corals appeared to be resorbed completely and were replaced with newly formed bone. Compared with specimens at 8 weeks, specimens of other groups did not show any particular change at 12 weeks. These results suggest that periosteum plays an important role of bone induction. It is expected that periosteum-wrapped coral will be able to be used not only as the simple onlay bone graft, but also as a substitute of vascularized bone graft after bone formation is accomplished, furthermore as a free flap. In addition, the use of coral shortens the operating time during the craniomaxillofacial reconstruction since it is no longer necessary to harvest a bone graft.

골대체물의 기초 및 최근 연구 동향

한종성,송형근 대한골절학회 2020 대한골절학회지 Vol.33 No.4

Bone substitutes are being used increasingly in bony surgery as more than two million bone grafts are performed worldwide per year. Autobone grafts represent the gold standard for bone grafting, but morbidity and limited availability are the main problems. Allobone grafts are osteoconductive, but there are still concerns regarding the infection risks, costs, and donor availability issues. As an alternative, widely used ceramic-based synthetic bone substitutes are based alternatively on calcium (hydroxyapatite, tricalcium phosphate, calcium sulfate, calcium phosphate). Ceramic-based bone substitutes are osteoconductive, but they are weaker than cortical bone and are not osteoinductive. Bone morphogenic protein, demineralized bone matrix, and platelet-rich plasma are used to obtain an osteoinductive function. Recently, cell-based and gen-based bone substitutes were developed and studied. This paper reviews the basic information and the latest concepts on bone grafts and bone substitutes. 골대체제는 전 세계적으로 한 해에 200만 건 이상 사용되고 있다. 자가골 이식이 골이식 중 가장 좋은 방법이나, 공여부의 문제, 채취량의 제한 등의 문제로 사용에 제한이 있다. 이를 대체하기 위하여 동종골 이식이 사용되나 동종골은 골전도능은 있으나, 자가골 이식에 비하여 골유도능이 부족하며, 감염의 위험, 면역반응 등의 문제가 있고 가격이 높고, 수급의 문제가 있을 수 있다. 그 대안으로 합성 골대체제가 만들어졌고 주로 세라믹 기반의 골대체제(황산칼슘, 인산칼슘, 삼인산칼슘, 수산화인회석 등)가 널리 사용되고 있다. 세라믹기반의 골대체제는 골전도능은 있으나 기계적 강도가 부족하고 생분해성의 문제가 있으며, 골유도능이 없다는 단점이 있다. 이에 골유도 기능을 얻기 위해 골형성단백질, 탈무기질화골기질, 혈소판 풍부 혈장 등이 사용되고 있다. 최근에는 세포 기반 및 유전자 기반 이식물들이 개발, 연구되고 있다. 이에 골이식, 골대체물에 대한 기본적인 사항과 최신 지견을 살펴보고자 한다.

Bone regeneration effects of human allogenous bone substitutes: a preliminary study

이덕원,구기태,설양조,이용무,구영,류인철,정종평,김태일 대한치주과학회 2010 Journal of Periodontal & Implant Science Vol.40 No.3

Purpose: The purpose of this study was to compare the bone regeneration effects of cortical, cancellous, and cortico-cancellous human bone substitutes on calvarial defects of rabbits. Methods: Four 8-mm diameter calvarial defects were created in each of nine New Zealand white rabbits. Freeze-dried cortical bone, freeze-dried cortico-cancellous bone, and demineralized bone matrix with freeze-dried cancellous bone were inserted into the defects, while the non-grafted defect was regarded as the control. After 4, 8, and 12 weeks of healing, the experimental animals were euthanized for specimen preparation. Micro-computed tomography (micro-CT) was performed to calculate the percent bone volume. After histological evaluation, histomorphometric analysis was performed to quantify new bone formation. Results: In micro-CT evaluation, freeze-dried cortico-cancellous human bone showed the highest percent bone volume value among the experimental groups at week 4. At week 8 and week 12, freeze-dried cortical human bone showed the highest percent bone volume value among the experimental groups. In histologic evaluation, at week 4, freeze-dried cortico-cancellous human bone showed more prominent osteoid tissue than any other group. New bone formation was increased in all of the experimental groups at week 8 and 12. Histomorphometric data showed that freeze-dried cortico-cancellous human bone showed a significantly higher new bone formation percentile value than any other experimental group at week 4. At week 8,freeze-dried cortical human bone showed the highest value, of which a significant difference existed between freeze-dried cortical human bone and demineralized bone matrix with freeze-dried cancellous human bone. At week 12, there were no significant differences among the experimental groups. Conclusions: Freeze-dried cortico-cancellous human bone showed swift new bone formation at the 4-week healing phase,whereas there was less difference in new bone formation among the experimental groups in the following healing phases.

Use of Porcine-derived Block Bone Substitutes for Guided Bone Regeneration in the Peri-implant Dehiscence Defects of the Mandibular Anterior Region

이재홍,정성념 대한구강악안면임플란트학회 2021 대한구강악안면임프란트학회지 Vol.25 No.4

Purpose: Various bone graft materials are currently used for guided bone regeneration (GBR), but data are lacking on the superiority of one biomaterial relative to the other. In addition, achieving successful bone augmentation remains challenging. When used in GBR, block bone substitutes show better augmentation stability of the bone than particulated bone substitutes. Recently developed softtype block bone substitutes are widely used in clinical practice. Materials and Methods: This study enrolled 12 patients who underwent implant placement with GBR in the mandibular anterior region between September 2016 and May 2021 in the Department of Periodontology, Daejeon Dental Hospital, Wonkwang University. GBR was performed using demineralized porcine bone mineral with 10% collagen (DPBM-C; LegoGraft®) and a resorbable collagen membrane (Bio-Gide® or Ossix Plus®). The surgical site was sutured with 4-0 e-PTFE (Biotex®) and 5-0 nylon (Monosof®) by using modified horizontal mattress and interrupted suture methods. Stitch-out was performed two weeks af ter the operation, and reentry surgery was performed within four to six months after the implant surgery. Results: There was a significant decrease in bone thickness after five months of implant surgery with GBR compared with the decrease immediately after surgery. However, bone gains of more than 1.5 mm were observed at all measurement sites compared with those at baseline. Conclusion: GBR performed using demineralized porcine bone mineral with 10% collagen in combination with a resorbable collagen membrane is an effective and favorable treatment modality for peri-implant dehiscence defects in terms of clinical and radiographic outcomes during the healing period.

Impact of simultaneous placement of implant and block bone graft substitute: an in vivo peri-implant defect model

Minh Khai Le Thieu,Amin Homayouni,Lena Ringsby Hæren,Hanna Tiainen,Anders Verket,Jan Eirik Ellingsen,Hans Jacob Rønold,Johan Caspar Wohlfahrt,Antonio Gonzalez Cantalapiedra,Fernando Maria Guzon Muñoz 한국생체재료학회 2021 생체재료학회지 Vol.25 No.4

Background: Insufficient bone volume around an implant is a common obstacle when dental implant treatment is considered. Limited vertical or horizontal bone dimensions may lead to exposed implant threads following placement or a gap between the bone and implant. This is often addressed by bone augmentation procedures prior to or at the time of implant placement. This study evaluated bone healing when a synthetic TiO2 block scaffold was placed in circumferential peri-implant defects with buccal fenestrations. Methods: The mandibular premolars were extracted and the alveolar bone left to heal for 4 weeks prior to implant placement in six minipigs. Two cylindrical defects were created in each hemi-mandible and were subsequent to implant placement allocated to treatment with either TiO2 scaffold or sham in a split mouth design. After 12 weeks of healing time, the samples were harvested. Microcomputed tomography (MicroCT) was used to investigate defect fill and integrity of the block scaffold. Distances from implant to bone in vertical and horizontal directions, percentage of bone to implant contact and defect fill were analysed by histology. Results: MicroCT analysis demonstrated no differences between the groups for defect fill. Three of twelve scaffolds were partly fractured. At the buccal sites, histomorphometric analysis demonstrated higher bone fraction, higher percentage bone to implant contact and shorter distance from implant top to bone 0.5 mm lateral to implant surface in sham group as compared to the TiO2 group. Conclusions: This study demonstrated less bone formation with the use of TiO2 scaffold block in combination with implant placement in cylindrical defects with buccal bone fenestrations, as compared to sham sites.

Bone regeneration effects of human allogenous bone substitutes: a preliminary study

Lee, Deok-Won,Koo, Ki-Tae,Seol, Yang-Jo,Lee, Yong-Moo,Ku, Young,Rhyu, In-Chul,Chung, Chong-Pyoung,Kim, Tae-Il Korean Academy of Periodontology 2010 Journal of Periodontal & Implant Science Vol.40 No.3

Purpose: The purpose of this study was to compare the bone regeneration effects of cortical, cancellous, and cortico-cancellous human bone substitutes on calvarial defects of rabbits. Methods: Four 8-mm diameter calvarial defects were created in each of nine New Zealand white rabbits. Freeze-dried cortical bone, freeze-dried cortico-cancellous bone, and demineralized bone matrix with freeze-dried cancellous bone were inserted into the defects, while the non-grafted defect was regarded as the control. After 4, 8, and 12 weeks of healing, the experimental animals were euthanized for specimen preparation. Micro-computed tomography (micro-CT) was performed to calculate the percent bone volume. After histological evaluation, histomorphometric analysis was performed to quantify new bone formation. Results: In micro-CT evaluation, freeze-dried cortico-cancellous human bone showed the highest percent bone volume value among the experimental groups at week 4. At week 8 and week 12, freeze-dried cortical human bone showed the highest percent bone volume value among the experimental groups. In histologic evaluation, at week 4, freeze-dried cortico-cancellous human bone showed more prominent osteoid tissue than any other group. New bone formation was increased in all of the experimental groups at week 8 and 12. Histomorphometric data showed that freeze-dried cortico-cancellous human bone showed a significantly higher new bone formation percentile value than any other experimental group at week 4. At week 8, freeze-dried cortical human bone showed the highest value, of which a significant difference existed between freeze-dried cortical human bone and demineralized bone matrix with freeze-dried cancellous human bone. At week 12, there were no significant differences among the experimental groups. Conclusions: Freeze-dried cortico-cancellous human bone showed swift new bone formation at the 4-week healing phase, whereas there was less difference in new bone formation among the experimental groups in the following healing phases.

Epigallocatechin-3-gallate 함유 β-TCP이식재의 골재생능에 관한 조직계측학적 평가

박진우(Jin-Woo Park) 대한치과재료학회 2018 대한치과재료학회지 Vol.45 No.3

This study investigated the effect of epigallocatechin-3-gallate (EGCG)-loaded microporous β-tricalcium phosphate (β-TCP) bone substitute in the bone healing of rabbit calvarial defects. New bone formation induced by β-TCP incorporating two different dose of EGCG [1 mg EGCG/200 mg β-TCP (TCP-1), 10 mg EGCG/200 mg β-TCP (TCP-10)] was compared with unloaded β-TCP (TCP-0). Calvarial defects 8 mm diameter created in 14 adult male New Zealand White rabbits were filled with three types of bone substitutes. The amount of newly formed bone was evaluated histomorphometrically at 4 and 8 weeks after implantation. The TCP-1 group exhibited increased bone healing capacity and numerous blood vessel formation compared with the other two groups. New bone formation was observed in the cental area of TCP-1 filled defects at 8 weeks. Histomorphometric analysis revealed significantly greater newly formed bone area in the TCP-1 group when compared with unloaded TCP-0 (p<0.05 at 4 and 8 weeks) and 10 mg EGCG-loaded TCP-10 groups (p<0.05 at 8 weeks). No difference was observed in new bone area between TCP-0 and TCP-10 groups. These results suggest that local delivery of 1 mg EGCG to β-TCP bone substitute by simple adsorption promotes bone regeneration in the healing of rabbit calvarial osseous defect and higher EGCG dose (in this study, 10 mg per defect) does not exert any positive effect on bone healing capacity of β-TCP. Thus, local delivery of EGCG to β-TCP bone substitute seems to be an effective approach for the treatment of osseous defects.

Periodontal regeneration capacity of equine particulate bone in canine alveolar bone defects

Kim, Tae-Il,Chung, Chong-Pyoung,Heo, Min-Suk,Park, Yoon-Jeong,Rhee, Sang-Hoon Korean Academy of Periodontology 2010 Journal of Periodontal & Implant Science Vol.40 No.5

Purpose: This study was performed to evaluate the periodontal wound healing effect of particulate equine bone mineral on canine alveolar bone defects. Methods: Twelve adult male beagle dogs were used as study subjects. The mandibular second and fourth premolars were extracted prior to the experimental surgery, and the extraction sites were allowed to heal for 8 weeks. After periodontal probing, two-walled defects were created at the mesial and distal sides of the mandibular third premolars bilaterally, and the defects were filled with equine particulate bone with collagen membrane or bovine particulate bone with collagen membrane, or collagen membrane alone. The defects without any treatment served as negative controls. After probing depth measurement, animals were sacrificed at 10, 16, and 24 post-surgery weeks for micro-computed tomographic and histomorphometric analysis. Results: The equine particulate bone-inserted group showed significantly decreased values of probing depth and first bone contact compared to the negative control and collagen membrane alone groups at weeks 10, 16, and 24 (P<0.05). There were no significant differences in the new cementum length, newly-formed bone area, or newly-formed bone volume between equine particulate bone- and bovine particulate bone-inserted groups, both of which showed significantly increased values compared to the negative control and collagen membrane alone groups (P<0.05). Conclusions: Equine particulate bone showed significant differences in probing depth, first bone contact, new cementum length, newly formed bone area, and bone volume fraction values when compared to the negative control and collagen membrane alone groups. There were no significant differences between equine and bovine particulate bone substitutes in these parameters; therefore, we can conclude that equine particulate bone is equivalent to bovine bone for periodontal regeneration.

Periodontal regeneration capacity of equine particulate bone in canine alveolar bone defects

김태일,정종평,허민석,박윤정,이상훈 대한치주과학회 2010 Journal of Periodontal & Implant Science Vol.40 No.5

Purpose: This study was performed to evaluate the periodontal wound healing effect of particulate equine bone mineral on canine alveolar bone defects. Methods: Twelve adult male beagle dogs were used as study subjects. The mandibular second and fourth premolars were extracted prior to the experimental surgery, and the extraction sites were allowed to heal for 8 weeks. After periodontal probing,two-walled defects were created at the mesial and distal sides of the mandibular third premolars bilaterally, and the defects were filled with equine particulate bone with collagen membrane or bovine particulate bone with collagen membrane, or collagen membrane alone. The defects without any treatment served as negative controls. After probing depth measurement, animals were sacrificed at 10, 16, and 24 post-surgery weeks for micro-computed tomographic and histomorphometric analysis. Results: The equine particulate bone-inserted group showed significantly decreased values of probing depth and first bone contact compared to the negative control and collagen membrane alone groups at weeks 10, 16, and 24 (P < 0.05). There were no significant differences in the new cementum length, newly-formed bone area, or newly-formed bone volume between equine particulate bone- and bovine particulate bone-inserted groups, both of which showed significantly increased values compared to the negative control and collagen membrane alone groups (P < 0.05). Conclusions: Equine particulate bone showed significant differences in probing depth, first bone contact, new cementum length, newly formed bone area, and bone volume fraction values when compared to the negative control and collagen membrane alone groups. There were no significant differences between equine and bovine particulate bone substitutes in these parameters;therefore, we can conclude that equine particulate bone is equivalent to bovine bone for periodontal regeneration.

Biosilicated collagen/β-tricalcium phosphate composites as a BMP-2-delivering bone-graft substitute for accelerated craniofacial bone regeneration

Dong-Keon Lee,기미란,Euy-Hyun Kim,Chang-Joo Park,Jae-Jun Ryu,Hyonseok Jang,백승필,Yun Kee Jo,Sang-Ho Jun 한국생체재료학회 2021 생체재료학회지 Vol.25 No.2

Background: Bioceramic β-tricalcium phosphate (β-TCP) is used as a bone-grafting material and a therapeutic drug carrier for treatment of bone defects in the oral and maxillofacial regions due to the osteoconductivity and biocompatibility. However, the low mechanical strength and limited osteoinductivity of β-TCP agglomerate restrict bone regenerating performance in clinical settings. Methods: Herein, a biomimetic composite is proposed as a bone morphogenetic protein-2 (BMP-2)-delivering bone graft substitute to achieve a robust bone grafting and augmented bone regeneration. Results: The sequential processes of brown algae-inspired biosilicification and collagen coating on the surface of β-TCP enable the effective incorporation of BMP-2 into the coating layer without losing its bioactivity. The sustained delivery of BMP-2 from the biosilicated collagen and β-TCP composites promoted in vitro osteogenic behaviors of pre-osteoblasts and remarkedly accelerated in vivo bone regeneration within a rat calvarial bone defect. Conclusions: Our multicomposite bone substitutes can be practically applied to improve bone tissue growth in bone grafting applications with further expansion to general bone tissue engineering.