Review
A Scoping Review on The
Effectiveness of Bone Regeration Procedures Using Bovine Bone Block Grafts: A
Summary of 20 Years of Research Experience
Reza A.
Fessi1*, Coen P. Danudiningrat2, Anita Yuliati3,
Prasiddha M.E. Fadhlallah4
1Post Graduate
Doctoral Program, Faculty of Dental Medicine, Airlangga University, Surabaya,
Indonesia / Jl. Mayjen Prof. Dr. Moestopo No.47, Surabaya,
East Java, Indonesia, 60132 / reza.al.fessi@fkg.unair.ac.id / Fax. +62315030255; Tel. +62315030255
2Department of
Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Airlangga
University, Surabaya, Indonesia / Jl. Mayjen Prof. Dr.
Moestopo No.47, Surabaya, East Java, Indonesia, 60132 / coen-p-d@fkg.unair.ac.id / Fax. +62315030255; Tel. +62315030255
3Department
of Dental Material, Faculty of Dental Medicine, Airlangga University, Surabaya,
Indonesia / Jl. Mayjen Prof. Dr. Moestopo No.47, Surabaya,
East Java, Indonesia, 60132 / anita-y@fkg.unair.ac.id / Fax. +62315030255; Tel. +62315030255
4Residency
Program of Oral and Maxillofacial Surgery, Faculty of Dental Medicine,
Airlangga University, Surabaya, Indonesia / Jl. Mayjen Prof.
Dr. Moestopo No.47, Surabaya, East Java, Indonesia, 60132 / prasiddha.mahardhika.el-2018@fkg.unair.ac.id / Fax. +62315030255;
Tel. +62315030255
*Corresponding author:
Post Graduate
Doctoral Program,
Faculty of
Dental Medicine,
Airlangga
University,
Jl. Prof. Dr.
Moestopo No.47, Surabaya, East Java, Indonesia.
E-mail address: reza.al.fessi@fkg.unair.ac.id
Tel: +62315030255; Fax: + 62315030255.
ABSTRACT:
As a practical and safe substitute for autologous
transplants, xenografts and alloplastic bone substitutes are available.
Numerous research projects conducted at numerous research centers in various
parts of the world have investigated the efficacy of these products. The
purpose of the investigation is to determine whether bovine bone blocks are
efficient as regenerative bone replacement treatments, specifically whether
they are effective in both in vivo and in vitro tests as bone substitutes. A
total of 235 publications were found through an electronic search of the
Pubmed, Scopus, Science Direct, and Google Scholar databases. Evaluation of complications
at the implant site is low (n=13) with only one study showing 8.9% implant
failure, 30% unhealthy implant (n=4) and a complication rate of 12.5% with the
most common complications being dehiscence, bruising and oedema (n=3). The most
commonly used parameter in most studies was vertical bone gain (n=26), with a
mean VBG of 4.5 mm and new bone formation (n=11), with a mean NFB of 14.5%,
indicating adequate integration between graft and host bone. The resorption
rate (n=6) was found to be 22% on average or approximately 2.7 mm over a 4
month to 3 year observation period. Bovine blocks can serve as a useful bone
graft substitute in regenerative surgery and are improved by the addition of
BMP-2, PDGF and collagen membrane.
KEYWORDS:
Bone regeneration, Bovine bone block, Xenograft,, Bone
subtitute, Regenerative surgery
INTRODUCTION :
Bone regeneration
in maxillofacial defects, which often caused by bone resection due to benign
and malignant tumors, trauma, and osteoradionecrosis, is a challenge in oral
and maxillofacial surgery.1,2,3 Bone reconstruction in maxillofacial
regions need surgical, material, and biochemistry approach. Autograft is gold
standard for bone defect reconstruction because its optimum biological
properties including osteogenic, osteoconductive, and osteoinductive. Beside
those benefits, it has high complication on donor site.4,5,6,7
Different
techniques were used depending on the type of defect (horizontal/vertical)8,9,
local anatomy (maxilla/mandibula, anterior/posterior region)10,11,
defect size and rehabilitation plan12,13,14. Because they are
carefully regulated to minimize patient morbidity during donor harvesting,
xenografts and alloplastic bone substitutes constitute an effective and secure substitute
for autologous grafts15,16,17. Numerous investigations conducted in
various research institutes across the globe have assessed the efficacy of
these products. This study was conducted in stages, beginning with cell culture
tests conducted in vitro, moving on to investigations conducted in vivo using
animal models, and concluding with studies involving humans.
Studies in histology and morphometry at the
microscopic level are able to demonstrate how the bone responds to the graft
and provide reliable data on the graft's behavior, the resorption process, bone
formation, and the long-term assessment of the regenerated tissue. Furthermore,
these methods have been implemented using many techniques, such as Radiography,
Histological staining, Scanning Electron Microscopy (SEM), Energy Dispersive
X-Ray (EDX), Fourier Transform Infrared (FTIR), Enzyme-linked immunisorbent
assay (ELISA), and Micro-CT Scan, to investigate the physicochemical and
biological processes, as well as the surface characterisation of biomaterials.
This scientific approach aims to increase the predictability of the procedure
in the selection of the ideal scaffold shape (particulates/blocks), surgical
technique and graft manipulation and stabilization methods. The purpose of this
review was to elucidate the effectiveness of several procedures for jaw
regeneration using different types of bovine bone grafts.18,19
MATERIALS AND
METHODS:
For research
screening, the electronic databases PubMed, Scopus, Science Direct, and Google Scholar
were utilized. Specific keyword: bovine bone block graft, cortico-cancellous
bovine bone xenograft, jawbone
regeneration, maxillofacial bone regeneration, Bio-Oss® AND jaw bone
regeneration, Cerabone® AND jaw bone regeneration, paper then filtered through
a qualitative and quantitative selection.
Inclusion
Criteria
The research
published between 2002 to October 2022 were only reviewed in English. The
publications focusing to bovine bone substitute and scaffold for maxillofacial
bone regeneration were a limitation of the study. Barrier membrane usage was
not subject to any limitations during the course of the organized research
procedure. The in vitro and in vivo research as well as reports were considered
as part of the inclusion criteria. Off-topic publications weren't included in
the analysis. The papers were then divided into groups based on the type of
surgery and the study methodology.
Selection of the
Studies
Reviewers who were
qualified and subject matter experts independently screened the study's data
and analysis. Every abstract of the discovered papers was evaluated as the
first step of screening after a preliminary check on the research title. It was
possible to access the complete texts of the included papers, and they were
also categorized for the qualitative synthesis. The electronic database
research has discovered a total of 235 manuscripts. 148 papers were taken into
consideration for the full-text review after 87 duplicates were eliminated from
the screening. 11 full texts not found and 96 full texts found out of topic to
be exclude. Finally, 41 papers in all
have been incorporated into the analytical synthesis.
Description of
the Bovine Bone Block Graft
Figures below
(Figure 1) show the properties and clinical applications of various bovine bone
block materials used and cited in selected publications (Table 1). To attain
the optimum handling and osteogenic properties for the optimal regeneration
outcome, specific formulations have been created for each clinical application.
Successful bone grafting depends on factors like biocompatibility, chemical
resemblance to autologous bone, progressive degradation of bone matrix through
the development of new bone, and osteogenic potential. These elements are
essential for the success of bone regeneration procedures that can be further
enhanced by this xenograft.20,21,22
Figure 1. PRISMA Flowchart of the study design and
manuscript-selection process.
Table
1. Various bovine bone block materials used. 20,21,22
|
|
Bone Block
Product Used
|
|
Product
Processing
Survival rate
Size
Clinical
Application
|
: Bio-Oss
: Demineralized
Bovine cancellous/spongious bone
: Over 95%
: 20 x 10 x 10 mm
: Alveolar Bone Regeneration,
Implant Placement Preparation, Mandibular Defect Reconstruction
|
|
Product
Processing
Survival rate
Size
Clinical
Application
|
: Orthogen
: Lyophilized or
freeze dried bovine medullary bone
: Over 93%
: 10 x 10 x 10 mm
and preshaped fit to defect.
: Calvarial bone
defect, alveolar bone regeneration.
|
|
Product
Processing
Survival rate
Size
Clinical
Application
|
: NuOss
: Chemical
extraction process and heat treatment to remove the organic components of the
bone. Composite comprised of 80% anorganic bovine bone and 20% type I bovine
collagen.
: 96%
: 1 mm
: In vitro
characterization, Calvarial bone defect and Mandibular defect regeneration
|
|
Product
Processing
Survival rate
Size
Clinical
Application
|
: Straumann
Xenograft
: Completely
removed the organic components by solvent and temperature treatment (> 500
°C) and handling with low temperature (non-sintered).
: 95%
: fit to defect
: Alveolar Bone
Regeneration
|
|
Product
Processing
Survival rate
Size
Clinical Application
|
: Sticky Bone
: Bovine
xenograft (Bio-Oss) mixed with human autogenous bone graft
: 98%
: fit to defect
: Alveolar Bone
Regeneration
|
|
Product
Processing
Survival rate
Size
Clinical
Application
|
: SmartBone
: Deproteinized
bovine bone block with various size and shape
: 97%
: fit to defect
(around 20 x 10 x 10 mm)
: Alveolar Bone
Regeneration
|
|
Product
Processing
Success rate
Size
Clinical
Application
|
: Freeze Dried
Bovine Bone Block (FDBB) or Lyophilized Bovine bone Mineral Block (LBMB)
: Freeze dry or
Lyophilized
: 95%
: 10 x 5 x 5 mm
: In vitro
characterization, Calvarial bone defect and Mandibular defect regeneration
|
RESULT:
The table below
shows the key outcomes of each bovine bone block xenograft biomaterial when
used either individually or in combination. (Table 2 and Table 3).
Table
2. Bone
regeneration procedures with bovine bone block xenograft: Alveolar Bone Regeneration
(ABR) and Implant Placement (IP)
|
Reference
|
Clinical
Indication
|
Biomaterial
|
Result
|
|
Felice et
al.,
201742
|
ABR
and IP
(Animal
study)
|
Bio-Oss
|
Bovine bone block
has the highest mean vertical adjustment than autogenous and equine bone
block after 3 to 5 month healing. Bovine bone block has higher implant
failure (8.9%) but not significant to autogenous (5.6%) and equine (4.0%).
Mean height
increase is 5.48 mm in bovine with mean adjustment 1.26 mm higher than equine
(0.92 mm) and autogenous (1.06).
|
|
Li et al.,
201343
|
ABR
(Clinical
study)
|
Bio-Oss
|
Consistently,
subperiosteal tunneling from bovine bone block resulted in new bone growth.
On top of the graft material, bone was directly implanted. Height
measurements of the level of bone augmentation varied from 4.1 to 6.0 mm.
|
|
Mirković et
al., 201544
|
ABR
(Clinical
study)
|
Custom 3D
printing bovine xenograft
|
The specially
designed grafts were easy to implant during surgery and closely matched the
contour of the bone abnormalities. Block measurements were 36.7 x 14.2 x 12
mm, and they were applied to patients whose ridges had lost more than 20 x 3
x 2 mm. The operation took less time thanks to the contour matching, and the
defect healed properly as a result.
|
|
Ortiz-VigĂłn et al., 201845
|
ABR
and IP
(Clinical
study)
|
Bio-Oss
|
The average
increase in ridge width was 4.12 +/-1.32 mm. A total of 35.7% of soft tissue
dehiscence occurred throughout the course of the follow-up at various points
in time. A high frequency of early implant loss (30.8%) was also observed.
|
|
Chen, 202045
|
ABR
(Animal
study)
|
Bio-Oss
|
Decellularized
porcine bone xenograft has higher new bone formation (3.7 : 2.2 mm) and bone
bridging (3.7 : 1.7 mm), but less amount of fluorescent labeling than those
of the Bio-Oss
|
|
Felice et
al.,
201346
|
ABR
and IP
(Clinical
study)
|
Bio-Oss
|
With the use of a
block of collagenated bovine bone measuring 35 x 10 x 5 mm and
five-millimeter implants, augmented bone was successfully created. Since
short implants fixation is a quicker, less expensive, and less morbid
alternative to bone augmentation, it may be desirable in posterior mandibles.
|
|
Simion, 200735
|
ABR
(Clinical study)
|
Bio-Oss with
rhPDGF
|
The basal bone
had merged with the bovine block. In histological analysis, the entire bovine
bone block trabeculae were totally integrated with the newly formed bone,
resulting in an 8 mm vertical increase. A deproteinized bovine bone block and
PDGF can be used to successfully augment severely atrophic ridges vertically.
|
|
Antunes et al.,
201547
|
IP
(Animal
study)
|
Bio-Oss
|
DBBM block
presented the highest volume of porosity (Block 74.24%, Sponge 54.63%,
Granules 53.44%) . Bone repair is greater in DBBM sponges and granules when
inserted to fill up between bone defect and implant.
|
|
Borgia et
al.,
202241
|
ABR
and IP
(Clinical
study)
|
Bio-Oss with
collagen membrane
|
Alveolar ridge
changes, periimplant clinical parameters, and patient satisfaction did not
differ between DBBM with collagen membrane and a block of bone from the
tuberosity. Autologous 86.7%, DBBM 62.5% of healthy implants. Periimplant
mucositis and periimplantitis were not observed. DBBM 2.57mm mean pocket
depth; autologous 2.87mm
|
|
Cardaropoli, 200936
|
ABR
and IP
(Clinical
study)
|
Bio-Oss with
rhPDGF
|
after tooth
extraction, vertical ridge augmentation on a 9 mm defect utilizing rhPDGF and
DBBM block. After six months, the transplanted bovine bone had fully
assimilated with residual basal bone, forming bone-like tissue. The
radiographic examination of the implant revealed stability, no
periimplantitis, and a satisfactory integration of the bovine xenograft with
the remaining basal bone as well as ideal bone-to-implant contact.
|
|
Schwarz et
al.,
201048
|
ABR
(Animal
study)
|
Bio-Oss
|
Bone ingrowth consistently
higher in Equine Bone Block than Bovine but not significant. Newly formed on
bovine bone was 13.78%, lower than
equine 28.7%. Both are not had an adverse clinical or histopathological
reaction which lead to failure.
|
|
Bashara et al.,
201249
|
ABR
(Animal
study)
|
Bio-Oss and
compared to membrane addition
|
In
micro-CT sections, there are no significant differences between the crests of
the buccal and lingual bones. Both inside and outside of the titanium
granules, new bone formation was observed, whereas six months after placement
in the bovine bone scaffold, newly formed bone was discovered surrounding the
block.
|
|
Alayan and
Ivanovski, 201839
|
ABR
(Clinical
study)
|
Bio-Oss with type
1 collagen matrix
|
Bone volume and
greater bone contact generated after bovine bone block with collagen
treatment on maxillary sinus bone defect. Similar result with bovine bone
block plus autogenous bone group.
Additional
vertical augmentation found 10% from samples treated with bovine block with
collagen. Do not significant differences on outcome of bone graft volume
(1.46 cm without collagen, 1.27 with collagen). Ridge increase 3.13 on
ABBM+AB while 3.04 on ABBM+C.
|
|
Zang et
al.,
201749
|
In
vitro and in vivo (Animal study)
|
Chitosan + Bovine
Xenograft, hJBMMSCs
|
Pore size,
porosity, and water absorption are all increased with a higher percentage of
chitosan in the scaffold material, while compressive strength is decreased.
In contrast to other groups in rat calvarial defects, the CS/BDX (40:60)
scaffold seeded with hJBMMSCs was the most successful in promoting new bone
formation as demonstrated by improved histomorphometry data, a larger new
bone area, and more visible mature lamellar bone formation. 8 weeks post
implantation
|
|
Felice et
al.,
200951
|
ABR
(Clinical
study)
|
Bio-Oss
|
The bovine was
less invasive and may be preferred, however both bovine bone block xenograft
and autograft obtained good results.
|
|
Lee, 201738
|
ABR
(Clinical
study)
|
Straumann
Xenograft + rhPDGF-BB
|
Subperiosteal
minimally invasive aesthetic ridge augmentation technique (SMART) prevents
the morbidities, complication, and soft tissue disfigurements caused by
invasive flap technique while providing consistently increased bone volume
and greater predictability. With an average gain in ridge width of 5.11 mm,
the SMART approach using bovine xenograft and PDGF offers excellent results.
|
|
Victor, 201152
|
ABR
(Clinical
study)
|
Deproteinized
bovine bone + PDGF
|
Deproteinized
bovine bone with PDGF-BB appears to induce stronger bone formation and rapid
wound closure, promoting the development and maintenance of bone and gingival
forms important for achieving an esthetic implant.
|
|
Talebi and
Janbakhsh, 201953
|
ABR
(Clinical
study)
|
Cerabone block
|
Bone gain means after
augmentation is 4.4 mm in width and 4.2 mm in height. Histological
evaluations found that the xenograft were integrated into the newly formed
bone.
|
|
Nevins et al.,
200937
|
ABR
(Clinical
study)
|
Bio-Oss and
rhPDGF-BB
|
Inorganic bovine
bone graft carriers and freeze-dried bone allografts proved to be good
scaffolds for the delivery of recombinant human platelet-derived growth
factor BB for ridge augmentation with minimally invasive techniques.
|
|
Naruse et al.,
201054
|
ABR
(Clinical
study)
|
Anorganic
deproteinized bovine bone
|
After a 9-month
augmentation, there were no statistically significant differences in the
histomorphometric examination of autogenous bone, DFDBA, HA, calcium
phosphate, and anorganic deproteinized bovine bone material. 15 x 10 mm bone
augmentation achieved after operation.
|
|
Barbu et al.,
202155
|
ABR
(Clinical
study)
|
Sticky bone
(Bovine xenograft
+
Autograft)
|
Sticky bone (80%
autogenous and 20% bovine xenograft) resulting sufficient crestal width
increase to perform horizontal ridge augmentation. Average ridge width gain
was 3.7 mm, the bone shell technique performed higher width gain 3.7 mm.
|
|
Cristalli et
al.,
202029
|
ABR
(Clinical
study)
|
Smartbone
|
The graft blocks'
flexibility to be customized decreased surgical invasiveness and shortened
procedure times. After six months, histological examination revealed the
presence of newly formed bone, and CBCT examination demonstrated adequate
integration between the transplant and recipient site. No indications of
inflammation or bone resorption were seen at the 2-year control.
|
|
Messo et
al.,
202029
|
ABR
(Clinical
study)
|
Smartbone
|
The
accuracy, lack of infection or rejection, and overall clinical outcome of
SmartBone® on Demand are demonstrated by very long-term volume stability
recorded over 7 years of follow-up as well as histologically by the formation
of new, healthy bone via a full remodeling process following an 8-month
healing period.
|
|
Teng et
al.,
202033
|
ABR
and IP
(In
vitro and Animal study)
|
DBB with BMP-2
|
In
comparison to unloaded blocks (6.45 mm) and blocks with adsorbed BMP-2 (6.03
mm), the DBB blocks with coating-delivered BMP-2 considerably improved the
efficacy of alveolar bone augmentation (8.04 mm).
|
|
Thoma et
al.,
201932
|
ABR
(Clinical
study)
|
DBBM block with
rhBMP-2
|
The ridge width
was successfully increased by both the autogenous bone block and the DBBM
block with rhBMP-2. 6.86 mm compared. 7.13 mm for the median RW,
respectively. Resorption caused the ridge width to increase to 5.35 mm from
5.15 mm after 4 months.
|
|
Bienz et
al.,
202134
|
ABR
and IP
(Clinical
study)
|
Bio-Oss with
BMP-2
|
23
patients with 40 implants were assessed after the third year. In both groups,
the implant survival rate was 100%. Marginal hard tissue levels were 0.4 mm
in the BMP group and 0.7 mm in the ABB group at baseline. These values were
0.2 mm (BMP) and 0.6 mm (ABB) at 3 years. At the time of the baseline
measurement, the buccal hard tissue measured 1.1 mm (BMP) and 1.4 mm (ABB)
thick at the level of the implant shoulder. At 3 years, it was 0.9 mm (BMP)
and 0.7 mm (ABB) in size.
|
|
Mordenfeld et
al.,
201456
|
ABR
(Clinical
study)
|
Bio-Oss mixed
with autogenous bone
|
After 7.5 months,
the 60:40 mixture compared to 90:10 considerably increased the alveolar
crest's mean width by 3.5 (1.3) mm and 2.9 (1.3) mm, respectively.
|
|
Benic et
al.,
201957
|
ABR
(Clinical
study)
|
Bio-Oss particulate
vs block
|
After six months
of healing, block bone replacement used for GBR of peri-implant deficiencies
was superior to particle bone replacement in terms of the dimension of the
augmented hard tissue. In the block group, the horizontal thickness decreased
to 2.90 mm (mean: 2.71) and in the particulate group, to 0.2 mm (mean: 0.52).
|
|
Schmitt et
al.,
201358
|
ABR
(Clinical
study)
|
Straumann®
BoneCeramic,
Bio-Oss®, Puros®, and
autologous bone.
|
The gold standard
for sinus floor augmentation remains to be AB. BCP, ABB, AB, and MCBA all had
new bone formation measurements of 30.28 ± 2.16%, 24.9±5.67%, 41.74
± 2.1%, and 35.41 ± 2.78%,
respectively.
|
|
Bohner 201659
|
ABR
(Clinical
study)
|
Orthogen with
stereolithographic model for shaping
|
Clinical
evaluation at 9 months revealed healthy, highly vascularized bone to support
dental implants (3.8 mm x 11.5 mm), and radiographic examinations at 7 years
revealed the preservation of bone structure.
|
Table
3.
Bone regeneration procedures with bovine bone block xenograft: Mandibular
Defect Reconstruction (MDR) and Implant Placement (IP)
|
Reference
|
Clinical
Indication
|
Biomaterial
|
Result
|
|
Hernández-Alfaro et al., 201259
|
MDR
and IP
(Clinical
study)
|
Bio-Oss
|
Mandibular reconstruction
with bone block xenograft mixed with recombinant BMP-7 and stem cells achieve
sufficient quantity and quality of new bone formation to allow implant
placement with reduced patient morbidity and surgical time compared to
conventional reconstruction methods.
|
|
Soares et
al.,
201960
|
MDR
(Animal
study)
|
Bio-Oss and
orthogen
|
After 6 months,
it was impossible to visually tell the difference between the graft and host
in the rabbit mandibular defect treated with LBMB grafts due to their clear
integration with the neighboring host cortical bone.
|
|
Zang et
al.,
201750
|
Calvarial
bone defect
(Animal
study)
|
Chitosan + Bovine
Xenograft + hJBMMSCs
|
Critical size
calvarial bone defect in rats showed significantly highest bone volume,
trabecular thickness, and trabecular number on Chitosan + Bovine Xenograft +
hJBMMSCs.
|
|
Veis et
al.,
201561
|
MDR
(Animal
study)
|
Bio-Oss
|
In the
block-shaped group, the mean values of graft area (GA) were slightly higher
at 37% vs. 31% and new bone area (NBA) was slightly higher at 9.68% vs.
5.71%, while the mean values of maximum vertical height (MVH) and bone to
graft contact (BGC) were more substantial in the particulate group at 78.78%
vs. 83.22% and 35.13% vs. 39.22%, respectively.
|
|
Paknejad et
al., 201462
|
MDR
(Animal
study)
|
Bio-Oss and NuOss
|
Both the NuOss
and the Bio-Oss exhibit comparable physicochemical properties. In order to
stimulate bone regeneration, deproteinized bovine bone can be employed as a
scaffold in bone defects. The percentage of new bone was comparable after
four weeks (16%) but higher after eight weeks (NuOss 25% vs. BioOss 23%).
|
|
Al-Rasheed et
al., 201663
|
Calvarial
bone defect
(Animal
study)
|
NuOss with BMSCs
|
In the bone graft
+ BMSC + CM group, bone volume and bone mineral density as well as new bone
formation were all shown to be significantly greater. The best quality
and quantity of NFB were produced when adjunct BMSCs were used with bone
transplant and CM for guided bone regeneration in standardized rat calvarial
lesions. 13 mm bonegraft only, 17.75 mm bonegraft + CM, and 19.52 mm
bonegraft + BMSCS + CM NFB on 24 weeks. All groups displayed 5 mm NFB at 4
weeks, and after 8 weeks, 9.3 mm bonegraft alone, 10 mm bonegraft + CM, and
11.34 mm bonegraft + BMSC+CM.
|
|
Durual et al.,
202140
|
Calvarial
bone defect
(Animal
study)
|
Bio-Oss® Collagen
|
Saline soaking
ensures qualitative bone tissues growths, quicker regeneration kinetics, and
simplified handling. It should make it possible to standardize clinical
protocols and could be an alternative to conventional blood pre-treatment. As
compared to blood pre-treatment, new bone growth on DBBM with NaCl 0.9% was
noticeably higher within the first month (3.4% vs. 2%)
|
|
Gehrke, MazĂłn, PĂ©rez-DĂaz,
et al., 201964
|
In vitro
characterization
|
Orthogen Bone
(sintered)
Lumina Bone (non sintered)
|
Sintered bovine
bone block showed bigger pores (500-700nm vs 200-400nm), slightly higher
total porosity (20.21% vs 19.28%), similar compressive strength (x̄ 450N)
also viability and proliferation of cells (x̄ 0.2-0.4)
|
|
Gehrke, MazĂłn, Del Fabbro, et
al.,
201964
|
Calvarial
bone defect
(Animal
study)
|
Orthogen Bone
(deproteinization)
Lumina Bone (non
sintered)
|
6mm diameter and
5mm high bovine bone block screwed onto rabbit calvarial bone. After 8 weeks,
sintered bovine bone has lower bone resorption (10% vs 25%) and neo formation
(12.86% vs 16.10%) than non sintered bovine bone.
|
|
Kamal et al.,
202265
|
Mandibular
bone defect
(Animal
study)
|
Cerabone,
Bio-Oss, Autogenous,
|
Histological
analysis after 12 weeks demonstrated bone healing pattern in grafting site,
same with what was seen in the CBCT images. Osseous shell technique
successful to treat mandibular defect on mice.
|
|
Nugraha et al.,
202366
|
In vitro
|
FDBB plus hUCMSCs
|
Compared to
dc-FDBB and DBBM, FDBB demonstrated a greater capability for both
osteoinductive and osteogenic activity. FDBB showed higher RUNX2 (0.55 and
2.43)
|
|
Montessory et
al.,
202224
|
In vitro
|
FDBB
|
Damaged osteocyte
cell remnants were visible under the microscope with HE scaffold FDBB
labeling, however these remnants were not visible with dc-FDBB and DBBM.
|
DISCUSSION:
Bovine bone block
xenograft is a type of bone graft material which widely used in oral surgery to
promote bone regeneration in areas where there is insufficient bone to support
dental implants or other prosthetic devices, also on maxillofacial bone defect.23
This type of bone graft material is created from cow bones that have undergone
processing and sterilization to eliminate all organic material and any
potential pathogen-transmitting sources. The resulting bone block is then cut
to size and shape for use in specific surgical procedures. Majority it derived
from femur bone of cows, although it can also be sourced from other bovine
bones such as the tibia or the iliac crest.24
During a bone
graft procedure using bovine bone block xenograft, the material is placed into
the site where new bone growth is needed. Bovine bone block xenograft gradually
integrates with the patient's own bone tissue by acting as a scaffold for new
bone cells to develop and adhere to. However, as with any medical procedure,
there may be some risks or complications associated with the use of this
material, and patients should always discuss the potential benefits and risks
of any treatment with their healthcare provider.23,25
A recent study
published in the Journal of Materials Science: Materials in Medicine in 2020
examined the composition and microstructure of bovine femur bone used for
xenografts. The study found that the cortical bone from the femur of bovine is
an ideal source for producing bone graft materials due to its high mineral
content, low organic content, and excellent biomechanical properties. The study
also noted that the processing and sterilization methods used to prepare the
bovine bone block xenograft can have an impact on the material's properties,
and emphasized the importance of strict quality control measures to ensure the
safety and efficacy of these grafts.26,27,28
To meet various
surgical requirements, bovine bone block is offered in a range of shapes
and sizes. The size of the bone block can have an impact on the graft's outcome
because while larger blocks may offer more structural support, they may also
take longer to integrate with the patient's own bone tissue.29,30
The size of bovine bone blocks widely used in dental implant procedures ranged
from 5 mm x 5 mm x 5 mm to 15 mm x 10 mm x 10 mm. The study found that larger
bone blocks tended to result in higher rates of implant success, but also noted
that the size of the bone block should be tailored to the specific needs of
each patient and surgical site. Larger bovine bone blocks (10 mm x 10 mm x 10
mm) resulted in greater bone formation and integration than smaller blocks (5
mm x 5 mm x 5 mm), particularly when used in combination with other bone graft
materials.31
Evaluations
performed at the graft site on the host after treatment with bovine bone block
xenograft demonstrated low rates of complications and failure (Table 4). Of the
13 journals searched that reported graft complications, 5 of them showed no
complications at all. While others reported minimal complications that only one
study shown implant failure 8.9%, not healthy implant mean (n=4) 30%, and 12.5%
complication rate (n=3). The most complication found is dehiscence, bruising,
and oedema.
Table 4. Summary of Bone Graft Parameters
|
Parameters
|
Publication
(n)
|
Result
|
Finding
|
|
Clinical
Complication
|
13
|
8.9
% Failure
|
Low
complication
|
|
Vertical
Bone Gain
|
26
|
4.5
mm
|
Adequate
bone gain
|
|
Newly
Formed Bone
|
11
|
14.5
%
|
Good
bone integration
|
|
Resorption
Rate
|
6
|
22%
or 2.7mm
|
Biocompatible
for host
|
Table 5. Additional osseointegration factor on
bone graft and its effect
|
Additional
factors
|
Publication (n)
|
Finding
|
|
MSCs
|
4
|
Higher NFB, and
RUNX-2
|
|
PDGF
|
4
|
Only slightly higher
VBG (mean (4.53mm)
|
|
BMP
|
3
|
Higher VBG (mean
7mm)
|
|
Collagen
|
4
|
Slightly higher
NFB (3.4%)
|
Clinical
parameters vertical bone gain (VBG) and newly formed bone (NFB) are the most
used for evaluating treatment success. VBG is important because alveolar ridge
augmentation is the most case in oral and maxillofacial surgery because of its
vertical defect should be solved for next dental treatment like implant or
denture. Mean vertical bone gain (n=26) is 4.5 mm with newly formed bone (n=11)
14.5% of total bone in grafting area. These result indicates that all previous
research that we found showed adequate integration between graft and host bone.
Resorption rate of
a bone graft material is an important factor in assessing its biocompatibility
and long-term success. The optimum bone graft material should have a resorption
rate that is equal to the rate of new bone growth. If the graft material
resorbs too quickly, it may not provide adequate structural support for the
newly forming bone, leading to compromised stability and integration. On the
other hand, if the graft material resorbs too slowly, it may impede the
remodeling and replacement of the graft with new host bone. Rapid or excessive
resorption may trigger an inflammatory response or adverse tissue reactions,
while slow resorption can lead to prolonged immune responses or complications
such as infection. Resorption rate (n=6) found in 4 month until 3 years
observation with mean 22% or found approximately 2.7mm.
Bovine Bone Block
Xenograft Treatment Success Increased by Addition of BMP-2, PDGF, and Collagen
Membrane (Table 5). Studies have suggested that the success rate of bovine bone
block xenograft procedures may be improved by the addition of growth factors
and/or a collagen membrane to the graft site. These materials can help to
promote bone growth and integration and may enhance the overall effectiveness
of the bone graft procedure. The study found that the use of this combination
of materials resulted in significantly higher rates of implant success and bone
formation compared to the use of bovine bone block xenograft alone.70
BMP-2 addition shows
greater success rate on bovine bone block treatment32,33,34. A
powerful osteogenic growth factor that is essential for bone regeneration and
repair is bone morphogenetic protein 2 (BMP-2). By promoting the development of
mesenchymal stem cells (MSCs) into osteoblasts, the cells responsible for bone
production, BMP-2 has been found to improve osteogenesis on bovine bone block.
When BMP-2 is applied to bovine bone block, it initiates a signaling pathway
that promotes the recruitment and differentiation of MSCs to the site of the
graft. These MSCs then differentiate into osteoblasts, which begin to lay down
new bone tissue and integrate the bovine bone block with the surrounding bone.
Additionally, BMP-2 has been shown to enhance the production of extracellular
matrix proteins, such as collagen and osteopontin, which are essential
components of bone tissue. These proteins serve as a support for the
growth of new bone and aid in maintaining the graft site's stability. 67,68,69
PDGF increase bone
formation on defect site treated with bovine bone block35,36,37,38. By
promoting the proliferation and development of mesenchymal stem cells (MSCs),
which are the cells responsible for bone production, PDGF is known to promote
osteogenesis on bovine bone blocks70,71. By establishing a physical
barrier that limits the infiltration of soft tissue, encouraging the migration
and proliferation of osteogenic cells, and promoting the formation of
extracellular matrix proteins, collagen membrane can greatly improve
osteogenesis on bovine bone block grants.39,40,41
CONCLUSION:
The appropriate
size of bovine bone block xenograft for a particular patient and surgical site
will depend on a variety of factors, including the amount of bone loss, the
location of the graft, and the specific goals of the procedure. Additional
osteogenic factors such as BMP-2 and PDGF also collagen membrane on the
operative site can provide better output after treatment. For best results,
dental practitioners must thoroughly assess each patient's particular needs and
choose the proper size and shape of bone graft material.
CONFLICT
OF INTEREST:
The authors have
no conflicts of interest regarding this investigation.
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