Autologous Bone Graft: When Shall We Add Growth Factors?
Section snippets
The use of autologous bone grafting or reaming by-products
Tibia is the most common long bone to sustain a fracture. It has a high risk of developing nonunion because of the compromised soft tissue envelope especially over its anterior medial area.25, 29 Consequently, it represents the bone with the highest overall incidence of nonunion, and the “nonunion model.”25
In the atrophic nonunions, the biologic factor is considered to be mostly the problem, despite the perception that the vascularity at the nonunion site is not compromised. The oligotrophic
The use of growth factors
Aiming to overcome the limitations of the autologous bone grafting, bone morphogenetic proteins (BMP-7 and BMP-2) were produced by recombinant DNA technology.57, 58 They are substances with great osteoinductive properties for the enhancement of bone regeneration in various clinical applications, including the treatment of fracture nonunions.8, 59, 60 The safety of their administration, combined with the lack of morbidity and the quantity restrictions that characterize autologous bone grafts,
Discussion
Autogenous bone grafting, usually derived from the iliac crest, is frequently used in the treatment of fracture nonunions. The donor-site morbidity and potentially limited supply of suitable autogenous bone are commonly recognized drawbacks. The proven value of reaming by-products, an internal autografting, is quite often inadequate to overcome adverse local circumstances.
Regardless of the ongoing developments of new approaches or the improvement of the current ones for the treatment of
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Cited by (17)
Effect of Choukroun Platelet-Rich Fibrin Combined With Autologous Micro-Morselized Bone on the Repair of Mandibular Defects in Rabbits
2018, Journal of Oral and Maxillofacial SurgeryCitation Excerpt :Although the repair of mandibular defects has long been a focus of research in oral plastic surgery, the repair and reconstruction of mandibular defects remain a formidable problem in head and neck reconstruction surgery.13 Choukroun PRF and autologous bone are obtained from a patient's own body, and these materials contain growth factors that contribute to tissue regeneration and healing in the defect area.16,17 Furthermore, immunologic rejection and complications are rare.18,19
Effect of Emdogain enamel matrix derivative and BMP-2 on the gene expression and mineralized nodule formation of alveolar bone proper-derived stem/progenitor cells
2014, Journal of Cranio-Maxillofacial SurgeryCitation Excerpt :Several products aiming at augmenting tissue regeneration have been developed and have been used in clinical practice with promising results. Among these potential agents are Emdogain (Straumann, Freiburg, Germany) (Sculean et al., 2007) and bone morphogenetic proteins (BMPs) (Giannoudis and Dinopoulos, 2010). Emdogain is a commercially available enamel matrix derivative (EMD) (Trombelli and Farina, 2008), composed of a mixture of hydrophobic enamel matrix proteins, nearly 90% of which one is amelogenin, along with other enamel matrix proteins, such as enamelin, tuftelin, amelin, and ameloblastin (Robinson et al., 1998), in a propylene glycol alginate (PGA) carrier.
Growth factors and bone regeneration: How much bone can we expect?
2011, InjuryCitation Excerpt :It is important to recognize that when significant bone regeneration is required (e.g. in the setting of a bone defect) it is advisable to combine BMP with an osteoconductive substance such as cancellous allograft (see Fig. 1).35 Recently, a number of authors have advocated for the use of BMPs in combination with autograft as a form of ‘graft expansion’, particularly in the treatment of non-unions which have failed previous bone grafting procedures or in the setting of significant bone defects.14 This is based on the concept that the combined administration of BMP and AICBG provides optimized osteogenesis, osteoconduction, and osteoinduction, thereby enhancing all three critical components of the fracture healing process.
Corticoperiosteal flap in the treatment of nonunions and small bone gaps: Technical details and expanding possibilities
2011, Journal of Plastic, Reconstructive and Aesthetic SurgeryCitation Excerpt :Electric stimulation, ultrasound stimulation and high-energy extracorporeal shock waves have shown good results in hypertrophic nonunions but less so in atrophic nonunions or in the presence of a large gap.10 Percutaneous injection of autogenous bone marrow and different osteoinductive molecules (transforming growth factor-B (TGF-B) subfamily, bone morphogenetic protein (BMP) subfamily or platelet-derived growth factor (PDGF)) have been used in the treatment of nonunions with promising but still non-conclusive results.11 Because of its osteogenic capability, periosteal grafts have a significant potential in the reconstruction of bone defects and it has been shown experimentally that the association of a periosteal flap and cancellous bone is a better means by which to produce compact bone than either a vascularised periosteal flap alone or an isolated cancellous bone graft.