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Guided Bone Regeneration

The future of bone substitutes

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Is it already the time for “doped” bone substitutes? A look into the crystal ball.

Prof. Christer Dahlin | Sweden

Deproteinized bovine bone, which is widely used as grafting material for oral applications, contains only the mineral phase of bone after removal of organic components and purification.1 Deproteinized bovine bone is classified amongst the calcium phosphate group of materials with a chemical composition mimicking that of human skeletal bone. Numerous reports have shown that deproteinized bovine bone facilitates bone healing and subsequent implant integration.

Many efforts have been made to develop synthetic grafting materials as options for bone substitution. This is not only due to concern regarding the origin of autogenous and xenogenic graft material, but also because novel techniques within tissue engineering allow controlled and standardized modifications of the chemistry and structure of synthetic materials.

The role of ions

Bone mineral is a carbonate containing hydroxyapatite and, hence, various amounts of different ions are present in the tissue, such as sodium, fluoride, magnesium, strontium and others. In order to mimic original human bone, extensive efforts have been made to introduce these components into synthetically manufactured materials. From a biological perspective, this is quite an interesting development, since several of the previously mentioned ions are considered bioactive, and this “doping” of a calcium phosphate structure can alter its biological performance.2 One example of such an ion is strontium, which has received attention for stimulating bone formation and inhibiting bone resorption.3,4 An interesting observation regarding deproteinized bovine bone is that this material also demonstrates an active release of silicon ions, which are considered stimulatory for osteoblast activity. Furthermore, an active uptake of calcium ions on the surface of deproteinized bovine bone particles further confirms that this material most probably is quite actively involved in the early bone formation stage.5

Future perspectives

Based on current trends and knowledge, I foresee evaluations of different bone substitutes or scaffolds that are “doped” in order to trigger specific cellular and molecular events during bone healing. Another area of great potential interest is to explore whether it is advantageous to prime both bone substitutes as well as membranes with, for example, mesenchymal cells in order to optimize healing.

In summary, I expect research within the fields of GBR will not develop with isolated projects on membranes and bone substitutes, respectively. Current findings strongly suggest that membranes and bone substitutes are tightly linked to one another during healing and should be evaluated as a “family” of regenerative biomaterials.

Prof. Christer Dahlin

Prof. Christer Dahlin | Sweden

University of Gothenburg
Sahlgrenska Academy,
Inst. of Clinical Sciences

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