Inductive biomaterials for bone regeneration
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Cato T. Laurencina) Institute for Regenerative Engineering, University of Connecticut Health Center, Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, and Department of Orthopaedic Surgery, Farmington, CT 06030, USA; Department of Materials Science and Engineering, Department of Chemical and Biomolecular Engineering, and Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA (Received 7 September 2016; accepted 17 January 2017)
Inductive biomaterials are sought as alternatives to traditional materials used to treat bone defects. Traditional materials include autologous bone grafts that must be obtained surgically, and allografts that carry the risk of disease transmission and infection. Whereas the use of growth factors to stimulate bone growth has seen considerable advances, their efficacy is usually limited to supra-physiological doses with considerable side effects. On the other hand, certain biomaterials have an intrinsic ability to stimulate bone regeneration in lieu of growth factor use, and their use in repairing bone defects as well as improving the osteointegration of implants has been promising. These materials known as osteoinductive biomaterials include ceramics, metals, polymers, and composites of these materials. In this review, we examine the relevant properties of these different materials in their ability to induce bone formation.
I. INTRODUCTION
Despite tremendous advances in treating various musculoskeletal disorders, critical sized bone defects remain a challenge for the orthopedic surgeon. Autologous bone grafts are currently the material of choice for filling or replacing bony lesions; however, these grafts require an additional donor surgery and yield a complication rate of one in five.1 Whereas new intramedullary reamer systems may modestly drop the complication rate to one in fifteen,1 they are still invasive and associated with significant costs.2 In addition to the morbidity associated with both procedures, obtainable quantities of graft materials are limited and can pose a significant challenge for large lesions. The use of allografts over autografts eliminates the donor site morbidity and allows for larger volume harvests, but adds the risks of disease transmission3 and increased post-operative infection rates.4 For these reasons, the development of graft substitutes that are safe, abundant, and effective is of significant interest.
Contributing Editor: Adrian B. Mann a) Address all correspondence to this author. e-mail: [email protected] b) These authors contributed equally to this work. This paper has been selected as an Invited Feature Paper. DOI: 10.1557/jmr.2017.39
The success of the autologous bone graft seems to be dependent on its osteogenic (inherent ability to produce bone), osteoconductive (mechanical support of bone growth), and osteoinductive (induction of surrounding progenitor cells to produce bone) properties (see Table I).5,6 Graft-substitutes with inherent osteogenic properties (i.e., the abil
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