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Open AccessReview

Cellular Mechanisms Responsible for Success and Failure of Bone Substitute Materials

1
Department of Orthopedics, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
2
Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
3
Institute of Veterinary Anatomy, Histology and Embryology, Justus Liebig University of Giessen, 35385 Giessen, Germany
4
Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany
5
Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
*
Author to whom correspondence should be addressed.
Int. J. Mol. Sci. 2018, 19(10), 2893; https://doi.org/10.3390/ijms19102893
Received: 29 August 2018 / Revised: 17 September 2018 / Accepted: 20 September 2018 / Published: 23 September 2018
(This article belongs to the Special Issue Biomaterials for Bone Tissue Engineering)
Bone grafts, i.e., autologous, allogeneic or synthetic bone substitute materials play an increasing role in reconstructive orthopedic surgery. While the indications and materials differ, it is important to understand the cellular mechanisms regarding their integration and remodeling, which are discussed in this review article. Osteoconductivity describes the new bone growth on the graft, while osteoinductivity represents the differentiation of undifferentiated cells into bone forming osteoblasts. The best case is that both mechanisms are accompanied by osteogenesis, i.e., bone modeling and remodeling of the graft material. Graft incorporation is mediated by a number of molecular pathways that signal the differentiation and activity of osteoblasts and osteoclasts (e.g., parathyroid hormone (PTH) and receptor activator of nuclear factor κβ ligand (RANKL), respectively). Direct contact of the graft and host bone as well as the presence of a mechanical load are a prerequisite for the successful function of bone grafts. Interestingly, while bone substitutes show good to excellent clinical outcomes, their histological incorporation has certain limits that are not yet completely understood. For instance, clinical studies have shown contrasting results regarding the complete or incomplete resorption and remodeling of allografts and synthetic grafts. In this context, a foreign body response can lead to complete material degradation via phagocytosis, however it may also cause a fibrotic reaction to the bone substitute. Finally, the success of bone graft incorporation is also limited by other factors, including the bone remodeling capacities of the host, the material itself (e.g., inadequate resorption, toxicity) and the surgical technique or preparation of the graft. View Full-Text
Keywords: bone substitute; biomaterial; osteoclast; osteoblast; remodeling; bone regeneration bone substitute; biomaterial; osteoclast; osteoblast; remodeling; bone regeneration
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MDPI and ACS Style

Rolvien, T.; Barbeck, M.; Wenisch, S.; Amling, M.; Krause, M. Cellular Mechanisms Responsible for Success and Failure of Bone Substitute Materials. Int. J. Mol. Sci. 2018, 19, 2893.

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