Search Results (385)

Autologous tooth-derived grafts are increasingly being investigated for bone regeneration, as dentin shares with bone a mineral phase and an organic matrix rich in type I collagen and non-collagenous proteins. Deciduous teeth are particularly attractive as biomaterials because they are easily obtained after physiological exfoliation, without additional surgical harvesting or donor-site morbidity and may expose a protein-rich matrix after processing. Whether deciduous teeth retain a biologic advantage after prolonged dry storage remains poorly documented. This proof-of-concept ex vivo and in vitro study compared pooled deciduous teeth from six different donors (exfoliated at least 10 years before the experiment and stored dry at room temperature conditions) with six freshly extracted third molars. The teeth were ground using a dedicated device, and conditioned supernatants were collected at 72 h (T1) and 28 days (T2). Osteocalcin, osteonectin, and BMP-2 were quantified by ELISA, and T1 supernatants were applied to human primary osteoblasts to assess the osteogenic response using qRT-PCR and immunofluorescence. Deciduous teeth-conditioned supernatants showed higher osteocalcin and osteonectin release than permanent teeth at both time points, whereas BMP-2 levels were comparable, though with higher values in deciduous samples. In osteoblasts, deciduous teeth-conditioned supernatants induced enhanced osteogenic responses, including greater activation of Collagen I, Osterix, RUNX-2, Osteocalcin, BMP-2 genes, and higher expression of bone-related proteins. Within the limits of this exploratory study, dry-stored deciduous teeth preserved a biologically active dentin matrix and showed a more favorable osteogenic profile than freshly extracted permanent teeth, supporting further investigation into standardized storage protocols and their potential use in regenerative applications. Full article

Critical size bone defects (CSBD) remain a major challenge in orthopedic surgery. Autologous bone grafting is considered the gold standard but is limited by restricted availability and significant donor-site morbidity. Synthetic bone substitutes offer an alternative; however, these materials are avital and lack osteoinductive properties. This study evaluated whether intraoperative bioactivation of bone substitutes using a surgical suction handle can safely enhance their regenerative potential. Fifty patients with CSBD, non-unions, or high-risk defects were enrolled, and calcium phosphate-based ceramics were intraoperatively coated with autologous tissue via a surgical suction handle and implanted into the defects. Clinical outcomes—including pain, range of motion, and wound healing—were scored using a standardized system, with all patients achieving results in the “excellent” range (10–13 points). Radiographic follow-up showed progressive cortical and extracortical bone formation in all patients. Surgeons reported high ease-of-use for the device, and no device-related complications occurred. Although biomaterial resorption was incomplete in some cases (36% with <75% resorption at six months), no patient required revision surgery. Our data indicate that intraoperative bioactivation of bone substitutes using a surgical suction handle is safe, feasible, and promotes local bone regeneration, providing a minimally invasive and practical approach to enhance the performance of synthetic grafts in challenging defects. Full article

Background and Objectives: Tooth loss affects quality of life and chewing ability and is associated with natural ridge resorption after extraction. Implants are a viable option for the anchorage of removable or fixed prostheses. Successful implant placement requires adequate bone availability. To minimize bone loss after extraction and to avoid the need for additional augmentation before implant placement, ridge preservation techniques are employed. The aim of this study was to assess volume changes in extraction sockets after ridge preservation with a collagen-based bovine/porcine xenogenic material, Bio-Oss^® Collagen (Geistlich, Switzerland), in molar and premolar regions. Materials and Methods: A retrospective study was designed and implemented. Subjects who underwent tooth extraction and consecutive ridge augmentation with Bio-Oss^® Collagen between 2018 and 2022 and complied with the inclusion criteria were selected. The volume of the tooth root prior to extraction (alveolar socket volume surrogate) was estimated from pre-extraction CBCT scans and panoramic radiographs (predictor variable). The volume of the socket after extraction and ridge preservation was measured in CBCT datasets (outcome variable). The results were tabulated and analyzed (p < 0.05). Results: The study sample was composed of 80 subjects (37 female, 43 male; 20 premolars, 60 molars; average age: 59 ± 12.5 years). Of those, 60 cases qualified for comparative analyses (27 female, 33 male; 15 premolars, 45 molars; avg. age 59 ± 12.7 years). Compared with the pre-extraction alveolar socket volume in this subset of 60 subjects (maxillary premolar: 195.20 ± 33.40 mm³, maxillary molar: 470.41 ± 99.92 mm³, mandibular premolar: 220.42 ± 102.03 mm³, mandibular molar: 544.76 ± 137.32 mm³), ridge preservation cases still exhibited a volume loss of approximately 3–18% due to residual resorption depending on the location of the augmentation site (volume after ridge preservation: maxillary premolar: 192.07 ± 63.50 mm³, maxillary molar: 381.96 ± 81.38 mm³, mandibular premolar: 199.86 ± 73.70 mm³, mandibular molar: 475.85 ± 152.26 mm³. The highest resorption rates were observed in maxillary molar sites (approximately 18%), whereas maxillary premolar sites showed the lowest rates (around 3%). Conclusion: The study demonstrates that ridge preservation with the xenograft Bio-Oss^® Collagen (Geistlich, Switzerland) can reduce ridge resorption following tooth extraction. Full article

Hydroxyapatite–calcium sulfate (HACaS) bone cements have been clinically established. Combining HACaS with an antiresorptive (zoledronic acid, ZA) and osteoanabolic agent (bone morphogenic protein 2; BMP-2) may enhance the performance of HACaS bone cements in challenging indications, but it must be ensured that this does not impair their setting and mechanical properties. This study established a Vicat/Gillmore-inspired indentation protocol to quantify force-based endpoints and the setting of HACaS with biological adjuvants. HACaS was mixed with or without ZA and/or BMP-2 at 0 min and after a 2 min pre-setting phase with reduced NaCl content (lower liquid-to-powder ratio). For each time point (3–90 min), three cylindrical pellets (Ø 4 mm, height 6 mm) underwent single indentation. Setting was defined as the maximum force at needle penetration, and endpoint hardness was defined as peak force at failure. For 24 h endpoints, specimens were incubated in blood at 37 °C. One-way ANOVA with Tukey’s H post hoc test was performed per time point (n = 3; 24 h endpoints n = 5). All 2 min protocols showed accelerated setting, consistent with the initial lower liquid-to-powder ratio. ZA significantly delayed setting and remained lowest at 90 min and after 24 h in blood. Mixing sequence and vehicle composition critically influenced early mechanical properties and should be considered in the further preclinical evaluation of HACaS with osteoanabolic or antiresorptive agents. Full article

Bone is a hierarchically organized composite material with unique mechanical properties and an intrinsic regenerative capacity that conventional repair strategies, including autografts, allografts, xenografts, and metallic or ceramic implants, fail to fully replicate due to donor scarcity, immunogenicity, mechanical mismatch, and poor long-term integration. Bone tissue engineering (TE) offers a biologically informed alternative by integrating osteoconductive scaffolds, osteogenic progenitor cells, and osteoinductive signaling molecules into a unified regenerative framework. Unlike existing reviews that evaluate these components in isolation, this review provides a mechanistically integrated analysis that repositions scaffold design as a biologically instructive platform whose topography, stiffness, porosity, and surface chemistry collectively govern cell adhesion, mechanotransduction, osteogenic differentiation, and extracellular matrix remodeling. Critically, it moves beyond cataloging materials and fabrication approaches to evaluate how specific scaffold features drive biological outcomes and to identify frequently understated limitations, including polymer-ceramic degradation kinetics and the inadequacy of small-animal models for clinical translation. By synthesizing advances in biomaterials, additive manufacturing, and smart scaffold technologies within this integrative framework, this review provides researchers and clinicians with a structured framework for evaluating emerging strategies and prioritizing future directions in functional bone regeneration. Full article

Polycaprolactone (PCL) is widely utilized in bone tissue engineering due to its excellent biocompatibility and processability; however, its inherent bioinertness and hydrophobicity significantly restrict its clinical osteogenic efficacy. To overcome these limitations, we incorporated sol–gel synthesized silicate-based bioactive glass (BG) into a PCL matrix and fabricated a series of composite scaffolds with varying BG contents via direct ink writing (DIW) 3D printing. Rheological characterization confirmed that all ink formulations exhibited shear-thinning behavior, with viscosity increasing monotonically with BG content. DSC analysis revealed that BG incorporation progressively reduced the crystallinity of PCL from 51.47% to 36.23%. We systematically evaluated the physicochemical properties, mechanical resilience, and in vitro degradation behavior of these scaffolds. The results indicated that BG incorporation significantly improved the surface hydrophilicity, with the contact angle decreasing from 104.8 ± 2.81° to 69.8 ± 2.91°. Furthermore, as the BG content increased, the porosity and mechanical strength exhibited an initial increase followed by a subsequent decrease, yet all values remained within the range of human cancellous bone. Notably, cellular assays revealed that the introduction of 58SBG enhanced cell–matrix interactions; the PCL/BG scaffolds promoted superior cell attachment and more extensive morphological spreading compared to pure PCL. Among all groups, the PCL/30BG composite scaffold demonstrated the most optimal balance of mechanical integrity and biological response. Consequently, the PCL/30BG scaffold developed in this study exhibits immense potential as a bone graft substitute, providing a promising approach for clinical bone defect repair strategies. Full article

Mineral powder–based bone grafts exhibit excellent osteoconductivity; however, their clinical efficacy is often compromised by insufficient early-stage tissue ingrowth, leading to particle aggregation and pocket formation within the defect site during the initial healing phase. Here, we report a cotton-type nanofiber-guided mineral graft designed to overcome this early integration failure by creating fibrous pathways for tissue ingress. Cotton-type polycaprolactone (PCL) nanofibers were fabricated via electrospinning using a pin-based collector engineered to induce strong inter-fiber repulsion, resulting in a highly expanded, three-dimensional cottony architecture. Tetracalcium phosphate (TTCP) and α-tricalcium phosphate (α-TCP) mineral particles were subsequently deposited onto the surface of the cottony nanofibers, forming a fibrous–mineral hybrid graft (c-NF@T/α-TCP) in which the nanofibers act as a transient, functionally defined tissue-guiding framework during the early healing phase. The cottony nanofiber network effectively prevented mineral particle aggregation and generated continuous pathways within the graft, facilitating early tissue infiltration and vascular ingress during the first week after implantation. In vivo evaluation in a bone defect model demonstrated that c-NF@T/α-TCP significantly reduced tissue pocket formation at early time points and promoted subsequent bone regeneration compared to mineral powder-only grafts. This study highlights the critical importance of early-stage structural guidance in mineral-based bone grafts and introduces cotton-type nanofiber–guided pathway engineering as a simple yet effective strategy to unlock the regenerative potential of conventional inorganic bone substitutes. Full article

Background/Objective: Advanced peri-implantitis presents a significant challenge in contemporary implant dentistry and sometimes necessitates implant removal when regenerative therapies are no longer reliable. Protocols for staged bone reconstruction, re-implantation, and definitive prosthetic rehabilitation following peri-implantitis continue to evolve. This study aims to present a clinical case of advanced peri-implantitis with vertical interproximal bone loss managed with a staged surgical and prosthetic approach and review current concepts in implant removal, bone regeneration, re-implantation, and soft-tissue management. Methods: A patient with peri-implantitis affecting two maxillary implants underwent treatment over one year. The initial surgical stage included removal of the failing implants and reconstruction of the defects using guided bone regeneration with a composite graft of 50% xenogeneic bone substitute and 50% autogenous bone, covered by a barrier membrane. After six months of healing, a second surgical stage was performed, involving placement of two new implants in positions 2.2 and 2.4, additional bone augmentation, and soft tissue grafting to enhance soft tissue volume and the width of keratinized gingiva following mucogingival line rebounce. After an additional six months of osseointegration, full maxillary prosthetic rehabilitation was completed in August 2025. Results: Clinical and radiographic assessments demonstrated successful bone regeneration, stable implant integration, adequate peri-implant soft-tissue conditions, and favorable functional and esthetic outcomes at follow-up. The case is discussed in the context of current evidence regarding indications for implant removal, regenerative strategies after explantation, timing of re-implantation, and the importance of keratinized gingiva and prosthetic design in long-term peri-implant health. Conclusions: Staged explantation, guided bone regeneration, delayed re-implantation, and comprehensive soft-tissue and prosthetic management may represent a viable treatment strategy in selected cases of advanced peri-implantitis. Full article

Adequate alveolar bone volume is a prerequisite for predictable and long-term success in dental implant therapy. Physiological post-extraction remodeling frequently results in horizontal and vertical ridge deficiencies, which may compromise optimal implant placement. Guided bone regeneration (GBR) has become a cornerstone procedure in implant dentistry, with clinical outcomes largely influenced by the biological and mechanical characteristics of grafting materials. Different bone grafts and their combinations are currently clinically applicable, each exhibiting distinct osteogenic, osteoinductive, and osteoconductive properties, as well as varying resorption profiles and volumetric stability. This narrative review aims to analyze the biological principles of alveolar ridge augmentation, compare the properties of commonly used graft materials, evaluate clinical outcomes, and discuss emerging regenerative strategies. Literature published between 2000 and 2025 was assessed to synthesize current evidence regarding graft integration, bone formation, desorption dynamics, and clinical indications. Autogenous bone remains the gold standard due to its combined osteogenic, osteoinductive, and osteoconductive potential; however, its limitations have driven the development of alternative materials, including allografts, xenografts, alloplastic substitutes, demineralized tooth matrices, platelet concentrates, and customized scaffolds. While no single material is universally ideal, appropriate selection based on defect characteristics and clinical objectives is essential for predictable outcomes. Future research should prioritize long-term comparative trials, biomaterial standardization, and biologically enhanced regenerative approaches. Full article

Background/Objectives: Healthcare activities contribute significantly to climate change and environmental pollution. The demand for bone grafting is increasing, and the biological properties of bone substitute materials are critically important. A methodology aimed at preserving BMPs may offer an opportunity to improve the biological properties of donor cadaver-derived bone grafts. The aim of this study was to conduct a life cycle assessment of the BMP-preserving approach used in allograft production in order to enhance the environmental sustainability of bone grafting. Methods: Following primary data collection at the West Hungarian Regional Tissue Bank, environmental impacts were assessed using the OpenLCA software and the ReCiPe v1.03 (2016) midpoint and endpoint impact categories. A sensitivity analysis was also conducted under six alternative scenarios to evaluate which changes would have the greatest beneficial effect on environmental impacts. Results: The greatest environmental impacts of allograft production were observed in the categories of material resources: metals and minerals, terrestrial ecotoxicity, and climate change. The climate change impact was 66.759 kg CO₂-eq. The environmental impacts of the production process also had a significant influence on human health, with a total DALY value of 6.58 h. The impacts were primarily driven by electricity consumption and the chemicals used; however, in several impact categories, waste management also contributed substantially. Conclusions: Transitioning to more sustainable energy sources (e.g., wind power) would substantially improve the environmental performance of allograft production. Further research is needed to identify more sustainable alternatives for the chemical agents used during processing. Full article

Dental tissue regeneration, particularly alveolar bone and gingival repair, remains a major challenge in regenerative medicine. 3D bioprinting offers patient-specific and anatomically precise constructs, representing an advanced alternative to conventional grafting. In this study, nanohydroxyapatite (nHA), chitosan (CS), and collagen (CoL) were combined to fabricate and characterize 3D bioprinted dental grafts. SEM revealed a highly porous, interconnected architecture favorable for cell infiltration and nutrient exchange. EDS confirmed Ca/P ratios of 2.06 for nHA/CoL and 1.83 for nHA/CS/CoL, both of which are above the stoichiometric 1.67, indicating the presence of additional mineral phases and ion substitutions. FTIR and XRD verified characteristic functional groups and crystalline phases, including B-type HA with carbonate substitution. Mechanical testing showed that pure nHA exhibited the lowest compressive strength, whereas CoL incorporation improved stiffness. The nHA/CS/CoL composite achieved the highest compressive strength, elastic modulus, and toughness, demonstrating superior mechanical resilience. DSC analysis indicated endothermic peaks at 106.49 °C and 351.91 °C, with enthalpy values (264.91 J/g and 15.09 J/g) surpassing those of nHA alone. TGA revealed ~28.8% weight loss across three degradation stages, confirming enhanced thermal stability. In vitro cytocompatibility testing using L929 fibroblasts validated the biocompatibility of the composites. Collectively, the synergy between bioceramics and biopolymers markedly improved both mechanical and thermal performance. These findings position the nHA/CS/CoL scaffold as a promising candidate for clinical applications in dental tissue regeneration. Unlike conventional grafting materials, this study introduces a synergistically optimized nHA/CS/CoL bio-ink formulation specifically designed for extrusion-based 3D bioprinting of patient-specific dental constructs. The core innovation lies in the precise integration of nHA within a dual-polymer matrix (CS/CoL), which bridges the gap between mechanical resilience and biological signaling, achieving a compressive strength that mimics native alveolar bone while maintaining high cytocompatibility. Full article

Background: The management of bone defects in pediatric oncology represents a major challenge in orthopedics, as it requires preserving both joint function and skeletal growth. Traditional reconstructive approaches, such as autografts and allografts, are limited by availability, complications, and incomplete biological integration. In this context, xeno-hybrid bone substitutes have emerged as a promising alternative. The aim of this study was to evaluate the safety and effectiveness of SmartBone^® ORTHO in the reconstruction of post-oncological bone defects in children. Methods: Twelve pediatric patients treated at the Centro Traumatologico Ortopedico (CTO) and OIRM Hospital, AOU Città della Salute e della Scienza of Turin (Italy), between 2016 and 2019 were retrospectively analyzed. Lesions included simple and aneurysmal bone cysts, non-ossifying fibroma, chondroblastoma, and other benign conditions. All patients underwent curettage followed by defect filling with SmartBone^® ORTHO. Results: At clinical and radiological follow-up, nine patients (75%) showed stable graft integration and complete functional recovery. Three patients (25%) developed local recurrence, which was managed with revision surgery and re-implantation of SmartBone^®, with all achieving stable outcomes. Radiographs demonstrated progressive increases in bone density and trabecular thickness, reaching values comparable to those of native bone within 6–12 months. Conclusions: SmartBone^® ORTHO proved to be a safe and effective biomaterial for pediatric post-oncological bone reconstruction, promoting rapid osteointegration and physiological bone remodeling without infection or intolerance. Full article

Despite advances in periodontal regenerative therapies, consistent tissue regeneration remains challenging, with cells playing an essential role in successful repair. Therefore, this study tested different dental bone substitutes embedded in the chorioallantoic membrane (CAM) combined with periosteum-derived micrografts obtained using a chair-side device (Rigenera HBW system). Cell populations within the micrografts were identified and characterised via immunofluorescence and flow cytometry (CD31, CD105, CD34, CD90, CD73, and CD45). A CAM model was employed to examine the angiogenic potential of micrografts combined with bone substitutes, which were analysed through quantitative blood vessel/vascularisation assessments using the Ikosa software (2025), along with histological and immunohistochemical evaluations such as smooth muscle actin (SMA), H&E, and Masson’s trichrome staining. Statistical analysis was performed using GraphPad Prism 10. The addition of periosteum-derived micrografts resulted in angiogenic enhancement compared to the controls. Notable enhancement of total vessel area, total length, and branching points were obtained when Fisiograft^® (p = 0.0007, p = 0.0002, and p < 0.0001, respectively), New Shore^® (p = 0.0006, p = 0.0149, and p = 0.0083, respectively), and Bio-Oss^® (p = 0.0038 and p = 0.0010, respectively) were combined with micrografts, compared to the positive controls. The histological and immunohistochemical analyses confirmed increased vascularisation (positive staining for SMA) in the micrograft groups. Periosteum-derived micrografts represent a promising adjunct to conventional bone-grafting materials, promoting vascularisation and potentially enhancing tissue regeneration and healing outcomes. Full article

Lumbar interbody fusion is widely performed for degenerative, deformity-related, and instability-associated spinal conditions. Yet, reported outcomes remain variable across grafting strategies and surgical techniques. While advances in instrumentation and cage design improve immediate construct stability, successful arthrodesis depends on early graft behavior within the interbody environment. This includes positional stability, interface contact, and load transfer prior to mature bone formation. Synthetic bone graft substitutes are commonly used to supplement or replace autograft. However, the clinical literature describing these materials is heterogeneous with respect to composition, structural presentation, surgical context, and outcome reporting. This narrative review synthesizes clinical, translational, and biomechanical studies published between 2019 and 2025 that evaluate synthetic bone graft substitutes used in adult lumbar interbody fusion. Rather than comparing individual products or reported fusion rates, grafts are organized by material class and examined through early mechanical events such as graft migration, loss of graft–endplate contact, and cage subsidence. Across recent studies, variability in fusion definitions, imaging modalities, postoperative timepoints, and documentation of early mechanical events limits direct comparison and quantitative synthesis. These findings highlight the need for improved reporting consistency and greater emphasis on engineering-relevant variables in future investigations. Full article

Recombinant human bone morphogenic protein-2 (rhBMP-2) use in spinal fusion is limited by dose-dependent complications. Peptide amphiphile (PA) supramolecular polymers presenting a BMP-2–binding epitope have previously been developed to reduce the rhBMP-2 dose required for successful fusion. We evaluated PA implant biodegradation and tissue clearance in a rat posterolateral spinal fusion model as a prerequisite to clinical safety studies. Twenty-three female Sprague–Dawley rats underwent L4–L5 fusion with gadolinium (Gd)-labeled PA implants. Longitudinal magnetic resonance imaging (MRI) was performed up to 13 weeks postoperatively, while the spine and filter organs were harvested for inductively coupled plasma mass spectrometry (ICP-MS) quantification of Gd at multiple time points. Gd concentration at the fusion site decreased from 71% of maximum to 19.5% at 13 weeks, and MRI showed a complete loss of Gd signal enhancement by 8 weeks. In peripheral organs, peak Gd accumulation was 3% in the liver at 4 weeks, declining to 1.4% at 13 weeks, while Gd remained below 0.05% in the spleen, lung, and blood at all time points. These data indicate PA implant localization, with robust degradation and clearance and minimal off-target accumulation, supporting its translational potential for spinal fusion applications. Full article