Article
Bioceramic implants induce bone healing of large cranial defects
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Authors
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Thomas Engstrand
- Stockholm Craniofacial Centre, Department of Molecular Medicine and Surgery, Plastic Surgery Section
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Lars Kihlström
- Department of Clinical Neuroscience, Neurosurgical Section, Karolinska University Hospital and Karolinska Institute, Stockholm
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Kalle Lundgren
- Stockholm Craniofacial Centre, Department of Molecular Medicine and Surgery, Plastic Surgery Section
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Margarita Trobos
- Biomatcell, Vinn Excellence Centre of Biomaterials and Cell Therapy, University of Gothenburg, Sweden
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Håkan Engqvist
- Department of Engineering Sciences, Applied Materials Science Section, Uppsala University, Sweden
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Peter Thomsen
- Biomatcell, Vinn Excellence Centre of Biomaterials and Cell Therapy, University of Gothenburg, Sweden
| Published: | June 2, 2015 |
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Outline
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Objective: Autologous bone or inert alloplastic materials are today utilized in cranial reconstructions. Recent clinical data report 20-30 % complication rates with these techniques. In this context, new innovations in cranial repair are needed. In the present study we report comprehensive evidence of bone formation induced by a bioceramic implant in patients with cranial defects.
Method: Mosaic-designed calcium phosphate implants were manufactured with moulding technique. In two patients the implants were either replaced due to aesthetical concerns or surgically exposed for the removal of fixating titanium plates, respectively. This gave unique opportunities to inspect the reconstructed areas and obtain biopsies 9 and 50 months after surgery for gene expression analyses and histological examinations. Informed consent was obtained with signed approval to take perioperative biopsies.
Results: Gross inspection 9 months postoperatively revealed intact ceramic implant without macroscopic evidence of bone deposition. Histological examination showed mulinuclear cells in the central defect zone whereas bone ingrowth was evident in the bone-implant border zone. An increased expression of osteocalcin, collagen type I, osteopontin, calcitonin receptor, and cathepsin K was detected within the reconstructed area as compared to parietal bone whereas runx2 expression was low. In another patient the reconstructed parietal area was inspected 50 months postoperatively. Bleeding bone appeared to cover all ceramic tiles. Histological examination revealed vascularized compact bone in direct contact with remnants of ceramic materials.
Conclusions: The induction of compact cranial bone by calcium phosphate-based implants was demonstrated in patients. We believe that regeneration of bone may improve clinical outcome in cranial repair as compared to conventional techniques.
