Download Bone Grafting

INJECTABLE CALCIUM
PHOSPHATE CEMENT
Ryan Calouro
Problem Being Solved
• An important aspect of bone tissue repair is that its
clinical application is quite diverse.
• Due to this, there is not a specific method or
approach that applies to all clinical examples.
• The focus of this technology is applied when a bone
grafting procedure is used, or in other words, when
the structural damage outweighs the body’s capacity
to heal the bone on its own.
• Most patients requiring this technology have
experienced great trauma or require reconstructive
dental surgery.
Problem Being Solved
• Examples of application include:
• Non-union fractures
• Craniofacial reconstruction
• Segmental defect due to tumor removal
• Augmentation of bone- specifically hip
replacement
• Damaged articulation sites
• Spinal fusion
Bone Grafting
• This surgical procedure and the new technology being
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studied is very interrelated.
$2.5 billion spent on bone grafting procedures annually
as 2.2 million operations occur worldwide during that
timespan
Grafts are possible because bone tissue has the ability
to regenerate completely if there is enough space to
grow.
In most instances the grafting material is replaced
completely with a full section of regenerated tissue.
Missing bone is replaced in one of three ways:
• Autograft: bone harvested from one’s own body (iliac crest)
• Allograft: cadaveric bone (bone bank)
• Synthetically-biocompatible substances
• Four major mechanisms necessary to make bone grafting
most effective:
1.
2.
3.
4.
Osteoconduction- occurs when the grafting material serves as a
scaffold (integrated porous structure) for new bone growth allowing
osteoblasts to spread and generate new tissue in the damaged
area
Osteoinduction- the stimulation of osteoprogenitor cells to
differentiate into osteoblasts allowing faster integration of the
grafting material. (BMP most studied and effective)
Osteopromotion- the enhancement of osteoinduction
Osteogenesis- occurs when osteoblasts from the grafting material
itself contribute to new bone growth.
It is widely understood that an ideal bone graft includes an
osteoconductive matrix, osteogenic cells, and osteoinductive proteins.
Biological Mechanism
• Advantages:
• Autografting is the only
mechanism that contains all
properties naturally
• No immune reaction
• Disadvantages:
• Requires additional surgery to
acquire grafting material
• Very limited quantity
• Increased morbidity
• Infection
• Chronic Pain
• Cosmetic
Autografts
• Advantages:
• Eliminates the morbidity of patient’s donor site
• Helps solve supply issue
• Disadvantages:
• Immune reaction
• Greater risk of infection
• Disease transmission
• Reduction in osteogenic & osteoinductive properties
• Ethical & religious concerns
Allografts
• Advantages:
• Biodegradable/Biocompatible
• No risk of transfer disease or infection
• Non immunogenic
• Limitless supply
• Eliminates morbidity of patient’s donor
site
• Can be used to “fill” large fractures
• Disadvantages:
• Not much osteogenic or osteoinductive
property without added growth factors
Injectable Cement
• Mixture of biocemet and water or other
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aqueous solution
Dual-chamber syringe allows for accurate and
noninvasive placement while also leaving little
residue
Biocement is composed of several derivations
of the compound calcium phosphate
Calcium phosphate is a naturally occurring
compound in bone tissue, giving it
osteoinductive characteristics
Due to these characteristics the development of
bone fragment in the surrounding soft tissue
area is avoided
How does it work?
• Hard-setting paste provides mechanical strength comparable
to traditional bone grafting
• Provides a porous scaffold that resorbs overtime
• Osteoclast cells begin recycling the material at the junction
between bone and cement almost immediately
• Growth factors and antibiotics can be added to the paste in
order to compliment the natural regeneration process
• After healing, all of the cement is replaced with natural new
bone tissue
How does it work?
Limitations
• Can only be used in small operations, primarily spinal
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fusion
Cannot be used to fully reconstruct areas of deformation
Doesn’t yet replace the use of implantable screws and
plates, often serves as a compliment
Has received FDA approval, but the recipe for the
calcium phosphate cement is still being studied and
perfected.
Healing times may vary depending on patient
Future Direction
• Perfect recipe to allow for quicker healing times
• Develop a more workable substance that can be
used to build bone “mold”
• Replace the current use of screws and plates/bone
bank materials in general
• "Basic Healthcare - What Is Bone." Basic Healthcare - What Is Bone. N.p.,
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n.d. Web.
Burger, E. L. "Calcium Phosphates as Bone Graft
Extenders." Orthopedics 30.11 (2007): n. pag. Healio.
Ginebra M.P., Calcium Phosphate Cements as Bone Drug Delivery
Systems: A Review. Journal of Controlled Release 113: 102-110, 2006.
Horstmann W.G., An Injectable Calcium Phosphate Cement as a BoneGraft Substitute. PubMed, pp. 141-4, 2003.
Ibrahim, Rashid., Kaveh, Kamran., 2010. Bone Grafting and Bone Graft
Substitutes. Journal of Animal and Veterinary Advances, 9(6), pp. 10551067.
Nguyen Ngoc Hung., 2012. Basic Knowledge of Bone Grafting. Bone
Grafting, Dr Alessandro Zorzi (Ed.), InTech.
Vorndran, E. "Ready-to-use Injectable Calcium Phosphate Bone Cement
as Drug Carrier." Acta Biomaterialia 9.12 (2013): 9558-567. ScienceDirect.
Elsevier. Web.
References