Dimensional Stability of the Alveolar Ridge After Implantation of a Bioabsorbable Bone Graft Substitute: A Radiographic and Histomorphometric Study in Rats
This study evaluated reconstruction of the alveolar ridge after molar extraction in rats with bioabsorbable bone repair scaffolds. The material was prepared from the unsaturated polyester poly(propylene glycol-co-fumaric acid) (PPF), which may be cured in situ to form a porous scaffold. The intention is to use this material either as a stand-alone bone graft substitute or as an extender to autograft harvested from mandibular reconstruction sites. The bioactivity of the graft substitute was investigated in a rat residual ridge resorption model. PPF bone repair material was injected into the defect site, where it cross-linked in situ in the presence of a hydroxyapatite (HA) filler and effervescent agents. The PPF-based material develops porosity during an in situ cure by generating carbon dioxide during the effervescent reaction of citric acid and sodium bicarbonate. The incorporation of HA promotes osteoconduction within the bone repair scaffold. In this study, bioactivity of the porous scaffold was evaluated as a function of HA particle size (micrometer-sized vs nanometer-sized particles). The maxillary or mandibular molars on the right side were extracted from 96 adult Sprague-Dawley rats. A 2-mm round bur was used to create a uniform trench defect measuring 2 mm in diameter, 2 mm in depth, and 4 mm in length at each extraction site. The defect site was (1) treated with PPF bone repair material containing nanometer-sized HA, (2) treated with PPF material containing micrometer-sized HA, (3) treated with demineralized freeze-dried bone allograft , or (4) left untreated. Rats were sacrificed at 2, 4, 7, and 12 weeks postoperative. Resorption of the residual alveolar ridge was assessed by radiographic outcomes. Bone ingrowth through the defect site was measured by histomorphometric outcomes. Mandibular and maxillary ridge heights increased for all treatments used in this study. There were no clinical indications that addition of either of the PPF bone repair materials retarded hard- or soft-tissue healing of the extraction sites. Although not statistically significant, the mandibular defects treated with PPF containing nanometer-sized HA healed at a faster rate as determined by ridge height and new bone formation measurements when compared with the other treatments. These findings suggest the feasibility of using PPF bone graft substitutes for oral-maxillofacial applications.Abstract

Pore sizes of the cured poly(propylene glycol-co-fumaric acid) material ranged between 50 and 1000 micrometers as measured from scanning electron micrographs. The overall void fraction of the cured material was approximately 50%

Mandibular and maxillary ridge heights (C) were calculated from distance measurements A and B and angle measurement α using the Law of Cosines. Measurements were made on digitized radiographs that were magnified ×300


Extraction defects had healed by 12 weeks postoperative. Remnants of the poly(propylene glycol-co-fumaric acid) (PPF) scaffold (examples are marked with an asterisk) were observed to be surrounding by newly formed bone (marked with black arrows) in (A) nanometer-hydroxyapatite (HA)-augmented PPF and (B) micrometer-HA-augmented PPF materials. Defects filled with (C) demineralized freeze-dried human bone allograft were filled with new bone, whereas bone recovery was still occurring in (D) untreated defects

Contributor Notes
David D. Hile, PhD, is the engineering director of Biomedical Biomaterials, Stephen A. Doherty, PhD, is a senior scientist, and Debra J. Trantolo, PhD, is president and chief executive officer at Cambridge Scientific Inc, 180 Fawcett Street Street, Cambridge, MA 02138. Address correspondence to Dr Hile (hiledd@yahoo.com).
Stephen T. Sonis, DMD, DMSc, is the chairman of the Department of Oral Medicine, Infection, and Immunity in the Harvard School of Dental Medicine, Boston, Mass.
XiaoYan Tian, PhD, is a postdoctoral fellow in the Division of Radiobiology, Qing Zhang, PhD, is a laboratory aide in the Department of Chemistry, and Webster S. S. Jee, PhD, is a professor of Anatomy and Neurobiology in the Division of Radiobiology, University of Utah, Salt Lake City, Utah.