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Volumetric resorption of the alveolar ridge often occurs in both horizontal and vertical directions following tooth extraction. There is a specific lack of evidence for alveolar ridge reconstruction at molar and premolar sites with severe bone resorption. This randomized controlled trial used 3D and linear analyses to evaluate volumetric changes of the alveolar bone following alveolar ridge reconstruction (ARR) at molar and premolar sites with severe bone resorption as compared to unassisted socket healing before implant placement. A total of 31 patients (15 men, 16 women) with > 50% hard tissue loss in one or more socket walls were recruited and randomized into either a test group (postextraction ARR using deproteinized bovine bone mineral with 10% collagen [DBBM-C] and platelet-rich fibrin [PRF] with a resorbable collagen membrane) or a control group (natural healing after extraction). The clinical, linear, and volumetric implant-related and patient-reported outcomes were analyzed after 4 months of healing. Linear bone assessments revealed significantly greater ridge width gains in the test group (25% in the mesial, midfacial, and distal aspects) and less reduction of vertical bone ridge than in the control group (P < .05). Further, volumetric bone remodeling was significantly higher in the test group (35.1% ± 34.9% for ARR, 14.2% ± 12.8% for control; P < .05). Patient-reported discomfort and keratinized mucosal changes were comparable between groups. ARR with a combination of DBBM-C, PRF, and a resorbable membrane at posterior sites with a severe socket wall deficiency (> 50% bone loss) is a safe and more capable therapeutic method when compared to natural healing and unassisted sockets. Collectively, the present analyses demonstrate that ARR represents an efficient method to maintain and augment crestal bone at posterior extraction sites with severe bone defects when assessed after 4 months of healing. [ABSTRACT FROM AUTHOR]

Purpose: To present a sling suture technique used to stabilize a collagen membrane against the lateral bone window to improve bone substitute stability inside the sinus cavity. Materials and Methods: Maxillary sinus floor augmentation was performed on 17 patients (8 women and 9 men; mean age 58.2 years) using a lateral approach with the sling suture technique to maintain a collagen membrane against the lateral bone window. Postoperative CBCT images were captured at 6-month follow-up of each patient to monitor the bone graft stability at the level of the lateral antrostomy. Clinical postoperative pain and swelling were assessed via visual analog scale (VAS) questionnaire, measured from level 1 (low) to level 5 (acceptable) to level 10 (high) at 1 week postoperative. Results: No bone substitute displacement was observed in any clinical cases on the CBCT images at 6 months postoperative. The pain and swelling levels observed 1 week postoperatively were significantly low (mean ± SD; 1.6 ± 1.0 and 2.1 ± 0.9, respectively). Conclusions: The use of the sling suture technique to maintain a barrier membrane at the level of the lateral bone window in cases of maxillary sinus floor augmentation using a lateral approach is a predictable protocol to prevent bone substitute displacement outside the sinus cavity. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of lateral sinus floor elevation (LSFE) on sinus membrane (SM) thickness and sinus health in mucosa thickness < 5 mm and > 5 mm. Materials and Methods: LSFE was performed in a prospective controlled clinical trial on two groups with < 5 mm and > 5 mm SM thickness (Groups A and B, respectively) and followed for 6 months. Using preoperative and 6-month postoperative CBCT scans and clinical evaluation, SM thickness changes (primary outcome variable), sinus health, augmented bone height and length (augmentation adequacy), membrane-related variables, and operation time were measured. Results: Forty unilateral sinus augmentations (n = 20 for both groups) were performed on 40 subjects (72.5% men, mean age of 48.8 ± 7.6 years), and 52 implants were simultaneously placed. The mean preoperative and 6-month SM thicknesses were 1.4 ± 0.9 mm and 1.3 ± 0.6 mm in Group A, respectively, and were 6.8 ± 1.0 and 3.4 ± 1.7 mm in Group B, respectively. The mean postoperative SM thickness significantly decreased (P < .001) only in Group B. The mean SM thickness changes also revealed a noticeable difference between the two groups (P < .001). Augmentation adequacy and membrane perforation rate were similar in both groups. Clinical and radiographic rhinosinusitis was not detected in any of the patients. Bleeding during separation and resistance to elevation were significantly higher in Group B than in Group A (P = .003, P = .001). Surgical time was longer in Group B (12.08 ± 8.26 minutes) than in Group A (8.64 ± 3.70 minutes), without reaching significance (P = .097). Conclusions: LSFE in thickened mucosa (< 10 mm) and thinner mucosa (< 5 mm) does not cause abnormal changes in the SM and sinus health. LSFE in thickened mucosa results in adequate sinus augmentation. The thickened membrane does not appear to be a contraindication to LSFE. [ABSTRACT FROM AUTHOR]

Purpose: To assess histologic and imaging outcomes related to new bone formation around implants, inserted simultaneously with sinus augmentation, and compare different types of grafts. Materials and Methods: This systematic review (SR) was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Cochrane Handbook for Systematic Reviews of Interventions. LILACS/BVS, MEDLINE/PubMed, Cochrane Library, and Embase databases, including gray literature and manual investigations, were searched to identify clinical trials reporting specific requirements. The present study needed human histologic and imaging data of bone formation around implants inserted into the maxillary sinus simultaneously with elevation and augmentation procedures. Study selection, risk of bias (Rob 2.0 or ROBINS-I), quality of evidence (GRADE), and data collection were performed by two independent reviewers. Results: Of the 1,101 potentially eligible articles, 44 were retrieved, 12 were assessed for eligibility, and 5 were included (4 randomized and 1 controlled clinical trial). As a result, 130 grafted sinuses with 179 placed implants in 103 patients were analyzed. The patients were aged between 24 and 79 years and followed up between 6 and 15 months. The heterogeneity between studies did not allow the data to be combined for meta-analysis. All graft materials proved to be viable options for the intervention. The use of biphasic calcium phosphate was related to higher bone-to-implant contact. Conclusions: All of the assessed grafts are viable options for the addressed intervention. The use of some material is justified to maintain the sinus volume and allow bone formation in the apical implant site under the sinus membrane. Longer chair time and donor site morbidity should be considered when choosing autogenous bone. Synthetic biphasic materials can be selected for this intervention due to superior bone-to-implant contact compared to deproteinized bovine bone. [ABSTRACT FROM AUTHOR]

Purpose: To answer the following question: "Do recombinant, purified, and concentrated growth factors enhance the regenerative potential of particulate bone graft substitutes in maxillary sinus floor augmentation (MSA)" Materials and Methods: Human studies comparing histomorphometric data on new bone formation, residual graft material, and fibrous tissue ratio (outcomes of interest) following MSA procedures employing particulate bone grafts/substitutes in combination or not with growth factors were retrieved from PubMed/MEDLINE, Web of Science, Cochrane, and Scopus online databases and complemented with a hand search. Controlled studies published in English up to December 2022 and reporting on histomorphometric data expressed as volume percentage of the outcomes of interest were considered. Risk of bias was assessed, and a meta-analysis was performed to investigate the effects of supplementary growth factors on new bone formation, remaining graft particles, and fibrous tissue ratio. Results: Data were included from 613 samples in 477 patients reported in 22 publications. Meta-analysis showed that platelet-rich plasma or platelet-rich fibrin resulted in 49% more new bone formation than in control group areas (P = .004), and those areas supplemented with growth factors presented 57% less residual graft particles after healing (P < .0001). A significant (P = .03) 1.85-fold increase in connective tissue formation was noted in areas treated with recombinant human bone morphogenetic proteins (rhBMPs) after healing. Conclusions: Selective supplementary growth factors may enhance new bone formation and accelerate particulate graft turnover, while rhBMP may significantly increase connective tissue formation in MSA procedures in humans. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the dimensional stability and quality of the alveolar ridge augmented using a synthetic bone block (SBB) at damaged extraction sockets. Four participants were included, and socket augmentation was performed using SBB and a collagen membrane. Intraoral and CBCT scans were performed before extraction (baseline), immediately postoperative (IP), and at 6 months postoperative (6M). At 6M, a trephine biopsy sample was obtained during implant placement, and the sample was observed using synchrotron. Soft tissue profile changes were assessed using profilometric analysis of the intraoral scan data, while dimensional changes in hard tissue were evaluated based on CBCT measurements. Bone quality was analyzed using synchrotron imaging. There were minimal changes in the soft tissue profile between baseline and IP, baseline and 6M, and IP and 6M (0.11 ± 1.08 mm³, 0.02 ± 0.8 mm³, and -0.65 ± 0.82 mm3, respectively). Horizontal bone width was measured at 1-mm increments from the augmented bone crest to 5 mm apically and revealed only a slight reduction (< 1 mm) at all levels between IP and 6M. The augmented bone height was well maintained from IP until 6M (-0.21 ± 0.53 mm). Synchrotron analysis revealed low to moderate bone quality after 6M (percentage of new bone: 16.49% ± 4.91%). Socket augmentation using SBB appears to be a viable technique for regenerating damaged extraction sockets, with the augmented ridge dimensions maintained up to 6M. Further long-term randomized clinical trials are needed. [ABSTRACT FROM AUTHOR]

Bone graft materials are often used in implant treatment to optimize functional and esthetic outcomes. The requirements for bone grafting materials are the ability to maintain space for bone regeneration to occur and the capability of being resorbed by osteoclasts and replaced with new bone tissue occurring in passive chemolysis and bone remodeling. Carbonate apatite (CO3Ap) granules (Cytrans Granules, GC) are a chemically synthetic bone graft material similar to autogenous bone minerals and more biocompatible than allografts and xenografts. The aim of this report is to evaluate the efficacy of CO3Ap granules in implant treatments when used alone or in combination with autogenous bone. The clinical findings and the radiographic and histologic assessments in three cases of immediate implant placement and lateral and vertical guided bone regeneration are reported. Despite the short-term follow-ups, histologic findings showed that CO3Ap granules were efficiently resorbed and replaced bone in clinical use. Furthermore, the clinical findings showed that CO3Ap granules maintained their morphology around the implant. This limited short-term case report suggests that this bone substitute is effective. However, further clinical studies and long-term reports of this new biomaterial are needed. [ABSTRACT FROM AUTHOR]

Background: Platelet-rich fibrin (PRF) is used to prepare "sticky bone" by combining it with bone graft material. The present study investigated the ability of different bone grafts to absorb growth factors from the PRF and release them over time. Materials and Methods: Human blood was collected from 10 healthy volunteers for liquid PRF preparation. Bovine bone, allograft (mineralized and demineralized), and synthetic bone were each mixed with the PRF to prepare a sticky bone. All sticky bone samples were incubated for up to 4 days. The absorption and release pattern kinetics of two selective growth factors within the PRF--platelet-derived growth factor (PDGF) and bone morphogenetic protein-2 (BMP-2)--were quantified with immunofluorescence staining and enzyme-linked immunoassay (ELISA) testing. Results: All bone graft materials adsorbed the examined growth factors from the PRF. ß-TCP showed the highest adsorption levels, followed by the xenograft, and the allografts showed the lowest adsorption levels. Furthermore, PDGF showed a fast-release pattern from the grafts, whereas BMP-2 was released at a later stage. Similar to the adsorption pattern, the ß-TCP and xenograft were better able to sustain the release of the PRF growth factors from the graft than the allografts. Conclusions: The adsorption of PDGF and BMP-2 differ between graft materials, with superior results for ß-TCP, followed by xenograft, then allograft materials. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the present study was to compare the histomorphometrically evaluated new bone formation (NB), the radiographically measured graft stability, and the clinical implant outcome for maxillary sinus augmentation grafted with deproteinized bovine bone mineral (DBBM) with either small (Bio-Oss-S, Geistlich) or large (Bio-Oss-L, Geistlich) particles. Materials and Methods: Using a split-mouth study design, bilateral maxillary sinus augmentation was performed in 13 patients either with Bio-Oss-S particles (0.25 to 1 mm) or Bio-Oss-L particles (1 to 2 mm). After a healing period of 6 months, bone biopsies were axially retrieved in the molar region for histologic/histomorphometric analysis of NB, including subsequent staged implant placement. To determine graft stability, the maxillary sinus augmentation vertical graft heights were radiographically measured immediately after sinus augmentation, at implant placement, and at the 2- and 4-year post-augmentation follow-ups. In addition, the clinical implant-prosthodontic outcome (survival/success/marginal bone loss) was assessed at 1 and 3 years post-loading. Results: A total of 22 sinuses from 11 patients with split-mouth evaluation were ultimately available for data and statistical analysis. Histomorphometric analysis of the axially retrieved bone biopsies revealed the presence of NB (S: 25.5% ± 7.0% vs L: 23.6% ± 11.9%; P = .640), residual graft particles (S: 19.6% ± 9.2% vs L: 17.5% ± 6.3%; P = .365) as well as connective tissue (S: 54.9% ± 9.2% vs L: 58.9% ± 12.5%; P = .283), without significant differences between the use of small (Bio-Oss-S) and large (Bio-Oss-L) particles. However, there was significantly (P = .021) higher bone-to-graft contact (BGC) for the small-particle graft sites (27.9% ± 14.8%) compared to the large-particle graft sites (19.9% ± 12.9%), representing a significantly higher osteoconductivity. Both particle sizes showed significant (P < .01) vertical graft height reduction over time (4 years) of about 10%, with predominant graft reduction in the time period between sinus augmentation and implant placement compared to any follow-up periods after implant placement. At the 3-year post-loading implant evaluation, all implants and prostheses survived (100%), and the peri-implant marginal bone loss (S: 0.52 ± 0.19 mm; L: 0.48 ± 0.15 mm) as well as the peri-implant health conditions (S: 87.5%, L:81.2%) did not differ between implants inserted with the two different xenograft particles used. Conclusions: The use of small and large bovine xenograft particles for maxillary sinus augmentation provides for comparable bone formation, ensuring stable graft dimensions combined with high implant success and healthy peri-implant conditions. However, small particle size resulted in a higher BGC, providing for higher osteoconductivity than with the larger particle size. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the effectiveness of biomaterials in bone healing of critical bone defects created by piezoelectric surgery in rat calvaria. Method and materials: Histomorphologic analysis was performed to assess bone regeneration and tissue response. Fifty animals were randomized into five groups with one of the following treatments: Control group (n = 10), spontaneous blood clot formation with no bone fill; BO group (Bio-Oss, Geistlich Pharma; n = 10), defects were filled with bovine medullary bone substitute; BF group (Bonefill, Bionnovation; n = 10), defects were filled with bovine cortical bone substitute; hydroxyapatite group (n = 10), defects were filled with hydroxyapatite; calcium sulfate group (n = 10), defects were filled with calcium sulfate. Five animals from each group were euthanized at 30 and 45 days. The histomorphometry calculated the percentage of the new bone formation in the bone defect. Results: All data obtained were evaluated statistically considering P < .05 as statistically significant. The results demonstrated the potential of all biomaterials for enhancing bone regeneration. The findings showed no statistical differences between all the biomaterials at 30 and 45 days including the control group without bone grafting. Conclusion: In conclusion, the tested biomaterials presented an estimated capacity of osteoconduction, statistically nonsignificant between them. In addition, the selection of biomaterial should consider the specific clinical aspect, resorption rates, size of the particle, and desired bone healing responses. It is important to emphasize that in some cases, using no bone filler might provide comparable results with reduced cost and possible complications questioning the very frequent use of ridge presentation procedures. [ABSTRACT FROM AUTHOR]

Objectives: This case series aimed to assess the efficacy of a novel horizontal ridge augmentation modality using histology. Combinations of "sticky bone" and tenting screws without autologous bone were used as augmentative materials. Method and materials: Five individuals presenting healed, atrophic, partially edentulous sites that required horizontal bone augmentation before implant placement were enrolled. Patients underwent the same augmentation type and 5 months of postoperative reentry procedures. The first surgery served as implant site development, whereas the biopsy and corresponding implant placement were performed during reentry. The bone was qualitatively analyzed using histology and histomorphometry and quantitatively evaluated using CBCT. Results: Four individuals healed uneventfully. Early wound dehiscence occurred in one case. Histology showed favorable bone substitute incorporation into the newly formed bone and intimate contact between de novo bone and graft material in most cases. Histomorphometry revealed an average of 48 ± 28% newly formed bone, 19 ± 13% graft material, and 33 ± 26% soft tissue components. The CBCTbased mean alveolar ridge horizontal increase was 3.9 ± 0.6 mm at 5 months postoperatively. Conclusions: The described augmentation method appears suitable for implant site development resulting in favorable bone quality according to histology. However, clinicians must accommodate 1 to 2 mm of resorption in augmentative material width at the buccal aspect. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the usefulness of ridge augmentation using a customized titanium mesh (CTM) that was preformed by trimming and bending the commercial titanium mesh on a virtually reconstructed 3D acrylic resin model using clinical, radiologic, histologic, and histomorphometric analyses. Materials and Methods: This study was designed prospectively for patients who required vertical ridge augmentation using a staged approach before implant surgery. After installation of the CTM, grafting was performed using deproteinized porcine bone mineral covered with an absorbable membrane. Computed tomography was performed preoperatively and 6 months after simultaneous/staged guided bone regeneration to measure planned, reconstructed, and lacking bone volume, and the reconstruction rate was calculated based on these values. Clinical complications were also recorded, particularly the mesh exposure rate. At re-entry, the bone core was obtained using a trephine bur, and histologic and histomorphometric analyses were performed. Results: A total of 10 sites in eight patients were used for the study analysis. The mean planned bone volume was 1.15 cm3 (range: 0.78 to 1.56 cm3), mean lacking bone volume was 0.13 cm3 (range: 0 to 0.59 cm3), and mean reconstructed bone volume was 1.02 cm3 (range: 0.56 to 1.43 cm3). The exposure rate was 30% (3 out of 10 sites). The reconstruction rate was over 80%, except for one case that showed suppuration. From histomorphometric analysis, 27.52% ± 16.87% of new bone, 7.62% ± 5.19% of residual graft, and 64.86% ± 23.76% of connective tissue were observed. The core biopsy samples demonstrated different pseudoperiosteum layer appearances based on the healing stage of the augmented sites. In the premature bone, the inner osteogenic layer consisted of multiple layers of osteoblast cells with adjacent large blood vessels. However, in the mature augmented site, there was no specific inner osteogenic layer, and the outer fibrous layer was dominant. Conclusions: The fabrication of CTM based on the application of the 3D-printing technique makes vertical ridge augmentation easier and can reduce complications and achieve target bone acquisition. In addition, it is expected that quantitative analysis of the pseudoperiosteum layer will be facilitated using the CTM. [ABSTRACT FROM AUTHOR]

Hydroxyapatite, renowned for its biocompatibility and osteoconductive properties, plays a fundamental role in bone regeneration owing to its resemblance to natural bone mineral, thus offering considerable potential for advancing tissue engineering strategies. In this article, the innovative integration of silicon ions into biogenic (bovine-derived) hydroxyapatite (SiBHA) via a tailored sol-gel process is reported. The resultant SiBHA scaffolds exhibited an interconnected microporous structure with a total porosity of 70% and pore dimensions ranging from 120 to 650 µm. Fourier-transform infrared spectroscopy and X-ray diffraction studies validated the effective incorporation of silicon ions into the BHA lattice, with energy-dispersive X-ray and inductively-coupled plasma mass spectrometry further confirming a Ca/P molar ratio for SiBHA between 1.63 and 1.74. Moreover, SiBHA scaffolds demonstrated commendable chemical and thermal stability. Of note, SiBHA scaffolds were found to display significantly enhanced mechanical properties, including compressive strength and Young's modulus, compared to the control BHA scaffolds. In vitro assessments highlighted the capacity of SiBHA scaffolds to foster cell viability, proliferation, and osteogenic differentiation of Saos-2 cells. Immunohistochemical analysis revealed a significant increase in osteonectin expression, a key bone matrix protein, after 14 days of incubation under osteogenic conditions. These findings highlight the biocompatibility and therapeutic potential of SiBHA scaffolds, suggesting their suitability as biomaterials for dental bone regeneration applications. [ABSTRACT FROM AUTHOR]

Background: Chondroblastoma is classified as a benign bone tumor. However, postoperative local recurrence remains a concern. We analyzed the factors contributing to chondroblastoma local recurrence and the clinical challenges associated with treating these patients. Methods: This retrospective study examined 59 patients followed up at our hospitals for ≥ 1 year after surgery during 1990–2020. The most common lesion site was the epiphyses of long bones (42 cases, 71%), including the femur, tibia, and humerus. Curettage was performed in 57 cases; 2 cases with an iliac lesion underwent resection. The median postoperative follow-up period was 47 months. Clinical features of chondroblastoma were retrospectively investigated, and local recurrence and postoperative functional outcomes were assessed. Results: Local recurrence occurred in 9% (5/57) of patients after curettage but not in the resected cases. The median time to local recurrence was 14 months. The local recurrence-free survival (LRFS) rate for all patients was 92.7% at 2 years and 88.3% at 5 years. All patients with local recurrence were aged < 17 years at the time of surgery. Local recurrence was observed in the proximal humerus in two cases and the calcaneus, acetabulum, and distal femur in one case each. None of the adjuvant procedures (high-speed burr, ablation, bone replacement materials, and preoperative denosumab) helped reduce local recurrence risk (P > 0.05). Trends toward fewer local recurrences were observed in the group treated using the high-speed burr and in the group not treated using bone replacement materials. Among the groups treated with bone replacement materials, artificial bone achieved the best LRFS rate, followed by allograft and autograft. At the final follow-up, the mean Musculoskeletal Tumor Society score was 29.8 (range: 25–30), indicating excellent postoperative functional outcomes. Joint degeneration was observed in five patients. Patients with local recurrence had a high degree of disability and joint deformity (P < 0.05). Two patients received preoperative denosumab and neither experienced local recurrence nor functional impairments. Conclusions: Good oncological and functional outcomes were achieved. Age < 17 years was associated with a high risk of local recurrence after curettage (P = 0.0198). Patients with local recurrence exhibited poorer functional outcomes. High-speed burr may help reduce the recurrence risk. If bone grafts are necessary, materials with low biocompatibility, including artificial bone, may be optimal. Managing patients with chondroblastoma should encompass curative and functional aspects. [ABSTRACT FROM AUTHOR]

Featured Application: The potential application of intentionally exposing xenogeneic bone may benefit immediate implant placement in molar areas in specific conditions when a flapless approach with an intact buccal wall is granted. Outcomes after implant placement include maintenance of bone stability (both vertically and horizontally), at least 2 mm of keratinized mucosa around implants, and uneventful healing processes. This study evaluated the clinical and tomographic outcomes of socket healing. Immediate implants were placed in the molar area, and the gap was filled with either deproteinized bovine bone mineral (B) or collagen matrix (BM), n = 14/group. Scores of epithelization healing, immunoassay for VEGF, IL-1β, and FGF from wound exudate, keratinized mucosa variation (ΔKM), and bone levels were evaluated. The B group had slower tissue maturation than BM (p < 0.05), but gingival epithelialization was similar (p > 0.05). At the restorative phase, the B group exhibited greater ΔKM at prosthesis installation—1 to 2 months of postoperative (increase of 0.29 mm) compared to the BM group (reduction of −1.5 mm) (p < 0.05). Inflammatory tissue responses as well as vertical and horizontal bone remodeling were similar (p > 0.05). Crestal bone remodeling was limited to less than 0.8 mm for both groups. Taken together, the B and BM groups behaved similarly and promoted stable conditions for biomaterial incorporation in the socket healing after immediate implant placement in molar areas. [ABSTRACT FROM AUTHOR]

Under benign conditions, bone tissue can regenerate itself without external intervention. However, this regenerative capacity can be compromised by various factors, most importantly related with the extent of the injury. Critical-sized defects, exceeding the body's natural healing ability, demand the use of temporary or permanent devices like artificial joints or bone substitutes. While titanium is a widely used material for bone replacement, its integration into the body remains limited. This often leads to the progressive loosening of the implant and the need for revision surgeries, which are technically challenging, are commonly associated with high complication rates, and impose a significant economic burden. To enhance implant osseointegration, numerous studies have focused on the development of surface functionalization techniques to improve the response of the body to the implant. Yet, the challenge of achieving reliable and long-lasting prostheses persists. In this work, we address this challenge by applying a robust and versatile biofunctionalization process followed by the decoration of the material with oligopeptides. We immobilize four different peptides (RGD, CS-1, IKVAV, PHSRN) on R-THAB® functionalized surfaces and find them to be highly stable in the long term. We also find that RGD is the best-performing peptide in in vitro cell cultures, enhancing adhesion, proliferation, and osteogenic differentiation of mesenchymal stem cells. To assess the in vivo effect of RGD-decorated Ti-6Al-4V implants, we develop a calvarial model in murine hosts. We find that the RGD-decoration remains stable for 1 week after the surgical procedure and reduces post-implantation macrophage-related inflammation. These results highlight the potential of peptide decoration on R-THAB® functionalized surfaces to expedite the development of novel metallic biomaterials with enhanced biocompatibility properties, thereby advancing the field of regenerative medicine. [ABSTRACT FROM AUTHOR]

Background/Objectives: Following tooth extraction, resveratrol (RSV) can support healing by reducing inflammation and microbial risks, though its poor solubility limits its effectiveness. This study aims to develop a solid nanocomposite by embedding RSV in lipid nanoparticles (mLNP) within a hydrophilic matrix, to the scope of improving local delivery and enhancing healing. Hydroxyapatite (HXA), often used as a bone substitute, was added to prevent post-extraction alveolus volume reduction. Methods: The mLNP-RSV dispersion was mixed with seven different polymers in various mLNP/polymer ratios. Following freeze-drying, the powders were redispersed, and the resulting dispersions were tested by DLS experiments. Then, the best two nanocomposites underwent extensive characterization by SEM, XRD, FTIR, Raman spectroscopy, and thermal analysis as well as in vitro partitioning studies aimed at verifying their ability to yield the mLNP-RSV from the hydrophilic matrix to a lipophilic tissue. The characterizations led to identify the best nanocomposite, which was further combined with HXA to obtain hybrid nanocomposites, further evaluated as pharmaceutical powders or in form of mini-tablets. Results: PEG-based nanocomposites emerged as optimal and, following HXA insertion, the resulting powders revealed adequate bulk properties, making them useful as a pharmaceutical intermediate to produce ≈59 mm3 mini-tablets, compliant with the post-extraction socket. Moreover, they were proven ex vivo to be able to promote RSV and GA accumulation into the buccal tissue over time. Conclusions: The here-proposed mini-tablet offers an innovative therapeutic approach for alveolar wound healing promotion as they led to a standardized dose administration, while being handy and stable in terms of physical solid identity as long as it takes to suture the wound. [ABSTRACT FROM AUTHOR]

With the implementation of bone substitute materials, regeneration strategies have inevitably evolved over the years. Histomorphometry is the optimal means of quantitative evaluation of bone structure and morphology. This systematic review focuses on determining study models, staining methods and histomorphometric parameters used for bone regeneration research on non-decalcified plastic-embedded specimens over the last 10 years. After being subjected to the inclusion and exclusion criteria, 118 studies were included in this review. The results establish the most commonly selected animal model is rat, followed by rabbit, sheep and dog. Strong preference for staining samples with toluidine blue was noted. With regard to histomorphometric parameters, terms related to bone were most frequently assessed, amounting to almost half of recorded parameters. New bone formation was the main descriptor of this category. Residual bone graft and non-bone tissue parameters were also often evaluated. With regard to dynamic histomorphometry, mineral apposition rate (MAR) was the parameter of choice for most researchers, with calcein green being the preferred dye for fluorochrome labelling. An overview of the contemporary literature, as well as weaknesses in the current research protocols have been discussed. [ABSTRACT FROM AUTHOR]

Objective: Assess whether horizontal ridge augmentation with guided bone regeneration (GBR) using deproteinized bovine bone mineral (DBBM), autologous bone, and a resorbable collagen membrane supports successful implant placement. Materials and Methods: This open, prospective, single‐cohort, multicenter clinical study included patients with ridge defects that required GBR prior to implant insertion. The primary endpoint was radiologically assessed bone gain after 8 months post‐GBR, measured at the center of planned implant sites. Secondary endpoints included implant survival and success, marginal bone levels (MBLs), MBL changes, and soft tissue health. Results: Of 45 patients evaluated 8 months post‐GBR, nine experienced dehiscence in the first 3 weeks of the healing period. GBR led to radiologically determined mean bone width gain of 4.0 ± 1.5 mm and 4.8 ± 1.7 mm, measured 1 and 3 mm from the top of the crest, respectively, allowing successful implant placement in 44 patients (97.8%). The cumulative implant survival and success rates were 98.9% and 95.5%, respectively. MBLs were stable: −1.18 ± 0.64 mm at definitive prosthesis placement (DPP) and − 1.07 ± 0.74 mm at 1 year. Soft tissue health and esthetics (plaque and bleeding indices, papilla, keratinized mucosa, and pink esthetic score) improved from DPP to 1 year. Patients were highly satisfied with implant function and esthetics, and their oral health‐related quality of life improved. Conclusions: GBR using DBBM and a collagen membrane offered a safe and effective treatment option for horizontal ridge augmentation sufficient to support implant‐based tooth rehabilitation. Trial Registration: Registered at ClinicalTrials.gov NCT03028922 (registrations sites, as above listed affiliations, first posted January 23, 2017) [ABSTRACT FROM AUTHOR]

Purpose: As the number of instrumented fusions increases, so does the utilization of bone substitutes. However, controversies persist regarding the effectiveness of ceramics in promoting solid fusion. Few histological studies have been conducted on patients to address this issue. To contribute insights into this topic, we assessed bony fusion both intraoperatively and histologically in patients who underwent posterolateral instrumented fusions enhanced with a biphasic ceramic compound. Methods: We analyzed a series of 13 patients who underwent revision surgery due to adjacent segment disease following the initial use of ceramics as bone extenders in the index surgery. In each case, patients exhibited apparent radiological fusion in the instrumented posterolateral fusions. Follow-up exceeded 18 months. Bone fusion was assessed intraoperatively, and biopsies of the bone mass at the intertransverse area were examined under an optical microscope. Results: Surgical exploration of the fusion block at the intertransverse space did not indicate solid fusion. Moreover, histological analysis of the 13 biopsies revealed a lack of proper integration of the bone substitutes, incomplete resorption of hydroxyapatite granules, and substitution of ceramic particles by immature fibrous tissue lacking the structural competence to bear loads or add stability to spinal fusion. Conclusion: The utilization of biphasic ceramics proved ineffective in attaining a proper fusion mass between the intertransverse space. Both surgical inspection and histological studies confirmed the absence of integration. Prudence should be exercised regarding the use of ceramics. While no clear instability was observed, neither was there any integration. [ABSTRACT FROM AUTHOR]

This study examines the impact of titanium and copper ion modifications on the properties of hybrid hydroxyapatite/chitosan granules, which serve as components of novel injectable bone substitutes - biomicroconcretes. In addition to the hybrid granules, the powdered phase of the composites comprises highly reactive α-tricalcium phosphate (α-TCP) powder. The utilization of a mixture consisting of citrus pectin and disodium phosphate as the liquid phase of bone substitutes facilitated the development of easily mouldable, fully injectable biomicroconcretes based on calcium phosphate, characterized by distinct properties. The resulting biomicroconcretes demonstrated favourable cohesion and setting times falling within acceptable parameters. Furthermore, the incorporation of citrus pectin into the liquid phase significantly augmented the mechanical strength of the materials. The unique attributes of biomicroconcretes containing citrus pectin arise from the presence of both a dual setting system and a double hybrid system. The dual setting mechanism, stemming from the hydrolysis of α-TCP and the crosslinking of citrus pectin in the presence of Ca2⁺ ions, yielded materials distinguished by excellent cohesion and chemical stability. Conversely, the double hybrid system emerged from the coexistence of hybrid granules and interactions between polycationic chitosan within the hybrid granules and polyanionic citrus pectin. All obtained biomicroconcretes exhibited in vitro bioactivity, positioning them as promising candidates for further biological investigations. Notably, the integration of antibacterial copper ions into hybrid hydroxyapatite/chitosan granules significantly enhances their potential utility as bone substitute materials, effectively reducing the risk of S. aureus and E. coli infection during surgical procedures. It has been found that titanium modified composites reduced adhesion of S. aureus but did not reduce the adhesion of E. coli cells. This research validates the advantageous properties of the synthesized ceramic-based biomaterials and sets the stage for subsequent in vitro and in vivo studies. [ABSTRACT FROM AUTHOR]

Introduction: Different Guided Tissue Regeneration (GTR) procedures, such as membranes, bone substitute materials, and Autologous Platelet Concentrates (APCs), have been applied after surgical root canal treatment (SRCT), which produce different outcomes. This study aimed to evaluate the impact of regenerative procedures on the healing process following SRCT. Methods: A comprehensive search of PubMed, Embase, Scopus, Cochrane, and the Web of Science found Randomized Controlled Trials (RCTs) published until February 25, 2024. Manual searches were also conducted. Our main outcome was SRCT success or failure after GTR procedures. The Risk Ratio (RR) and failure rate meta-analysis used a fixed effects model with a 95% confidence interval (CI). Subgroup analyses were conducted based on the use of different GTR procedures for varying lesion types in SRCT. Results: Out of 1,605 records, 16 studies with 690 lesions were included. Overall, GTR procedures significantly improved healing after SRCT in both 2D (RR: 0.50; 95% CI, 0.34–0.73; P < 0.001) and 3D evaluation methods (RR: 0.36; 95% CI, 0.15–0.90; P < 0.001) with no significant difference between the two methods. Conclusion: GTR significantly improved SRCT healing regardless of the evaluation method used. Combining collagen membranes with bovine bone-derived hydroxyapatite significantly enhanced the healing process. Additionally, GTR procedures significantly improve healing in through-and-through lesions. [ABSTRACT FROM AUTHOR]

Autologous dentin materials are among the most promising bone substitutes for preventing osseous defects on the distal side of the lower second molar. This study aimed to investigate the effects of autologous demineralized dentin matrix on postoperative complications and wound healing after lower third molar surgery. Thirteen patients with bilateral symmetrical lower third molars participated in this split-mouth randomized clinical trial. After removal surgery, one socket of the lower third molar was grafted with dentin material (demineralized dentin matrix side), and a piece of collagen sponge was used for the tooth socket of the remaining side (control side). The upper third molar on the same lateral side was extracted immediately before lower third molar surgery and used to create a demineralized dentin matrix according to the manufacturer's protocol (KometaBio). After lower third molar surgery, pain, swelling, trismus, and Inflammatory Proliferative Remodeling Scale scores were used to evaluate postoperative complications and wound healing. Pain, swelling, and trismus of the demineralized dentin matrix and control sides were not significantly different at any assessment time (P > 0.05). The wound-healing scores of the demineralized dentin matrix side were better than those of the control side; however, the differences were only significant at 7th and 30th days (P < 0.05). Grafting autologous demineralized dentin matrix into the tooth socket did not increase the postoperative complications after lower third molar surgery. However, wound healing on the graft side was comparatively better than that on the control side. NCT06073639, date 10 October, 2023. This is a retrospectively registered trial. [ABSTRACT FROM AUTHOR]

Invasive bone tumors pose a significant healthcare challenge, often requiring systemic chemotherapy and limb salvage surgery. However, these strategies are hampered by severe side effects, complex post-resection bone defects, and high local recurrence rates. To address this, we developed dual-functional bone substitute biomaterials by functionalizing commercially available bone substitute granules (Bio-Oss® and MBCP®+) with the established anticancer agent cisplatin. Physicochemical characterization revealed that Bio-Oss® granules possess a higher surface area and lower crystallinity compared to MBCP®+ granules, which enhances their capacity for cisplatin adsorption and release. In co-cultures with metastatic breast and prostate cancer cells (MDA-MB-231 and PC3) and bone marrow stromal cells (hBMSCs), cisplatin-functionalized granules and their releasates exhibited dose-dependent cytotoxic effects on cancer cells while having less impact on hBMSCs. Furthermore, investigations on the mechanism of action indicated that cisplatin induced significant cell cycle arrest and apoptosis in MDA-MB-231 and PC3 cells, contrasting with minimal effects on hBMSCs. In a rat femoral condyle defect model, cisplatin-functionalized granules did not evoke adverse effects on bone tissue ingrowth or new bone formation. Importantly, local application of cisplatin-functionalized granules resulted in negligible cisplatin accumulation without signs of apoptotic damage in kidneys and livers. Taken together, we here provide hard evidence that cisplatin-functionalized granules maintain a favorable balance between biosafety, anticancer efficacy, and bone regenerative capacity. Consequently, loading granular bone substitutes with cisplatin holds promise for local treatment of bone defects following bone tumor resections, presenting a safe and potentially more effective alternative to systemic cisplatin administration. Current treatments in combating malignant bone tumors are hampered by severe side effects, high local tumor recurrence, and complex bone defects after surgery. This study explores a facile manufacturing method to render two types of commercially available bone substitute granules (Bio-Oss® and MBCP®+) suitable for local delivery of cisplatin. The use of cisplatin-functionalized granules has shown promising results both in killing cancer cells in a dose-dependent manner and in aiding bone regeneration. Importantly, this local treatment strategy avoids the systemic toxicity associated with traditional chemotherapy to excretory organs. This dual-functional strategy represents a significant advancement in bone cancer treatment, offering a safe and more efficient alternative that could improve outcomes for patients following bone tumor resection. [Display omitted] [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Key points Plain language summary Recombinant human fibroblast growth factor‐2 (rhFGF‐2) has been shown to effectively promote the formation of new periodontal tissues, and its efficacy has been demonstrated in clinical settings. Moreover, the clinical and radiographic outcomes in the treatment of periodontal infrabony defects can be improved by using rhFGF‐2 in combination with a bone substitute. Here, we present a case of four‐wall bone defect in a tooth treated by combination regenerative therapy using rhFGF‐2 and beta‐tricalcium phosphate (β‐TCP).A 43‐year‐old male with a four‐wall bone defect in tooth #28 was subjected to combination therapy with rhFGF‐2 and β‐TCP. Periodontal clinical parameters and radiographic images were evaluated at the first visit, after the initial periodontal treatment, and after 4 months and 4 years postoperation.Although gingival recession and nonvital pulp were observed postoperation, improvements in the periodontal parameters and radiographic outcomes were subsequently recorded.Periodontal regenerative therapy with a combination of rhFGF‐2 and β‐TCP showed great potential in the treatment of four‐wall bone defects of teeth. Periodontal regenerative therapy using recombinant human fibroblast growth factor‐2 (rhFGF‐2) and beta‐tricalcium phosphate (β‐TCP) showed immense potential in the treatment of four‐wall bone defect in teeth. In addition to using computed tomography for assessing bone defects and root morphologies, an evaluation of root canal morphology and pulp diagnosis is essential for understanding the internal and external aspects of the defect, which would aid in tooth preservation. Appropriate periodontal and endodontic treatments enabled tooth preservation following apical periodontitis after periodontal regenerative therapy. This case report focuses on a new approach for the treatment of a four‐wall bone defect, a significant dental issue in which the bone around the tooth is damaged, thereby decreasing the stability of the tooth. We treated a 43‐year‐old male patient with a combination of two key components: the growth factor rhFGF‐2, which helps promote the growth of new tissues, and the synthetic bone graft substitute β‐TCP, which acts as a substitute for the missing bone. Over the course of 4 years, we monitored the patient's progress using dental exams and X‐ray photos. Despite some minor side effects, such as gum recession and the loss of tooth vitality, the overall condition of the tooth and surrounding bone showed significant improvement. This combination therapy shows promise in repairing similar bone defects, which would help save teeth that might otherwise be lost. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusion Trial Registration To evaluate the potential mid‐term benefit of the use of a bone substitute material in the reconstructive surgical treatment of peri‐implantitis.A total of 120 subjects (127 implants) affected by peri‐implantitis were followed over 3 years in a multicenter randomized clinical trial. Participants had been randomized to either control (access flap surgery) or test group (access flap surgery and bone substitute material). Clinical, radiographic, and patient‐reported outcomes were assessed. The primary outcome was a composite measure including probing pocket depth ≤ 5 mm, absence of bleeding and suppuration on probing, soft tissue recession ≤ 1 mm, and implant neither reoperated nor lost. In an additional outcome (disease resolution), we allowed for one bleeding site and did not consider recession.While 14 implants (11%) were lost and a second surgical intervention had been performed at 3 implants (2.4%), pronounced improvements of clinical parameters were noted at remaining implants in both treatment groups at the 3‐year follow‐up. This was illustrated by a 3.2–3.5 mm reduction in probing pocket depth and a marginal bone level gain of 1.1–1.3 mm. The primary composite outcome, however, was only achieved at 14% of implants. The second composite outcome defining disease resolution was accomplished at 39% of implants. Patient‐reported outcomes were generally favorable.At 3 years, the use of a bone substitute material in the surgical therapy of peri‐implantitis did not result in a clear benefit over access flap surgery alone.ClinicalTrials.gov identifier: NCT0307706 [ABSTRACT FROM AUTHOR]

Polyetheretherketone (PEEK) implants have emerged as a clinically favored alternative to titanium alloy implants for cranial bone substitutes due to their excellent mechanical properties and biocompatibility. However, the biological inertness of PEEK has hindered its clinical application. To address this issue, we developed a dual-functional surface modification method aimed at enhancing both osteogenesis and antibacterial activity, which was achieved through the sustained release of chondroitin sulfate (CS) and levofloxacin (LVFX) from a biomimetic polydopamine (PDA) coating on the PEEK surface. CS was introduced to promote cell adhesion and osteogenic differentiation. Meanwhile, incorporation of antibiotic LVFX was essential to prevent infections, which are a critical concern in bone defect repairing. To our delight, experiment results demonstrated that the SPKD/CS-LVFX specimen exhibited enhanced hydrophilicity and sustained drug release profiles. Furthermore, in vitro experiments showed that cell growth and adhesion, cell viability, and osteogenic differentiation of mouse calvaria-derived osteoblast precursor (MC3T3-E1) cells were significantly improved on the SPKD/CS-LVFX coating. Antibacterial assays also confirmed that the SPKD/CS-LVFX specimen effectively inhibited the growth of Escherichia coli and Staphylococcus aureus, attributable to the antibiotic LVFX released from the PDA coating. To sum up, this dual-functional PEEK implant showed a promising potential for clinical application in bone defects repairing, providing excellent osteogenic and antibacterial properties through a synergistic approach. [ABSTRACT FROM AUTHOR]

Background/Objectives: Traditional autologous bone grafts as a treatment for bone defects have drawbacks like donor-site morbidity and limited supply. PerOssal®, a ceramic bone substitute, may overcome those drawbacks and could offer additional benefits like prolonged, local antibiotic release. This study investigates the clinical and radiological outcomes, including patient-reported outcomes, of using PerOssal® in nonunions (NU) and high-grade chronic osteomyelitis (COM). Methods: A single-center, retrospective study, investigating patients treated with PerOssal® between January 2020 and December 2023. Collected data include patient characteristics as well as various surgical and outcome parameters including the Lower Extremity Functional Scale (LEFS). Results: A total of 82 patients were analyzed. Reinfection occurred in 19.5% of cases. Osseous integration of PerOssal® was achieved in 89% of cases, higher in cavitary defects (91.5%) than segmental defects (72.7%). The revision rate was 32.9%, mainly due to wound healing disorders and reinfections. Mean LEFS score was 53.4 which was heavily influenced by sex (male: 50.7 vs. female: 63.4), revision surgery (no: 55.7 vs. yes: 49.1), reinfection (no: 56.6 vs. yes: 39.4), and osseous integration of PerOssal® (yes: 55.8 vs. no: 38.4). Conclusions: PerOssal® demonstrates promising outcomes in treating NUs and high-grade COM, especially in cavitary defects, with high osseous integration rates and acceptable functional results. However, reinfection remains a concern, particularly with difficult-to-treat pathogens and extensive surgical histories. Early, comprehensive surgical intervention and tailored antibiotic strategies are essential. Patient selection, defect characteristics, and comorbidities significantly influence success. Further research is needed to optimize treatment protocols. [ABSTRACT FROM AUTHOR]

Magnesium oxychloride bone cement (MOC) is a bone replacement material that exhibits excellent mechanical properties and is non-toxic. However, the material exhibits poor water resistance, as the 5-phase composition of MOC decomposes readily in the presence of water. Tannic acid (TA) is an organic acid with favorable biocompatibility, containing a large amount of -OH that can form chelates with metal ions. Therefore, we plan to control spill Mg2+ in MOC using TA to improve its water resistance. The results demonstrate that the addition of TA resulted in a denser structure of MOC, an improved stability of the 5-phase in solution, a reduced degradation rate and pH value of MOC in body fluids, and the generation of hydroxyapatite in vitro. Furthermore, the MOC modified with TA demonstrated enhanced cell proliferation and increased new bone formation in cellular and animal experiments. This high-strength, highly bioactive material system is adaptable to patient-specific requirements and has significant potential for clinical translation. [Display omitted] [ABSTRACT FROM AUTHOR]

Polyetheretherketone (PEEK), bearing an elastic modulus that effectively simulates the innate properties of natural bone, has come into the spotlight as a promising bone substitute material. Nonetheless, the biologically inert nature of PEEK, combined with its insubstantial osseointegration and sterilization capabilities, pose constraints on its clinical application in the realm of implants. RNA interference (RNAi), an effective technique used for gene expression regulation, has begun to be applied in implant surface modification. Herein, siCKIP-1 is securely affixed to the surface of PEEK implants, aided by an antibacterial polyphenol tannic acid (pTAN) coatings, enhancing physiologic osseointegration and inhibiting bacterial infection. This method breakthrough not merely facilitates the convenience, but also multifaceted PEEK implants' refinements. The modified PEEK implants have impressive biocompatibility coupled with a noteworthy degree of antibacterial properties. Meanwhile, modified PEEK implants improved osteogenic differentiation of rat bone mesenchymal stem cells (rBMSCs) and demonstrated excellent osteointegrative properties in rat femur implantation models. Therefore, identifying a new implant material with excellent biocompatibility and biomechanical properties is essential. [ABSTRACT FROM AUTHOR]

Highlights In bone tissue engineering, polycaprolactone (PCL) has been extensively employed as a bone substitute due to its good biocompatibility, outstanding mechanical properties, controllable degradation rate, and excellent processability. However, PCL is a bioinert polymer with poor hydrophilicity, and it fails to actively induce new bone formation after implantation into the lesion. Therefore, it is generally necessary to find a bioactive material to improve these deficiencies of PCL. In this study, we first prepared a silicate‐based bioactive glass (SBG, 48SiO2‐24Na2O‐24CaO‐4P2O5, in mol%) using the melt‐quenching method, and then fabricated a series of PCL/SBG composite scaffolds with varying SBG powder contents (0, 10, 20, 30, and 40 wt.%) by 3D fiber deposition. The physico‐mechanical properties, mineralization capability, degradability and biological behavior of PCL/SBG scaffolds were systematically characterized. The results showed that the contact angle of the scaffolds decreased from 121.90 ± 3.74° to 86.29 ± 3.46° with the increase of SBG content, implying that the hydrophilicity was improved, and meanwhile the porosity and mechanical strength of PCL/SBG scaffolds first increased and then decreased, but they were within the range of human cancellous bone. Additionally, the degradation rate of PCL/SBG groups can be regulated by adjusting the SBG content. Finally, compared to the pure PCL group, the cell viability and alkaline phosphatase activity of MC3T3‐E1 on PCL/SBG groups were significantly enhanced. In the present work, the PCL/30SBG group exhibited great potential as a viable alternative to autografts and offers promising clinical applications for bone defect repair in the future. The addition of SBG powders accelerates the degradation of PCL. The addition of SBG powders enhances the hydrophilicity of PCL scaffolds. The degradation rate and bioactivity of PCL/SBG scaffolds can be regulated. The mechanical strength is within the range of human cancellous bone. PCL/30SBG shows improved cell viability and ALP activity. [ABSTRACT FROM AUTHOR]

In recent years, additively manufactured metallic scaffolds have generated significant interest among researchers working in the field of bone tissue engineering and orthopaedic implants. Although such intricate, porous architectures are promising as bone substitutes, they need to be thoroughly tested for structural robustness as well as their capacity for bony integration. In this present work, we introduced and preclinically evaluated the biomechanical viability of Weaire-Phelan (WP) Ti-alloy scaffolds as bone replacement components. Two distinct groups of WP scaffolds, namely WPA and WPD, of varying porosities were examined for comparative assessment. Finite element (FE) analysis, computational fluid dynamics (CFD) and uniaxial compression tests were performed on 3D printed as-built scaffolds to comprehensively evaluate the structural, hemodynamic, fatigue and morphometric properties of the two groups. The mechanical performances of the WP scaffolds of 70%, 80% 90% porous group (relative density 0.3 and lower) were found to accord with the natural trabecular bone tissue. However, WPA scaffolds demonstrated slightly superior mechanical performances as compared to WPD scaffolds (22%– 63% greater compressive modulus depending on the porosity). On the other hand, WPD scaffolds showed improved hemodynamic properties thereby implying enhanced osteogenic potential. Moreover, the range of effective elastic moduli corresponding to the WP scaffolds was found to be in good agreement with that of the natural bone tissue. As such, these designs were categorized based on their suitability at different anatomical sites. The overall performance metrics of the WP scaffolds underscore its potential for improved osseointegration, structural conformities and greater capacity for customization with enhanced manufacturability. [ABSTRACT FROM AUTHOR]

Background: Bone cysts are tumor-like formations with varying fluid contents that resembled cavities. In flat bones, it is frequently asymptomatic until it is unintentionally found during imaging. Objective: This study aimed to evaluate clinical and radiological results in management of benign bone cyst by using bone marrow and bone substitute composite. Patients and methods: This study included 30 patients with benign bone cystic lesion were discovered accidentally or come with pathological fracture who were admitted to Orthopedic department, Zagazig University Hospitals. Plain radiographs were reviewed to determine the anatomic location, presence of pathological fracture, cyst size (cyst index), postoperative osseous healing, and the presence of local recurrence. The follow up period was 2 years. Results Age was distributed as 17.64±6.3 and males represented 66.6%. Unicameral bone cyst was 50% then aneuresmal bone cyst. The majority site was tibia with (53%). All patients were without nail except one case only fixed with nail. Only 3 cases had complication with 10% (one case with delay healing, one case with infection and one case with nonunion). Regarding progress distribution; the majority of patients were good (96.7%). There was no significant association except between complication and bad progress there was significant association between them. Conclusion: Bone marrow and bone replacement composite management of bone cysts is a useful technique with numerous benefits as a reconstructive and reparative therapy. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: Hydroxyapatite (HA) is a material with excellent bioactivity and chemical similarity to bone. It can be extracted from natural sources or fabricated synthetic sources. Objective: To synthesize HA from domestic chicken eggshells and to characterize it using Fourier transform infrared (FTIR), X-ray powder diffraction (XRD), scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy, and cell viability. Materials and Methods: Domestic chicken eggshells (Indian breed "Aseel") were used to synthesize HA through the chemical precipitation method. The processing was conducted at an elevated temperature (900°C). Characterization of the sample was performed using, FTIR, SEM, EDS, and XRD. The cell viability was tested in vitro using methyl thiazolyl tetrazolium assay. Results: Phosphate and calcium ions were confirmed by FTIR and EDS. The carbonate peaks observed were typical of biological apatite. XRD revealed its crystalline property. SEM analysis confirmed the particle size to be less than 100 μm and the presence of a porous structure. The material was found to be noncytotoxic and favored cell growth. Conclusion: The synthesized HA showed a crystalline nature and had good cell viability. Hence, it may be considered as a material for various biomedical applications. [ABSTRACT FROM AUTHOR]

Alveolar ridge resorption following tooth extraction poses significant challenges for future dental restorations. This study investigated the efficacy of fish scale–derived hydroxyapatite (FSHA) as a socket preservation graft material to maintain alveolar bone volume and architecture. FSHA was extracted from *Labeo rohita* fish scales and characterized using Fourier transform infrared (FTIR) analysis. In vitro, biocompatibility and osteogenic potential were assessed using Saos‐2 human osteosarcoma cells. Cell viability, migration, and proliferation were evaluated using MTT and scratch assays. In vivo performance was assessed in a rat model, and FSHA was compared to a commercial xenograft (Osseograft) and ungrafted controls. Histological analysis was performed at 8‐week post‐implantation to quantify new bone formation. FTIR confirmed the purity and homogeneity of FSHA. In vitro, FSHA enhanced Saos‐2 viability, migration, and proliferation compared to controls. In vivo, FSHA demonstrated superior bone regeneration compared to Osseograft and ungrafted sites, with balanced graft resorption and new bone formation. Histological analysis revealed an active incorporation of FSHA into new bone, with minimal gaps and ongoing remodeling. Approximately 50%–60% of FSHA was resorbed by 8 weeks, closely matching the rate of new bone deposition. FSHA stimulated more bone formation in the apical socket region than in coronal areas. In conclusion, FSHA is a promising biomaterial for alveolar ridge preservation, exhibiting excellent biocompatibility, osteogenic potential, and balanced resorption. Its ability to promote robust bone regeneration highlights its potential as an effective alternative to currently used graft materials in socket preservation procedures. Synopsis: This study explores the potential of fish scale–derived hydroxyapatite (FSHA) as a novel biomaterial for alveolar ridge preservation (ARP) following tooth extraction. FSHA was extracted from Labeo rohita fish scales and characterized using Fourier transform infrared analysis. The biocompatibility and osteogenic potential of FSHA were evaluated in vitro using Saos‐2 human osteosarcoma cells, demonstrating enhanced cell viability, migration, and proliferation compared to controls. The in vivo performance of FSHA was assessed in a rat model, which was compared to a commercial xenograft (Osseograft) and ungrafted controls. Histological analysis at 8‐week post‐implantation revealed that FSHA promoted superior bone regeneration compared to the other groups, with balanced graft resorption and new bone formation. FSHA is actively incorporated into new bone, with minimal gaps and ongoing remodeling, particularly in the apical socket region. The study highlights the promise of FSHA as an effective alternative to currently used graft materials in socket preservation procedures. FSHA exhibits excellent biocompatibility, osteogenic potential, and balanced resorption. These findings support further investigation and development of FSHA for ARP and other dental bone regeneration applications. [ABSTRACT FROM AUTHOR]

Background: Talar neck fractures are complex injuries that become particularly challenging when accompanied by bone loss or comminution. This case report introduces the use of an allograft bone screw as a novel method for bridging lateral comminution at the talar neck, providing structural support and promoting bone regeneration. Methods: A 20-year-old male sustained a comminuted talar neck fracture with subtalar and tibiotalar dislocation after a bouldering fall. Urgent surgical intervention involved open reduction and internal fixation using a two-incision technique. The medial key fragment was stabilized with two conventional compression screws, revealing a significant lateral bony defect. This was bridged and stabilized with an allogeneic cortical bone screw (Shark Screw®, Surgebright GmbH, Lichtenberg, Austria), supplemented by bone replacement material. Results: At three months, CT confirmed fracture healing, and weight-bearing was initiated. At six months, the AOFAS score was 85/100 and FAAM 69/84, with no significant pain or swelling. By one year, the patient demonstrated full weight-bearing with occasional pain (AOFAS 88/100, FAAM 79/84). At two years, the patient achieved a pain-free range of motion and full activity participation (AOFAS 100/100, FAAM 83/84). Conclusions: The successful application of this technique illustrates the potential of allograft bone screws for stabilizing and bridging defects in talar neck fractures. [ABSTRACT FROM AUTHOR]

Objective: The use of extracted teeth has been introduced as an option for bone grafting. However, the current method requires special machines and solutions, posing significant time and cost. The aim of this study was to evaluate the clinical performance of autogenous raw tooth particles (RTP), a grafting material made from a ground tooth using basic equipment, for alveolar ridge preservation. Materials and Methods: Twenty‐three patients (12 study/11 control), having 14 and 13 sites were included for the study and control groups (commercially available xenograft), respectively. Radiographic measurements were taken at the baseline and the 4‐month follow‐up appointment. Furthermore, a questionnaire survey concerning the general preference of the type of graft to receive (if needed), before and after knowing the price, was distributed at the completion of the procedure for patients to answer. Results: Alveolar ridge width change was −1.03 ± 0.64 and −0.84 ± 0.35 for the study and the control groups, respectively. Regarding the height, the study group showed a buccal and lingual change of −0.66 ± 0.48 and −0.78 ± 0.81, respectively, while this was −0.78 ± 0.56 and −0.9 ± 0.41 for the xenograft group. There was no statistically significant difference between the groups. Patients preferred the raw tooth particles over other grafting materials (p =.01). Conclusion: No core biopsies were taken to evaluate bone formation, which should be done in future studies. Within its limitations, the current study demonstrated that RTP graft could be an alternative graft for bone augmentation, offering a new cost‐effective option for clinicians when available. [ABSTRACT FROM AUTHOR]

Hydroxyapatite (HAp) is widely recognized for its application in medical implants, specifically as a bone substitute due to its biocompatibility. This study explores the synthesis of HAp using calcium oxide sourced from calcined eggshell waste treated with acetic acid. The focus is on evaluating the impact of varying concentrations of diammonium hydrogen phosphate ((NH4)2HPO4) and urea (CH4N2O) on the characteristics of carbonate-substituted hydroxyapatite. Calcining the eggshell waste at 900℃ produced calcium oxide with a high yield of 89.3 wt.% CaO. This CaO was subsequently utilized in reactions with (NH4)2HPO4 and urea to produce HAp. The introduction of (NH4)2HPO4 not only contributed to the phosphate content but also influenced the crystalline structure and visual properties, such as brightness, of the final HAp product. Fourier-transform infrared (FTIR) analysis identified functional groups including hydroxyl (OH-), phosphate (PO43-), and carbonate (CO32-). Scanning electron microscopy (SEM) revealed that the synthesized HAp exhibited a granular morphology with particles ranging in size from 111.7 to 189.8 nm. The study determined a calcium-to-phosphorus (Ca/P) ratio of 1.59, demonstrating the feasibility of using eggshell waste as a sustainable source for high-quality HAp production. [ABSTRACT FROM AUTHOR]

Introduction: In cases of atrophy in the maxillary posterior region, characterized by reduced vertical bone volume, implant placement becomes challenging. Augmentation procedures like sinus lifts are often needed to address insufficient bone volume. This study aims to explore if alveolar ridge preservation, using a bovine bone substitute and a porcine collagen membrane, significantly decreases the need for sinus lifts compared to natural wound healing after tooth extraction. Materials and methods: In this comparative clinical study, 40 patients requiring a total of 53 extractions were assigned to one of the following groups: a test group with bovine bone substitute material (Straumann® XenoFlex) and a porcine collagen membrane (Jason® membrane), or a control group with spontaneous socket healing. After 6 months, digital volume tomography was performed for implant planning. Results: For seven patients from the control group (n = 22 extracted sites) sinus lift augmentations were performed while only four sinus lift procedures were performed in the test group (n = 31 extracted sites), indicating a higher need for sinus augmentation procedures in the control group, however not statistically different on a p value of 0.05 (p = 0.168). In the control group, the mean value of the radiographically measured bone height (mesial and distal) was 11.13 ± 2.12 mm preoperatively before tooth extraction, while it was 11.3 ± 2.17 mm postoperatively after implant placement. In contrast, the mean value in the test group was 11.78 ± 3.09 mm preoperatively and 11.92 ± 2.79 mm postoperatively. Statistical analysis revealed no significant difference between the two groups (odds ratio 0.32; 95% CI: 0.08, 1.26; p = 0.951). The implant survival rate in the control group was 100%, compared to 96.77% in the test group. Conclusion: Within the limits of this study, the use of bovine bone substitute and a porcine resorbable membrane after tooth extraction in the posterior maxilla seems to reduce the need for sinus augmentation in comparison to spontaneous healing although the difference was not statistically significant. Additionally, the Alveolar Ridge Preservation in the test group made external sinus floor elevation unnecessary compared to the control group. The change in radiographically measured bone height pre‐ and postoperatively showed no significant difference between the two groups. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the efficacy of guided bone regeneration (GBR) for the treatment of peri‐implant dehiscence defects using a synthetic bone substitute (SBS) or a deproteinized bovine bone mineral (DBBM) as a bone substitute. Methods: Patients with expected dehiscence defects following implant placement were randomized to use either SBS or DBBM together with a bioabsorbable collagen membrane over dehiscenced implant surfaces aimed for GBR. The changes in the bone defect size were measured before the GBR procedure and 6 months after implant placement at the re‐entry surgery. Secondary outcomes included peri‐implant health outcomes, implant cumulative survival rates, bone level changes, and patient‐reported outcomes (PROMs) at prosthesis delivery and 1‐year follow‐up. Results: Of the 49 included patients, 24 were treated with SBS and 25 with DBBM. In the SBS group, the defect height (DH) at implant insertion was 5.1 ± 2.6 mm and was reduced at re‐entry to 1.3 ± 2.0 mm (74.5%). In the DBBM group, the respective changes in DH were 4.1 ± 1.7 mm and 1.5 ± 1.9 mm (63.4%). These differences were not statistically significant (p = 0.216). The complete defect resolution rate was also comparable in both groups without statistical difference (62.5% of patients (15/24) vs. 44% of patients (11/25)). Overall, the marginal bone levels remained stable during the 1‐year follow‐up in both groups. Conclusion: The SBS is noninferior to DBBM for simultaneous GBR to implant placement at implant sites with buccal dehiscences in terms of defect resolution and evaluated secondary outcomes (KCT0008393 − this clinical trial was not registered before participant recruitment and randomization). [ABSTRACT FROM AUTHOR]

Good bioactivity and tunable mechanical properties of akermanite (Ca2MgSi2O7), as compared to calcium phosphate materials, have garnered increasing attention as a potential bone substitute material. Typically, these Ca-Mg-Si bioceramics are synthesised using commercially available chemicals. In this study, we aimed to transform clinical dental mould waste (DMW) into an alternative calcium source used in synthesising akermanite ceramics. The DMW were initially refined involving alkaline roasting and caustic leaching, resulting in high purity Ca(OH)2 powder. This Ca(OH)2 powder was then mixed with MgO and SiO2 in stoichiometric proportion and subsequently subjected to planetary ball milling, pressed into pellets and sintered at 1200–1250 °C, forming the desired akermanite ceramics. Two calcium sources were investigated: Ca(OH)2 refined from DMW and chemically available CaO. Comparative analyses between Akr-Ca(OH)2 and Akr-CaO confirmed that both types of akermanite ceramics exhibited akermanite as the major phase with a minor phase of diopside. Regardless of the calcium source used, the physical and mechanical properties of the akermanite produced improved with increasing sintering temperature. However, Akr-Ca(OH)2 possess relatively lower mechanical properties than Akr-CaO. These intriguing findings underscored the potential for utilising calcium derived from DMW in producing akermanite ceramics with acceptable mechanical properties. Utilising this sustainable approach to create akermanite ceramics for bone substitutes may indirectly alleviate environmental pollution. This is because dental mould waste (DMW), which contains small amounts of chromium that can leach out and harm soil quality when discarded into landfills, is minimised. Furthermore, this innovative method shows potential for providing an affordable bone substitute option for patients in need. [ABSTRACT FROM AUTHOR]

Bone defects and fractures present significant clinical challenges, particularly in orthopedic and maxillofacial applications. While minor bone defects may be capable of healing naturally, those of a critical size necessitate intervention through the use of implants or grafts. The utilization of traditional methodologies, encompassing autografts and allografts, is constrained by several factors. These include the potential for donor site morbidity, the restricted availability of suitable donors, and the possibility of immune rejection. This has prompted extensive research in the field of bone tissue engineering to develop advanced synthetic and bio-derived materials that can support bone regeneration. The optimal bone substitute must achieve a balance between biocompatibility, bioresorbability, osteoconductivity, and osteoinductivity while simultaneously providing mechanical support during the healing process. Recent innovations include the utilization of three-dimensional printing, nanotechnology, and bioactive coatings to create scaffolds that mimic the structure of natural bone and enhance cell proliferation and differentiation. Notwithstanding the advancements above, challenges remain in optimizing the controlled release of growth factors and adapting materials to various clinical contexts. This review provides a comprehensive overview of the current advancements in bone substitute materials, focusing on their biological mechanisms, design considerations, and clinical applications. It explores the role of emerging technologies, such as additive manufacturing and stem cell-based therapies, in advancing the field. Future research highlights the need for multidisciplinary collaboration and rigorous testing to develop advanced bone graft substitutes, improving outcomes and quality of life for patients with complex defects. [ABSTRACT FROM AUTHOR]

Extensive research efforts have been focused on customizing the microstructure, macrostructure, and phase composition of calcium phosphate for enhanced biocompatibility and bioactivity in scaffolds for bone substitutes. Despite significant progress, achieving precise phase composition and microstructure remains a challenge, primarily due to the necessity of scaffold sintering. This study addresses the challenges in developing customized patient‐specific bone substitutes by proposing a sequential approach that reduces processing steps while providing control over the phase and morphology of the scaffolds' structure. The methodology utilizes freeze‐casting and sintering for highly porous the scaffolds' preparation, followed by hydrothermal treatment to modify the microstructure. The introduction of CaCO3 induces a phase transformation of tricalcium phosphate, increasing the hydroxyapatite content, while the overall macrostructure retains the characteristics of freeze‐casting. The surface morphology undergoes a transition from equiaxial grains to whiskers‐like structures and hexagonal rods, impacting compressive strength. Following hydrothermal treatment, the formation of whiskers‐like hydroxyapatite grains leads to a notable strength increase from 2.8 to 5.7 MPa. Remarkably, the scaffolds undergo nearly complete phase transformation, shifting from 100% tricalcium phosphate to 99% hydroxyapatite, all while conserving the macrostructure. [ABSTRACT FROM AUTHOR]

A postoperative maxillary cyst (POMC) is a delayed complication of the original Caldwell-Luc operation, which was once widely performed to treat chronic rhinosinusitis. Two patients who had previously undergone Caldwell-Luc operations desired dental implant treatment. In both cases, preoperative cone-beam computerized tomography (CBCT) revealed a POMC occupying the entire maxillary sinus on the side where the implants were to be placed. The residual bone height was 3–4 mm. Furthermore, the sinuses were divided into compartments by septum-like structures. An intraoral approach was applied for POMC enucleation and implant placement. The implants were placed with sinus floor penetration due to the small residual bone height. No bone substitute material was grafted in the sinus. Postoperative healing was uneventful. All implants were successfully osseointegrated and performed well (4 and 5 years for each patient). No sinonasal complications were reported. Follow-up CBCTs showed that the exposed implant parts were covered by newly formed bone. The intraoral approach is a feasible option for implant placement in a pneumatized maxillary sinus with POMC. [ABSTRACT FROM AUTHOR]

Modern dentistry is turning towards natural sources to overcome the immunological, toxicological, aesthetic, and durability drawbacks of synthetic materials. Among the first biomaterials used as endosseous dental implants, mollusk shells also display unique features, such as high mechanical strength, superior toughness, hierarchical architecture, and layered, microporous structure. This review focusses on hydroxyapatite—a bioactive, osteoconductive, calcium-based material crucial for bone healing and regeneration. Mollusk-derived hydroxyapatite is widely available, cost-effective, sustainable, and a low-impact biomaterial. Thermal treatment coupled with wet chemical precipitation and hydrothermal synthesis are the most common methods used for its recovery since they provide efficiency, scalability, and the ability to produce highly crystalline and pure resulting materials. Several factors, such as temperature, pH, and sintering parameters, modulate the size, purity, and crystallinity of the final product. Experimental and clinical data support that mollusk shell-derived hydroxyapatite and its carbonated derivatives, especially their nanocrystaline forms, display notable bioactivity, osteoconductivity, and osteoinductivity without causing adverse immune reactions. These biomaterials are therefore highly relevant for specific dental applications, such as bone graft substitutes or dental implant coatings. However, continued research and clinical validation is needed to optimize the synthesis of mollusk shell-derived hydroxyapatite and determine its applicability to regenerative dentistry and beyond. [ABSTRACT FROM AUTHOR]

Simple Summary: This study aimed to establish reference data on tooth root length and post-extraction alveolar volume for mature maxillary and mandibular incisors and canines in dogs. We determined the mean length and volume of these teeth in dogs in the weight ranges of 1–5 kg, 5–10 kg, 10–20 kg, and over 20 kg. The obtained values given showed a correlation between tooth length and alveolar volume in a specific weight range. The data obtained in the study can serve as reference values for tooth crown length and alveolar volume, allowing operators to plan a specific volume of bone substitute material for filling post-extraction alveoli. Filling post-extraction alveoli with hydroxyapatite-based materials is becoming an increasingly common procedure in veterinary dentistry. In dogs, tooth roots vary in structure depending on the weight of the dog, but data on tooth length and volume have not yet been described. This study aimed to establish reference data on tooth root length and post-extraction alveolar volume for mature maxillary and mandibular incisors and canines in dogs. We determined the mean length and volume of these teeth in dogs in the weight ranges of 1–5 kg, 5–10 kg, 10–20 kg, and over 20 kg. The obtained values given showed a correlation between tooth length and alveolar volume in a specific weight range. A review of the commercially available hydroxyapatite-based bone substitute materials was then conducted. A table is presented which shows how to calculate the volume of bone substitute material required to fill a post-extraction alveolus with a given material. Statistics were used to assess significant differences between the mass of the bone substitute product used (μL) for specific weight ranges and to demonstrate the correlation between tooth length and alveolar volume for a specific weight range. The data obtained in this study can serve as reference values for tooth crown length and alveolar volume, allowing operators to plan a specific volume of bone substitute material for filling post-extraction alveoli. This research is interesting because it shows that the weight of an animal is an important aspect in planning the amount of bone substitute material for tooth extraction. In clinical work, it is much easier to weigh an animal than it is to make calculations based on the length of the tooth root. [ABSTRACT FROM AUTHOR]

This study investigated the effect of platelet-rich fibrin (PRF) on bone healing around implants placed in elevated sinus cavities. Forty New Zealand albino rabbits were divided into eight groups, based on the time of sacrifice (14 or 40 days) and the material used: blood clot (control), hydroxyapatite (HA) from bovine bone, HA combined with PRF, and PRF alone. Each group consisted of five animals (n = 5). A histological analysis measured bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO). The results showed significant increases in the BIC and BAFO values at 40 days compared to 14 days in most groups. At day 14, the HA+PRF group had higher BIC than the clot and the PRF alone groups. At 40 days, HA+PRF maintained the highest BIC across all groups (p < 0.05), though it did not show an advantage for BAFO. These findings indicate that combining HA with PRF promotes better osseointegration around implants placed immediately in maxillary sinus augmentation. Given the limited research on PRF's biological impact, these results underscore the importance of evaluating PRF's role in peri-implant healing and its potential benefits for clinical use in sinus augmentation. [ABSTRACT FROM AUTHOR]

Featured Application: This study provides an innovative approach to prevent the migration of carbonate apatite (CAp) granules during implantation. The proposed method combines the setting properties of calcium sulfate hemihydrate (CSH) with CAp granules, enabling their use as a stable, porous scaffold for bone regeneration. Granular bone substitutes are commonly used in dental treatments owing to their adaptability to irregular bone defects. However, granule migration during and after implantation poses a significant challenge, impairing bone regeneration. This study addresses this issue by setting carbonate apatite (CAp) granules using crystal interlocking owing to the bassanite (calcium sulfate hemihydrate (CSH))-to-gypsum (calcium sulfate dihydrate (CSD)) transformation on the granule surface. CAp granules were mixed with CSH slurry (water/CSH ratio of 0.4) at varying CSH/CAp ratios of 0.33, 0.43, 0.54, 0.67, and 0.82. At all of these mixing ratios, needle-shaped CSD crystals formed on the CAp granule surface, and the CSD crystals interlocked with each other; consequently, CAp granules were set. As the CSH/CAp ratio increased from 0.33 to 0.82, the CSD crystal length increased from 6.58 to 6.79 μm, while the setting time decreased from 30.3 to 15.5 min. Although the porosity of the set CAp granules decreased with an increase in the CSH/CAp ratio, the set granules maintained intergranular spaces of 77.3 μm at a CSH/CAp ratio of 0.82 conducive to cellular infiltration. After immersion in saline for six days, the set CAp granules at a CSH/CAp ratio of 0.82 maintained their original shape, demonstrating enhanced stability compared to lower CSH/CAp ratios where partial or complete collapse occurred. The porosity and specific surface area increased to 59.9% and 3.66 m2/g, respectively, and the intergranular spaces increased to 176.4 μm. Therefore, mixing the CAp granules with CSH at a ratio of 0.82 may prevent granule migration during and after implantation. Moreover, the CSD component of the granules is likely to resorb more rapidly than the CAp component in vivo, promoting porosity in the set granules and facilitating efficient bone replacement. [ABSTRACT FROM AUTHOR]

In connection with the increase in the number and severity of various types of bone tissue injuries received as a result of wounds during military operations in Ukraine, an important issue in orthopedics and traumatology is making informed decisions about the possibility of restoring the integrity and functions of bone tissue when using different types of composition, porosity and strength of apatite-biopolymer composites. The scientific direction of research is the development of principles and methods for making scientifically based decisions in the design and additive manufacturing of bone substitutes based on apatite-biopolymer composites with functional properties depending on the nature of the localization of the cavity bone defect and its size. A set of methods for analyzing images of bone tissue, taking into account its spatial structure, which are obtained by sensors of different physical nature, with the use of neural network models, development of methods of their design, optimization and training is proposed. The new knowledge obtained as a result of the project will become the necessary basis for making optimal decisions in practice for the introduction of the latest methods of treatment and prosthetics in trauma surgery, oncology, cranio-maxillofacial surgery, dentistry, taking into account the risks of biocompatibility of apatite-biopolymer composites. Software development of an intelligent decision support system will be used to design bone substitutes with controlled composition, structure, porosity and mechanical strength for the further selection of additive technology for its production from apatite-polymer composites, which will contribute to increasing the efficiency of treatment and prosthetics in orthopedics and traumatology. [ABSTRACT FROM AUTHOR]