CLINICS

Clinics (Sao Paulo). 2017 July; 72(7): 449-453.
doi:10.6061/clinics/2017(07)10

Copyright © 2017 CLINICS

Osteointegration of porous absorbable bone substitutes: A systematic review of the literature

Maria Júlia Escanhoela Paulo , Mariana Avelino dos Santos , Bruno Cimatti , Nelson Fabrício Gava , Marcelo Riberto , Edgard Eduard Engel *

Departamento de Biomecanica, Medicina e Reabilitacao do Aparelho Locomotor, Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, Ribeirao Preto, SP, BR

*Corresponding author. E-mail: engel@fmrp.usp.br

received December 28, 2016; revised March 21, 2017; accepted May 5, 2017.

Abstract

Biomaterials’ structural characteristics and the addition of osteoinductors influence the osteointegration capacity of bone substitutes. This study aims to identify the characteristics of porous and resorbable bone substitutes that influence new bone formation. An Internet search for studies reporting new bone formation rates in bone defects filled with porous and resorbable substitutes was performed in duplicate using the PubMed, Web of Science, Scielo, and University of São Paulo Digital Library databases. Metaphyseal or calvarial bone defects 4 to 10 mm in diameter from various animal models were selected. New bone formation rates were collected from the histomorphometry or micro-CT data. The following variables were analyzed: animal model, bone region, defect diameter, follow-up time after implantation, basic substitute material, osteoinductor addition, pore size and porosity. Of 3,266 initially identified articles, 15 articles describing 32 experimental groups met the inclusion criteria. There were no differences between the groups in the experimental model characteristics, except for the follow-up time, which showed a very weak to moderate correlation with the rate of new bone formation. In terms of the biomaterial and structural characteristics, only porosity showed a significant influence on the rate of new bone formation. Higher porosity is related to higher new bone formation rates. The influence of other characteristics could not be identified, possibly due to the large variety of experimental models and methodologies used to estimate new bone formation rates. We suggest the inclusion of standard control groups in future experimental studies to compare biomaterials.

Keywords: Biomaterials, Osteointegration, Systematic Review, Bone Substitute


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