Compositional and mechanical properties of growing cortical bone tissue: a study of the human fibula.

Human cortical bone contains two types of tissue: osteonal and interstitial tissue. Growing bone is not well-known in terms of its intrinsic material properties. To date, distinctions between the mechanical properties of osteonal and interstitial regions have not been investigated in juvenile bone and compared to adult bone in a combined dataset. In this work, cortical bone samples obtained from fibulae of 13 juveniles patients (4 to 18 years old) during corrective surgery and from 17 adult donors (50 to 95 years old) were analyzed. Microindentation was used to assess the mechanical properties of the extracellular matrix, quantitative microradiography was used to measure the degree of bone mineralization (DMB), and Fourier transform infrared microspectroscopy was used to evaluate the physicochemical modifications of bone composition (organic versus mineral matrix). Juvenile and adult osteonal and interstitial regions were analyzed for DMB, crystallinity, mineral to organic matrix ratio, mineral maturity, collagen maturity, carbonation, indentation modulus, indicators of yield strain and tissue ductility using a mixed model. We found that the intrinsic properties of the juvenile bone were not all inferior to those of the adult bone. Mechanical properties were also differently explained in juvenile and adult groups. The study shows that different intrinsic properties should be used in case of juvenile bone investigation.

Three-dimensional reconstruction of Haversian systems in human cortical bone using synchrotron radiation-based micro-CT: morphology and quantification of branching and transverse connections across age.

This study uses synchrotron radiation-based micro-computed tomography (CT) scans to reconstruct three-dimensional networks of Haversian systems in human cortical bone in order to observe and analyse interconnectivity of Haversian systems and the development of total Haversian networks across different ages. A better knowledge of how Haversian systems interact with each other is essential to improve understanding of remodeling mechanisms and bone maintenance; however, previous methodological approaches (e.g. serial sections) did not reveal enough detail to follow the specific morphology of Haversian branching, for example. Accordingly, the aim of the present study was to identify the morphological diversity of branching patterns and transverse connections, and to understand how they change with age. Two types of branching morphologies were identified: lateral branching, resulting in small osteon branches bifurcating off of larger Haversian canals; and dichotomous branching, the formation of two new osteonal branches from one. The reconstructions in this study also suggest that Haversian systems frequently target previously existing systems as a path for their course, resulting in a cross-sectional morphology frequently referred to as 'type II osteons'. Transverse connections were diverse in their course from linear to oblique to curvy. Quantitative assessment of age-related trends indicates that while in younger human individuals transverse connections were most common, in older individuals more evidence of connections resulting from Haversian systems growing inside previously existing systems was found. Despite these changes in morphological characteristics, a relatively constant degree of overall interconnectivity is maintained throughout life. Altogether, the present study reveals important details about Haversian systems and their relation to each other that can be used towards a better understanding of cortical bone remodeling as well as a more accurate interpretation of morphological variants of osteons in cross-sectional microscopy. Permitting visibility of reversal lines, synchrotron radiation-based micro-CT is a valuable tool for the reconstruction of Haversian systems, and future analyses have the potential to further improve understanding of various important aspects of bone growth, maintenance and health.

Nonvascular transport distraction osteogenesis in bone formation and regeneration. Is it an accidental phenomenon?

PURPOSE: To explore the osteogenic mechanism of nonvascular transport distraction osteogenesis (NTDO) by constructing mandibular defects in dogs. METHODS: Sixty adult dogs were randomly divided into three groups with 20 dogs in each group. Canine mandibular defect models of NTDO were constructed. Animals were euthanized 1, 4 and 12 weeks after distraction, and the transport disc and surrounding tissue were collected and fixed. Histochemical staining using hematoxylin and eosin (H&E) and electron microscopic observations were used to examine bone regeneration. RESULTS: Distraction bone regeneration was observed in the distraction gap and around the transport disc, and osseous connections had formed between new bone and the transport disc after one week. Osteoclasts gathered around the transport disc, and bone absorption pit formation could be seen. After 4 weeks of distraction, the new bone around the transport disc was close to maturity with thick sclerostin on the middle of the transport disc. After 12 weeks the new bone and the transport disc were fully integrated, and were difficult to distinguish by H&E staining and electron microscopy. CONCLUSIONS: Canine mandibular defects were successfully repaired by NTDO resulting in ideal new bone formation and fully recovered mandibular physiological function. The surrounding tissues, including musculoskeletal tissues, the periosteum and other soft tissues and the nonvascular transport disc, together contribute to bone regeneration and neovascularization in NTDO.

Chemical etching in processing cortical bone specimens for scanning electron microscopy.

Transverse and longitudinal sectioning of undecalcified cortical bone is a commonly employed technique for investigating the lamellar structure of the osteons. Since a flat surface is required, the specimen has to be grinded and then polished. Whereas the smear of debris and inorganic/organic deposits left by these treatments cannot be removed by ultrasonication alone, a chemical treatment of the specimen surface with either a basic or an acid etching solution is currently employed. A further effect of the latter can be the enhancement of the lamellar bone pattern. The kind of etching solution, its pH, the concentration of etchants, and the contact time significantly affect the sectioned surface when it is observed with scanning electron microscopy (SEM). The etching procedures can severely influence the obtained images. Homogeneous cortical bone specimens were sampled from the first metatarsal of two fresh human subjects. One or two cut surfaces were exposed to different acid and basic solutions in bonded conditions. Considering the type of chemical agents, the solution pH, and the exposure time of the specimens, the effects of several etching media have been investigated and compared. Strong etching, either acid or basic produced surface decalcification and severe damage of the collagen matrix, compromising any morphological or morphometric analysis. Weak acid etching (for example citric and acetic acid), even though causing distinctive alteration of the sample, enhanced the visibility of the lamellar pattern, while the polyphosphate treatment of the surface decalcified a thin layer matrix, ensuring a good visibility of fibrils and avoiding rough distortions.

Bone repair of critical size defects treated with mussel powder associated or not with bovine bone graft: histologic and histomorphometric study in rat calvaria.

The objective of this study was to evaluate the bone repair of critical size defects treated with mussel powder with or without additional bovine bone. Critical size defects of 5 mm were realized in the calvaria of 70 rats, which were randomly divided in 5 groups - Control (C), Autogenous Bone (AB), Mussel Powder (MP), Mussel Powder and Bovine Bone (MP-BB) and Bovine Bone (BB). Histological and histomorphometric analysis were performed 30 and 90 days after the surgical procedures (ANOVA e Tukey p < 0.05). After 30 days, the measures of remaining particles were: 28.36% (MP-BB), 26.63% (BB) and 8.64% (MP) with a statistically significant difference between BB and MP. The percentage of osseous matrix after 30 days was, AB (55.17%), 23.31% (BB), 11.66% (MP) and 10.71% (MP-BB) with statistically significant differences among all groups. After 90 days the figures were 25.05% (BB), 21.53% (MP-BB) and 1.97% (MP) with statistically significant differences between MP-BB and MP. Percentages of new bone formation after 90 days were 89.47% (AB), 35.70% (BB), 26.48% (MP-BB) and 7.37% (MP) with statistically significant differences between AB and the other groups. Within the limits of this study, we conclude that mussel powder, with or without additional bovine bone, did not induce new bone formation and did not repair critical size defects in rat calvaria.

Alterations in the osteocyte lacunar-canalicular microenvironment due to estrogen deficiency.

While reduced estrogen levels have been shown to increase bone turnover and induce bone loss, there has been little analysis of the effects of diminished estrogen levels on the lacunar-canalicular porosity that houses the osteocytes. Alterations in the osteocyte lacunar-canalicular microenvironment may affect the osteocyte's ability to sense and translate mechanical signals, possibly contributing to bone degradation during osteoporosis. To investigate whether reduced estrogen levels affect the osteocyte microenvironment, this study used high-resolution microscopy techniques to assess the lacunar-canalicular microstructure in the rat ovariectomy (OVX) model of postmenopausal osteoporosis. Confocal microscopy analyses indicated that OVX rats had a larger effective lacunar-canalicular porosity surrounding osteocytes in both cortical and cancellous bone from the proximal tibial metaphysis, with little change in cortical bone from the diaphysis or cancellous bone from the epiphysis. The increase in the effective lacunar-canalicular porosity in the tibial metaphysis was not due to changes in osteocyte lacunar density, lacunar size, or the number of canaliculi per lacuna. Instead, the effective canalicular size measured using a small molecular weight tracer was larger in OVX rats compared to controls. Further analysis using scanning and transmission electron microscopy demonstrated that the larger effective canalicular size in the estrogen-deficient state was due to nanostructural matrix-mineral level differences like loose collagen surrounding osteocyte canaliculi. These matrix-mineral differences were also found in osteocyte lacunae in OVX, but the small surface changes did not significantly increase the effective lacunar size. The alterations in the lacunar-canalicular surface mineral or matrix environment appear to make OVX bone tissue more permeable to small molecules, potentially altering interstitial fluid flow around osteocytes during mechanical loading.

Histological comparison of long-bone cortex between 11-year-old giant cow with dermal dysplasia and the child cow aged 8.5 years.

Young calves are known to be formed with laminar bone in long-bone cortex during growing periods and the osteon formation begins later. Previously, we reported that an 11-year-old giant Holstein cow with dermal dysplasia showed a delayed osteon formation. An 8.5-year-old cow, born from the giant Holstein cow, also showed some dermal dysplasia and the outer-half layer of the child almost retained laminar bone similar to that of the mother, although the body weight was approximately normal. The mother had formed the inner circumferential lamella and the child was going to form the inner circumferential lamella, but their outer circumferential lamellas were not formed yet in both of them, when compared with a 12-years-old cow as a control of the mother. Therefore, we suggest on long-bone formation pattern that the child resembled the mother rather than the control, and that the child had more or less succeeded to the mother genes of delayed osteon formation as well as dermal dysplasia which seemed to be genetic collagen disorder, although there were mild gene appearances.

Ultrastructural cell response to tension stress during mandibular distraction osteogenesis.

The response of cells in the distraction gap during mandibular distraction osteogenesis was recorded by transmission electronic microscopy. We distracted the mandible on both sides in eight adult goats. Two animals were killed at 8, 16, 32, and 48 days, respectively, after activation of the device. The specimens were harvested and processed for histological and ultrastructural examination. The results showed that the cells and newly-formed extracellular matrix (ECM) were aligned with the tension vector. In the early stage of distraction osteogenesis, cells in the distraction gap were of the active proliferative phenotype. They then differentiated into fibroblast-like cells and osteoblasts, showing ultrastructural characteristics of the active synthetic and secretory phenotypes. Newly-formed collagen, bone canaliculi, and mineralisation of the ECM were clearly evident during distraction osteogenesis. Our results show that at the ultrastructural level cell proliferation is activated by tension and stress during the early stages, and synthetic and secretory function stimulated during the later stages of mandibular distraction osteogenesis.

Microscopic evaluation of mandibular symphyseal distraction osteogenesis.

The purpose of this study was to evaluate microscopically the newly formed hard tissue after a consolidation period of mandibular symphyseal distraction osteogenesis (MSDO). Sixteen patients underwent MSDO treatment. After a latency period of seven days, the distraction device was activated by the patient once in the morning and once in the evening, for a total of one mm per day for a mean 10.1 +/- 2.8 days, and the mean opening of the device was 8.1 +/- 1.7 mm. The device was usually maintained in position approximately 90 days after surgery. After the completion of the distraction period, the lower anterior teeth were bonded and tooth movement into the distraction site was initiated. After a consolidation period, second surgery was performed to remove the distraction devices. During the second surgery, hard tissue biopsies were taken on the apical region of the two central incisors and the left canine. The samples were fixed in 10% buffered formalin and decalcified in 3% HNO(3) solutions. New bone formation was present within the distraction gap immediately after the consolidation period. The cellular construction was more irregular in the distraction sections than in the normal bone sections. The newly distracted area was not complete immediately after the consolidation period. Furthermore, the newly formed bone had a membranous structure, which indicates continual maturation. Bone exposed to stretching forces undergoes new bone formation, and the newly formed bone is of a membranous type also named as a woven type.

The TEM characterization of the lamellar structure of osteoporotic human trabecular bone.

The lamellar structure of osteoporotic human trabecular bone was characterized experimentally by means of transmission electron microscopy (TEM). More specifically, the TEM was used to determine if trabecular bone exhibits similar lamellar structural motifs as cortical bone by analyzing unmineralized, mineralized and demineralized bone, and to study the influence of the osteocyte network on the lamellar structure of osteoporotic trabecular bone. Comparison with normal trabecular bone is included. This paper summarizes partial results of a larger study, which addressed the characterization of the hierarchical structure of normal versus osteoporotic human trabecular bone [Rubin, M.A., 2001. Multiscale characterization of the ultrastructure of trabecular bone in osteoporotic and normal humans and in two inbred strains of mice. MS Thesis, Georgia Institute of Technology.] at several structural scales.

Biological fixation of endosseous implants.

Primary implant stability is ensured by a mechanical fixation of implants. However, during implant healing a biological anchorage is necessary to achieve final osseointegration. Aim of this study was to investigate the histological aspects of biological fixation around titanium screws. Forty-eight titanium screws with different surfaces (smooth, plasma sprayed, sand blasted) were inserted in tibiae and femura of sheep and analyzed by light microscope and SEM 1 hour, 14 and 90 days after implantation. One hour after implantation the implant-bone gap was filled with a blood clot and host bone chips arising from burr surgical preparation or friction during implant insertion. Fourteen days after implantation new trabecular bone and enveloped bone chips were observed in the gap: no osteogenesis developed where implant threads were in contact with host bone. Ninety days after surgery all trabecular bone and most of the bone chips were substituted by a mature lamellar bone with few marrow spaces. Our results suggest that the trabecular bone and bone chips represent a three-dimensional network ensuring a biological implant fixation in all different implant surfaces 2 weeks after surgery. Host bone chips could favour the peri-implant osteogenesis. Inter-trabecular and implant-trabecular marrow spaces of both trabecular and lamellar bone may favour the peri-implant bone turnover.

Some considerations on biomaterials and bone.

Osteoinduction is a property not traditionally attributed to Calcium Phosphate ceramics. Histologic, SEM and X-ray microanalyses of a biopsy of pulmonary alveolar microlithiasis allow to discredit this opinion. Bone, even lamellar type, was ectopically formed on microliths undergoing osteoclastic erosion. The SEM and X-ray microanalyses of coral granules implanted in humans indicate an osteoconductive property for both Calcium and Phosphorus. Analysis of in vitro allows to propose an enhancement of the osteocapability of coral. Lamellar bone formation in the near absence of loads undermines the opinion which sees a correlation between lamellar bone and mechanical loads. Analysis of the bone surrounding an uncemented titanium hip prosthesis highlights that both remodeled and newly formed bone have lamellae oriented parallel to prosthesis surfaces, i.e. orthogonal to loads, as opposed to that of lamellar bone of osteons which are oriented parallel to loads. Analysis of longitudinal sections of cortical bone under polarized light points out that lamellae are displaced parallel to the cement line surface both in the conic end of osteons and in Volkman's canals with thick wall, i.e. undergoing sloped load directions. In conclusion, there may be a relationship between lamellae formation and gravity.

Atomic force microscopy on human trabecular bone from an old woman with osteoporotic fractures.

AFM images were taken of the exterior surface of a single trabecula, extracted from a human femoral head removed during surgery for a hip fracture in an old women with former fractures. The images showed a dense structure of bundled collagen fibrils banded with 67 nm periodicity. Bundles were seen to run in parallel in layers confirming the collagen structure seen by other techniques. Single collagen fibrils were seen to cross the bundles, thus forming cross-links between neighboring bundles of collagen fibrils. Some of these crossing fibrils did not have the 67 nm band pattern and their dimensions were about half compared to the neighboring collagen fibrils. Very little mineral was found on the surface of the trabecula. An AFM image of a fracture plane was also displayed. The trabecula was extracted from a region close to the hip fracture. However, there were in this case no obvious features in the images that could be linked directly to osteoporosis, but altered collagen banding and collagen protrusions may alter mechanical competence. A path to extensive studies of the nanometer scale structure of bone was demonstrated.

Histologic evaluation of immediate versus delayed placement of implants after tooth extraction.

OBJECTIVE: Full osseointegration is necessary to achieve long-term success of dental implants. We aimed to find out the relative merits of immediate and delayed insertion of implants after dental extraction. STUDY DESIGN: We completed a histologic and histomorphometric examination of the tissue adjacent to delayed and immediate implants in 8 beagle dogs. In 4 dogs, implants were inserted immediately after the extraction of second premolars; in the remaining 4, the implants were inserted 6 months after the extraction. Fluorochrome bone markers were injected on 2 occasions before the dogs were killed 8 months after the implants had been inserted. Each implant and its surrounding tissue was examined macroscopically and microscopically. Both histologic dynamic and histologic static histomorphometry were used in this analysis. Statistical significance was tested by using the Student t test for paired and unpaired observations, the Dunnett t test, and Fisher's least significant difference method for multiple comparisons. RESULTS: The implants placed immediately had 76% of their surface covered with bone, whereas the implants placed after bony healing had 81% of their surface covered with bone. The fibrous tissue at the cervical end of the implant was more dense; the delayed implants also had a greater number of adhesive epithelial elements (hemidesmosomes). Use of dynamic and static histomorphometry revealed no significant differences between the 2 groups. CONCLUSION: We found new soft and hard tissue around dental implants 8 months after their insertion in both groups. Pseudoankylotic healing was seen in the osseous part. The lower level of osseointegration in the immediately placed implants was attributable to the early resorption of bone in the crestal part, resulting in a larger part of the implant being surrounded by soft tissue.

Analysis of the osseous/metal interface of drill free screws and self-tapping screws.

AIM: A comparison of metal/osseous interface and bone remodelling after insertion of different types of titanium bone screws in vivo. MATERIAL: Samples of five of each of the following bone screw types were inserted into the anterior wall of the frontal sinus of five Göttingen minipigs: self-tapping micro- (1.5mm) and miniscrews (2.0 mm) or drill free micro- (1.5 mm) and miniscrews (2.0 mm) (Martin Medizintechnik, Tuttlingen, Germany). Screw length was 7mm. METHODS: Sequential intraperitoneal injections of fluorochromes were performed between the second and ninth postoperative week. After 6 months the pigs were sacrificed, the screw-bone-blocks resected, and microradiographic, histological and fluorescence microscopical examinations were carried out. RESULTS: Using drill free screws, mean screw/bone contact was 88.4% (miniscrews), or 93.8% (microscrews). With self-tapping miniscrews it was 54.9%, but in microscrews 81%; the differences were statistically significant (t-test: p<0.05). By fluorescence microscopy, the amount of bone remodelling (ratio of residual vs. newly formed bone) was measured. Significantly more of the residual bone was found in the region of the screw threads using drill free screws (miniscrews: mean 71.8%, microscrews: mean 67.9%) than in the region of screw threads with self-tapping screws (miniscrews: mean 33.1%, microscrews: mean 42.4%). CONCLUSION: The present data support the view that screw/bone contact with drill free screws was superior to that of self-tapping screws; the greater amount of original bone in the threads of drill free screws demonstrated that the insertion of drill free screws did not cause harm to the surrounding bone. Both results are important for osteosynthesis in regions where thin cortical bone is present, such as the central midface.

Regulatory pathways in blood-forming tissue with particular reference to gap junctional communication.

Blood formation by pluripotent stem cells and their progeny is thought to be regulated by receptor-ligand interactions between cell-substrate, cell-cell and cell-matrix in the bone marrow. Primitive stem cells form progenitors and, in their turn, these give rise to haemopoietic progeny which are more specifically committed in that they can form progressively fewer types of blood cells. Recently we have established that direct cell-cell communication via gap junctions may be part of this regulatory system. Connexin43 gap junctions metabolically couple the three dimensional meshwork of bone marrow stromal cells to form a functional syncytium in which some blood-forming cells are also coupled. The expression of gap junctions in the bone marrow is markedly upregulated when there is an urgent and substantial demand for blood-formation; for example, following cytotoxic injury after 5-fluorouracil or irradiation; or during neonatal blood-formation and in the epiphysis of growing bones. Chemical blockade of gap junctions blocks blood-formation in long-term cultures but is reversible after the blockade has been relieved. This short review highlights briefly the known regulatory mechanisms of blood-formation with especial attention to gap junctional communication.

Characteristics of bone ingrowth and interface mechanics of a new porous tantalum biomaterial.

We have studied the characteristics of bone ingrowth of a new porous tantalum biomaterial in a simple transcortical canine model using cylindrical implants 5 x 10 mm in size. The material was 75% to 80% porous by volume and had a repeating arrangement of slender interconnecting struts which formed a regular array of dodecahedron-shaped pores. We performed histological studies on two types of material, one with a smaller pore size averaging 430 microm at 4, 16 and 52 weeks and the other with a larger pore size averaging 650 microm at 2, 3, 4, 16 and 52 weeks. Mechanical push-out tests at 4 and 16 weeks were used to assess the shear strength of the bone-implant interface on implants of the smaller pore size. The extent of filling of the pores of the tantalum material with new bone increased from 13% at two weeks to between 42% and 53% at four weeks. By 16 and 52 weeks the average extent of bone ingrowth ranged from 63% to 80%. The tissue response to the small and large pore sizes was similar, with regions of contact between bone and implant increasing with time and with evidence of Haversian remodelling within the pores at later periods. Mechanical tests at four weeks indicated a minimum shear fixation strength of 18.5 MPa, substantially higher than has been obtained with other porous materials with less volumetric porosity. This porous tantalum biomaterial has desirable characteristics for bone ingrowth; further studies are warranted to ascertain its potential for clinical reconstructive orthopaedics.

Bone formation in furcation defects. An experimental study in the dog.

The aim of the present investigation was to study bone formation in an experimentally-produced furcation defect in the dog. 15 foxhound dogs (group A) and 4 large mongrel dogs (group B) were used. The 2nd and 4th mandibular premolars were extracted and the 3rd lower premolars (3P3) were assigned as experimental teeth. "Through and through" furcation defects, about 4 mm high and 3 mm wide, were first produced in the experimental teeth of the dogs in group A. Reconstructive surgery was subsequently performed in group A using a GTR technique. The dogs of group A were scheduled for biopsy 2 weeks (2 dogs), 1 month (2 dogs), 2 months (2 dogs), 4 months (3 dogs), 5 months (3 dogs) and 6 months (3 dogs) after GTR. The dogs in group B (4 animals) represented healthy, untreated pristine furcations and served as positive controls. Biopsies from the 3P3 regions were harvested, embedded in paraffin and prepared for histological analysis. Mesio-distal sections were cut with the microtome set at 7 microm. The sections were stained in hematoxylin and eosin, and Van Gieson. 3 sections, about 50 microm apart, and representing the central portion of the furcation site were selected for histological measurements. In group A, the proportions of various structures in the newly formed bone and marrow were assessed. In addition, the proportions of primary and secondary osteons, and the number of bone multicellular units (BMU)/mm2 mineralized bone tissue were determined. In the pristine furcations (group B), the histological analyses were performed in a corresponding area to that of the healing furcations. The results demonstrated that the process of bone formation in a large "suprabony" furcation defect can be divided into 3 different phases, namely, (i) the formation of a provisional connective tissue, (ii) the development of a primary bone spongiosa (including mainly woven bone), (iii) the replacement of the spongiosa by lamellar bone and bone marrow through processes of modeling and remodeling. The newly-formed trabeculae of woven bone were reinforced by the deposition of parallel-fibered bone and lamellar bone, a finding which substantiates the validity of the concept that woven bone possesses poor weight-bearing properties and, hence, needs to be re-inforced by a more mature type of bone. The modeling of the newly-formed bone resulted in the formation of (i) one large marrow space in the center of the furcation and, in addition, (ii) a smaller bone marrow space in the most coronal portion of the defect. At the end of the study (6 months), the bone marrow occupied a much larger space than in the bone tissue of pristine furcations. It was suggested that the process of modeling or remodeling of bone tissue in the furcation defect was not completed at the end of the study.

The self adapting washer for lag screw fixation of mandibular fractures: finite element analysis and preclinical evaluation.

Besides rigid fixation, lag screws have distinct advantages compared with plates in appropriate indications in mandibular fractures. However, in current lag screw systems, the relatively small area of the screw head has to transfer the tensile force which can exceed 1000 N in the symphysis, to the thin cortical bone plate. Countersinking, which is obligatory in most systems, will weaken the cortical plate. Finite element analysis (FEA) revealed that load in this situation can exceed the normal tensile strength of metal and bone. Consequently, a new washer was constructed which both increased the supporting surface and did not require countersinking. The washer is self adapting (SAW) to the cortical plate in a defined position, forming a ball and socket joint with the screw head. Using the FEA model, a ten-fold reduction in load on bone and metal was observed with the new washer. In a miniature pig mandibular symphysis fracture model, the clinical applicability and a favourable histological reaction were demonstrated, compared with conventional lag screw designs.

Long-term bone ingrowth and residual microhardness of porous block hydroxyapatite implants in humans.

PURPOSE: This study examined the ingrowth of bone into coralline, porous hydroxyapatite (HA) block (Interpore 200) over long periods after orthognathic surgery and analyzed their microhardness as a measure of the structural integrity of the ingrown bone as well as of the HA. MATERIALS AND METHODS: Twenty-five maxillary HA implants (4 to 138 months of implantation; mean, 32 months) were removed from 17 patients. These implants had been placed into the lateral maxillary wall, juxtapositioned to the maxillary sinus during orthognathic surgery, and were harvested for analysis after voluntary consent. RESULTS: Microscopic examination showed normal bone morphology in all implants; no inflammatory response was observed. Histomorphometric measurements indicated that there was significant bone ingrowth in all implants, with an overall mean of 23+/-7% bone (range, 7% to 31%), 51%+/-7% HA matrix (range, 39% to 65%), and the remainder being soft tissue or void at 26%+/-9% (range, 10% to 40%). No significant difference in microhardness values between the bone in the implant and the bone surrounding the implant was noted, indicating that the structural integrity of the porous block HA/bone aggregate had been maintained. Bone ingrowth appeared to plateau around 20 months, reaching an equilibrium in which the relative amount of osseous tissue remained constant. CONCLUSION: Based on the findings in this study, porous block HA is a viable material for long-term implantation in the maxilla during orthognathic surgery.