Elastin-derived scaffolding associated or not with bone morphogenetic protein (BMP) or hydroxyapatite (HA) in the repair process of metaphyseal bone defects.

Tissue engineering represents a promising alternative for reconstructive surgical procedures especially for the repair of bone defects that do not regenerate spontaneously. The present study aimed to evaluate the effects of the elastin matrix (E24/50 and E96/37) incorporated with hydroxyapatite (HA) or morphogenetic protein (BMP) on the bone repair process in the distal metaphysis of rat femur. The groups were: control group (CG), hydrolyzed elastin matrix at 50°C/24h (E24/50), E24/50 + HA (E24/50/HA), E24/50 + BMP (E24/50/BMP), hydrolyzed elastin matrix at 37°C/96h (E96/37), E96/37 + HA (E96/37/HA), E96/37 + BMP (E96/37/BMP). Macroscopic and radiographic analyses showed longitudinal integrity of the femur in all groups without fractures or bone deformities. Microtomographically, all groups demonstrated partial closure by mineralized tissue except for the E96/37/HA group with hyperdense thin bridge formation interconnecting the edges of the ruptured cortical. Histologically, there was no complete cortical recovery in any group, but partial closure with trabecular bone. In defects filled with biomaterials, no chronic inflammatory response or foreign body type was observed. The mean volume of new bone formed was statistically significant higher in the E96/37/HA and E24/50 groups (71.28 ± 4.26 and 66.40 ± 3.69, respectively) than all the others. In the confocal analysis, it was observed that all groups presented new bone markings formed during the experimental period, being less evident in the CG group. Von Kossa staining revealed intense calcium deposits distributed in all groups. Qualitative analysis of collagen fibers under polarized light showed a predominance of red-orange birefringence in the newly regenerated bone with no difference between groups. It was concluded that the E24/50 and E96/37/HA groups promoted, with greater speed, the bone repair process in the distal metaphysis of rat femur.

Complication Rates After Bone Morphogenetic Protein (BMP) Use in Orthopaedic Surgery in Children: A Concise Multicenter Retrospective Cohort Study.

BACKGROUND: The use of bone morphogenetic protein (BMP) has been associated with a number of complications in adult patients. However, this association is less established in children. The aim of this study was to evaluate the safety of BMP use in children by determining the complication rates after BMP use at multiple institutions. METHODS: In a retrospective study (2000 to 2013), the medical records of all patients who received BMP at any of the 5 institutions were reviewed. Demographic information, preoperative data, and postoperative follow-up data were collected on those patients who were under the age of 18 at the time of surgery. RESULTS: A total of 312 pediatric patients underwent surgery with BMP application during the study period. The surgical procedures consisted of 228 spinal fusions, 39 pars repairs, 33 nonunion repair, and 12 other various procedures. Overall 21% (65/312) of patients who had BMP utilized had a complication. Fifty-five percent (36/65) of patients with a complication required a revision surgery. The average follow-up was 27 months (range, 3 to 96 mo); 80% of patients had a follow-up period of >12 months. The average age at the time of surgery was 13 years (range, 1 to 17 y). Males and females were almost equally represented in the study: 143 males (46%) and 168 females (54%). Of the patients who received BMP, 9% had minor complications and 13% had major complications. Wound dehiscence without infection was the most common minor complication and occurred in 59% (16/27) of patients with minor complications. Infection and implant failures were the most frequent major complications, occurring in 38% (15/39) and 33% (13/39) of patients with major complications, respectively. Five of 312 (2%) patients had neurological injury, 3 of which were only temporary. CONCLUSIONS: This multicenter study demonstrates a relatively high rate of complications after the use of BMP in children. However, further study is needed to attribute the complications directly to the use of BMP. LEVEL OF EVIDENCE: Level IV.

[Bone morphogenetic proteins (BMP): clinical application for reconstruction of bone defects]. / Proteínas morfogenéticas óseas (BMP): aplicación clínica para reconstrucción de defectos en hueso.

Since the introduction of bone morphogenetic proteins, their use has become an invaluable ally for the treatment of bone defects. These proteins are potent growth factors, related to angiogenic and osteogenic activity. The osteoinductive capacity of recombinant bone morphogenetic protein (rhBMP) in the formation of bone and cartilage has been confirmed in in vitro studies and evaluated in clinical trials. To obtain a therapeutic effect, administration is systemic, by injection over the physiological dose. Among the disadvantages, ectopic bone formation or high morbidity in cases of spinal fusion is observed. In this review, the roles of bone morphogenetic proteins in bone repair and clinical applications are analyzed. These findings represent advances in the study of bone regeneration and application of growth factors for more predictable results.

Repair of large segmental bone defects in rabbits using BMP and FGF composite xenogeneic bone.

The objective of this study was to determine the ability of bone morphogenetic protein (BMP) and fibroblast growth factor (FGF) to repair large segmental radial bone defects in rabbits. We treated calf cancellous bones with 3 mg/L BMP (Group A), 5 µg/L FGF (Group B), or 3 mg/L BMP plus 5 µg/L FGF (Group C). A bone damage model was established using healthy radii from rabbits. The complexes were implanted in the areas of the bone defects in the radii. After successful transplantation, the rabbits underwent radiographic imaging, and bone graft specimens were detected by histopathology methods. Biomechanical indexes were also assessed in order to observe the healing status of the bone defects. Our results indicated that the repair of bone defects was significantly better in Group C compared to the other 2 groups. Therefore, we concluded that combining BMP and FGF significantly promoted bone defect repair and achieved effects that were superior to the use of BMP alone.

Utilidad de la proteína morfogenética en el tratamiento de la seudoartrosis congénita de la tibia / Utility of morphogenetic protein for the treatment of congenital pseudoarthrosis of the tibia

Objetivo: Reportar la capacidad de la proteína morfogenética de lograr la consolidación ósea en pacientes con seudoartrosis congénita de tibia. Pacientes y métodos: Se realizó en tres pacientes con diagnóstico de seudoartrosis congénita de tibia, se hizo seguimiento durante seis meses a cada uno observando la consolidación y capacidad funcional de la extremidad. Resultados: Se logró consolidación en todos los casos presentándose ésta a los tres meses y medio en promedio. Conclusiones: La proteína morfogenética tiene utilidad como coadyuvante para conseguir la regeneración y consolidación ósea en pacientes con seudoartrosis congénita de tibia.

Objective: To report the ability of bone morphogenetic protein to achieve bone healing in patients with congenital pseudoarthrosis of the tibia. Patients and methods: Three patients with a diagnosis of congenital pseudoarthrosis of the tibia were followed-up for six months. Bone healing and functional capacity of the limb were observed. Results: Bone healing occurred in all cases at a mean of three and half months of treatment. Conclusions: Morphogenetic protein is useful as an adjuvant to achieve bone regeneration and healing in patients with congenital pseudoarthrosis of the tibia.

[Utility of morphogenetic protein for the treatment of congenital pseudoarthrosis of the tibia]. / Utilidad de la proteína morfogenética en el tratamiento de la seudoartrosis congénita de la tibia.

OBJECTIVE: To report the ability of bone morphogenetic protein to achieve bone healing in patients with congenital pseudoarthrosis of the tibia. PATIENTS AND METHODS: Three patients with a diagnosis of congenital pseudoarthrosis of the tibia were followed-up for six months. Bone healing and functional capacity of the limb were observed. RESULTS: Bone healing occurred in all cases at a mean of three and half months of treatment. CONCLUSIONS: Morphogenetic protein is useful as an adjuvant to achieve bone regeneration and healing in patients with congenital pseudoarthrosis of the tibia.

Dysphagia after anterior cervical spine surgery: a systematic review of potential preventative measures.

BACKGROUND CONTEXT: Anterior cervical spine surgery is one of the most common spinal procedures performed around the world, but dysphagia is a frequent postoperative complication. Many factors have been associated with an increased risk of swallowing difficulties, including multilevel surgery, revision surgery, and female gender. PURPOSE: The objective of this study was to review and define potential preventative measures that can decrease the incidence of dysphagia after anterior cervical spine surgery. STUDY DESIGN: This was a systematic literature review. METHODS: A systematic review in the Medline database was performed. Articles related to dysphagia after anterior cervical spine surgery and potential preventative measures were included. RESULTS: Twenty articles met all inclusion and exclusion criteria. These articles reported several potential preventative measures to avoid postoperative dysphagia. Preoperative measures include performing tracheal exercises before the surgical procedure. Intraoperative measures can be summarized as avoiding a prolonged operative time and the use of recombinant human bone morphogenetic protein in routine anterior cervical spine surgery, using small and smoother cervical plates, using anchored spacers instead of plates, application of steroid before wound closure, performing arthroplasty instead of anterior cervical fusion for one-level disease, decreasing tracheal cuff pressure during medial retraction, using specific retractors, and changing the dissection plan. CONCLUSIONS: Current literature supports several preventative measures that may decrease the incidence of postoperative dysphagia. Although the evidence is limited and weak, most of these measures did not appear to increase other complications and can be easily incorporated into a surgical practice, especially in patients who are at high risk for postoperative dysphagia.

Hydrogel of polysaccharide of sugarcane molasses as carrier of bone morphogenetic protein in the reconstruction of critical bone defects in rats.

PURPOSE: To evaluate the benefit of using carriers such as the biopolymer gel (hidrogel of polysaccharide of sugarcane molasses) associated with the bone morphogenetic proteins (BMP's) in the repair of critical bone defects in calvaria of Wistar rats. METHODS: Forty-two rats were submitted to a surgical calvaria bone defects. These animals were divided into two experimental groups, positive control group and negative control group. The Group I the calvaria defect was filled up with biopolymer gel, biological membrane, BMP and lyophilized graft. The Group II was treated with biopolymer gel, BMP and lyophilized graft. And the group III (positive control group) was treated with BMP, lyophilized graft and biological membrane. In the negative control group (Group IV) a defect was made in the rat calvaria and the animals were sacrificed immediately after the surgery. The animals of experimental groups and positive control group were slaughtered after subsequent periods of 90 and 180 days. In these periods, the histological analysis and image assessment by cone bean tomographic imaging were obtained. RESULTS: There was highest bone tissue formation with statistically significant results in the groups that associated biopolymer gel and membrane (Group I), followed by the group III (BMP, lyophilized graft and biological membrane). The lower bone formation occurred in the group not using the sugarcane biopolymer gel (Group II). The radiolucent areas of the analyzes of 180 days among the groups studied were respectively, 14.98 mm(2), 26.65 mm(2) and 35.81 mm(2). CONCLUSION: The biopolymer gel showed to be an excellent bone morphogenetic protein carrier, probably by facilitating the controlled release of these proteins in the process of bone repair.

Hydrogel of polysaccharide of sugarcane molasses as carrier of bone morphogenetic protein in the reconstruction of critical bone defects in rats

PURPOSE: To evaluate the benefit of using carriers such as the biopolymer gel (hidrogel of polysaccharide of sugarcane molasses) associated with the bone morphogenetic proteins (BMP's) in the repair of critical bone defects in calvaria of Wistar rats. METHODS: Forty-two rats were submitted to a surgical calvaria bone defects. These animals were divided into two experimental groups, positive control group and negative control group. The Group I the calvaria defect was filled up with biopolymer gel, biological membrane, BMP and lyophilized graft. The Group II was treated with biopolymer gel, BMP and lyophilized graft. And the group III (positive control group) was treated with BMP, lyophilized graft and biological membrane. In the negative control group (Group IV) a defect was made in the rat calvaria and the animals were sacrificed immediately after the surgery. The animals of experimental groups and positive control group were slaughtered after subsequent periods of 90 and 180 days. In these periods, the histological analysis and image assessment by cone bean tomographic imaging were obtained. RESULTS: There was highest bone tissue formation with statistically significant results in the groups that associated biopolymer gel and membrane (Group I), followed by the group III (BMP, lyophilized graft and biological membrane). The lower bone formation occurred in the group not using the sugarcane biopolymer gel (Group II). The radiolucent areas of the analyzes of 180 days among the groups studied were respectively, 14.98 mm², 26.65 mm² and 35.81 mm². CONCLUSION: The biopolymer gel showed to be an excellent bone morphogenetic protein carrier, probably by facilitating the controlled release of these proteins in the process of bone repair.

Does LED phototherapy influence the repair of bone defects grafted with MTA, bone morphogenetic proteins, and guided bone regeneration? A description of the repair process on rodents.

This work carried out a histological analysis on bone defects grafted (MTA) treated or not with LED, BMPs, and membrane (GBR). Benefits of their isolated or combined usage on bone repair were reported, but not their association. Ninety rats were divided into ten groups and each subdivided into three. Defects on G II and I were filled with the blood clot. G II was further LED irradiated. G III and IV were filled with MTA; G IV was further LED irradiated. In G V and VI, the defects were filled with MTA and covered with a membrane (GBR). G VI was further LED irradiated. In G VII and VIII, BMPs were added to the MTA and group VIII was further LED irradiated. In G IX and X, the MTA + BMP graft was covered with a membrane (GBR). G X was further LED irradiated. LED was applied over the defect at 48-h intervals and repeated for 15 days. Specimens were processed, cut, and stained with H&E and Sirius red and underwent histological analysis. The use of LED light alone dramatically reduced inflammation. However, its use on MTA associated with BMP and/or GBR increased the severity of the inflammatory reaction. Regarding bone reabsorption, the poorest result was seen when the LED light was associated with the MTA + BMP graft. In the groups Clot and MTA + GBR, no bone reabsorption was detectable. Increased collagen deposition was observed when the LED light was associated with the use of the MTA associated with BMP and/or GBR. Increased new bone formation was observed when the LED light was used alone or associated with the use of MTA + GBR, MTA + BMP, on association of MTA + BMP + GBR and when BMP was added to the MTA. Our results indicate that the use of LED light alone or in association with MTA, MTA + BMP, MTA + GBR, and MTA + BMP + GBR caused less inflammation, and an increase of both collagen deposition and bone deposition as seen on both histological and morphometric analysis.

Effects of LED phototherapy on bone defects grafted with MTA, bone morphogenetic proteins and guided bone regeneration: a Raman spectroscopic study.

We studied peaks of calcium hydroxyapatite (CHA) and protein and lipid CH groups in defects grafted with mineral trioxide aggregate (MTA) treated or not with LED irradiation, bone morphogenetic proteins and guided bone regeneration. A total of 90 rats were divided into ten groups each of which was subdivided into three subgroups (evaluated at 15, 21 and 30 days after surgery). Defects were irradiated with LED light (wavelength 850 ± 10 nm) at 48-h intervals for 15 days. Raman readings were taken at the surface of the defects. There were no statistically significant differences in the CHA peaks among the nonirradiated defects at any of the experimental time-points. On the other hand, there were significant differences between the defects filled with blood clot and the irradiated defects at all time-points (p < 0.001, p = 0.02, p < 0.001). There were significant differences between the mean peak CHA in nonirradiated defects at all the experimental time-points (p < 0.01). The mean peak of the defects filled with blood clot was significantly different from that of the defects filled with MTA (p < 0.001). There were significant differences between the defects filled with blood clot and the irradiated defects (p < 0.001). The results of this study using Raman spectral analysis indicate that infrared LED light irradiation improves the deposition of CHA in healing bone grafted or not with MTA.

Histological and radiographic evaluation of the muscle tissue of rats after implantation of bone morphogenic protein (rhBMP-2) in a scaffold of inorganic bone and after stimulation with low-power laser light.

OBJECTIVE: The present study histologically and radiologically evaluates the muscle tissue of rats after implantation of bone morphogenic protein (rhBMP-2) in a natural inorganic bone mineral scaffold from a bull calf femur and irradiation with low-power light laser. MATERIALS AND METHODS: The right and left hind limbs of 16 rats were shaved and an incision was made in the muscle on the face corresponding to the median portion of the tibia, into which rhBMP-2 in a scaffold of inorganic bone was implanted. Two groups of limbs were formed: control (G1) and laser irradiation (G2). G2 received diode laser light applied in the direction of the implant, at a dose of 8 J/cm2 for three minutes. On the 7th, 21st, 40th and 112th days after implantation, hind limbs of 4 animals were radiographed and their implants removed together with the surrounding tissue for study under the microscope. The histological results were graded as 0=absence, 1=slight presence, 2=representative and 3=very representative, with regard to the following events: formation of osteoid structure, acute inflammation, chronic inflammation, fibrin deposition, neovascularization, foreign-body granuloma and fibrosis. RESULTS: There were no statistically significant differences in these events at each evaluation times, between the two groups (P > 0.05; Mann-Whitney test). Nevertheless, it could be concluded that the natural inorganic bone matrix with rhBMP-2, from the femur of a bull calf, is a biocompatible combination. CONCLUSIONS: Under these conditions, the inductive capacity of rhBMP-2 for cell differentiation was inhibited. There was a slight acceleration in tissue healing in the group that received irradiation with low-power laser light.

Effect of bone morphogenetic protein-7 (BMP-7) on in vitro survival of caprine preantral follicles / Efeito da proteína morfogenética óssea 7 (BMP-7) para a sobrevivência in vitro de folículos pré-antrais caprinos

This study was conducted in order to verify the effect of different concentrations of BMP-7 in the in vitro survival and development of caprine preantral follicles. Fragments of caprine ovarian cortical tissue were cultured for 1 or 7 days in Minimum Essential Medium (MEM+) supplemented with different concentrations of BMP-7 (1, 10, 50 or 100ng/ml). Non-cultured fragments or those cultured for 1 or 7 days were processed for classical histology and transmission electron microscopy (TEM). Parameters such as follicular survival, activation and growth were evaluated. The results showed that, after 1 or 7 days of culture, the percentage of morphologically normal follicles was significantly reduced in all treatments when compared with fresh control, except at 1ng/ml of BMP-7 for 1 day. In addition, the concentration of 10ng/ml of BMP-7 significantly increases follicular diameter from day 1 to 7 of culture. There was no influence of the other concentrations of BMP-7 regarding to the follicular and oocyte diameter. Ultrastructure studies confirmed follicular integrity after 7 days of culture in 1ng/ml BMP-7. In conclusion, small concentrations of BMP-7 can improve the survival and growth of caprine preantral follicles during in vitro culture.

O presente trabalho foi conduzido de modo a se verificar o efeito de diferentes concentrações da BMP-7 no desenvolvimento in vitro de folículos pré-antrais caprinos. Fragmentos de tecido cortical ovariano caprino foram cultivados por 1 ou 7 dias em Minimum Essential Medium (MEM+) suplementado com diferentes concentrações de BMP-7 (1, 10, 50 ou 100ng/ml). Os fragmentos não cultivados ou aqueles cultivados por 1 ou 7 dias foram processados para histologia clássica e microscopia eletrônica de transmissão (TEM), sendo avaliados parâmetros morfológicos indicativos de viabilidade, ativação e crescimento. Os resultados mostraram que o percentual de folículos morfologicamente normais diminuiu significativamente em todos os tratamentos quando comparados ao controle, exceto na concentração de 1ng/ml por 1 dia de cultivo. Já no D7 todos os tratamentos reduziram significativamente os percentuais de folículos morfologicamente normais. Utilizando 10ng/ml de BMP-7 foi observado um aumento significativo no diâmetro folicular quando comparados os diferentes períodos de cultivo. Não houve influência das demais concentrações de BMP-7 quando avaliados além do diâmetro folicular o diâmetro oocitário. A análise por TEM confirmou a integridade ultra-estrutural nos folículos após 7 dias de cultivo com 1ng/ml de BMP-7 . Em conclusão, o BMP-7 em baixas concentrações pode melhorar a sobrevivência e o crescimento durante o cultivo in vitro de folículos pré-antrais caprinos.

Effect of bone morphogenetic protein-7 (BMP-7) on in vitro survival of caprine preantral follicles / Efeito da proteína morfogenética óssea 7 (BMP-7) para a sobrevivência in vitro de folículos pré-antrais caprinos

This study was conducted in order to verify the effect of different concentrations of BMP-7 in the in vitro survival and development of caprine preantral follicles. Fragments of caprine ovarian cortical tissue were cultured for 1 or 7 days in Minimum Essential Medium (MEM+) supplemented with different concentrations of BMP-7 (1, 10, 50 or 100ng/ml). Non-cultured fragments or those cultured for 1 or 7 days were processed for classical histology and transmission electron microscopy (TEM). Parameters such as follicular survival, activation and growth were evaluated. The results showed that, after 1 or 7 days of culture, the percentage of morphologically normal follicles was significantly reduced in all treatments when compared with fresh control, except at 1ng/ml of BMP-7 for 1 day. In addition, the concentration of 10ng/ml of BMP-7 significantly increases follicular diameter from day 1 to 7 of culture. There was no influence of the other concentrations of BMP-7 regarding to the follicular and oocyte diameter. Ultrastructure studies confirmed follicular integrity after 7 days of culture in 1ng/ml BMP-7. In conclusion, small concentrations of BMP-7 can improve the survival and growth of caprine preantral follicles during in vitro culture.(AU)

O presente trabalho foi conduzido de modo a se verificar o efeito de diferentes concentrações da BMP-7 no desenvolvimento in vitro de folículos pré-antrais caprinos. Fragmentos de tecido cortical ovariano caprino foram cultivados por 1 ou 7 dias em Minimum Essential Medium (MEM+) suplementado com diferentes concentrações de BMP-7 (1, 10, 50 ou 100ng/ml). Os fragmentos não cultivados ou aqueles cultivados por 1 ou 7 dias foram processados para histologia clássica e microscopia eletrônica de transmissão (TEM), sendo avaliados parâmetros morfológicos indicativos de viabilidade, ativação e crescimento. Os resultados mostraram que o percentual de folículos morfologicamente normais diminuiu significativamente em todos os tratamentos quando comparados ao controle, exceto na concentração de 1ng/ml por 1 dia de cultivo. Já no D7 todos os tratamentos reduziram significativamente os percentuais de folículos morfologicamente normais. Utilizando 10ng/ml de BMP-7 foi observado um aumento significativo no diâmetro folicular quando comparados os diferentes períodos de cultivo. Não houve influência das demais concentrações de BMP-7 quando avaliados além do diâmetro folicular o diâmetro oocitário. A análise por TEM confirmou a integridade ultra-estrutural nos folículos após 7 dias de cultivo com 1ng/ml de BMP-7 . Em conclusão, o BMP-7 em baixas concentrações pode melhorar a sobrevivência e o crescimento durante o cultivo in vitro de folículos pré-antrais caprinos.(AU)

Osteoinductivity potential of rhBMP-2 associated with two carriers in different dosages.

The objective of this study was to evaluate bone formation after application of different doses of recombinant human bone morphogenetic protein-2 (rhBMP-2) combined with monoolein or poloxamer gels, in critical bone defects of rats. Forty-five Wistar rats were divided into nine treatment groups with five animals each: I: application of 1 µg rhBMP-2 + monoolein; II: 3 µg rhBMP-2 + monoolein; III: 7 µg rhBMP-2 + monoolein; IV: 1 µg rhBMP-2 + poloxamer; V: 3 µg rhBMP-2 + poloxamer; VI: 7 µg rhBMP-2 + poloxamer; VII: monoolein only; VIII: poloxamer only; and IX: critical bone defect only. A critical-sized defect of 6 mm diameter was produced in the left parietal bone and it was filled with gels of the above mentioned treatments. After 2 weeks, the calvarial bones were removed for histological processing. Bone formation in the groups that received poloxamer gel and rhBMP-2 was not significantly different from the control group (IX). Groups receiving monoolein and rhBMP-2 (1 and 3 µg) and those that received only the carriers (VII and VIII) had less bone formation in relation to the control. The association of rhBMP-2 to both poloxamer and monoolein did not exhibit any significant differentiation in bone formation in comparison with the control group.

Effect of recombinant human bone morphogenetic protein-2 on bone formation in the acute distraction osteogenesis of rat mandibles.

BACKGROUND: Distraction osteogenesis (DO) is a method of producing new bone directly from the osteotomy site by gradual traction of the divided bone fragments. AIM: The purpose of the present study was to evaluate histomorphometrically whether acute DO would constitute a viable alternative to the conventional continuous distraction treatment and also to verify the capacity of a recombinant human BMP (rhBMP-2) associated with monoolein gel to stimulate bone formation in the acute distraction process. MATERIALS AND METHODS: Forty-eight Wistar rats were assigned to three groups: Group 1, treated at a conventional continuous distraction rate (0.5 mm/day), Group 2, treated with acute distraction of 2.5 mm at the time of the surgical procedure, and Group 3, subjected to acute distraction associated with rhBMP-2. The animals from each experimental group were killed at the end of the second or fourth post-operative weeks and the volume fraction of newly formed bone trabeculae was estimated in histological images by a differential point-counting method. RESULTS: The results showed that after 2 and 4 weeks, bone volumes in the rhBMP-2 group were significantly higher than in the other groups (P<0.05), but no significant difference was observed in the volume fraction of newly formed bone between the continuous and acute DO groups. CONCLUSION: In conclusion, the study indicates that rhBMP-2 can enhance the bone formation at acute DO, which may potentially reduce the treatment period and complications related to the distraction procedure.

BMP implant associated with platelet-rich plasma in orbit fracture repair.

PURPOSE: To evaluate a bone morphogenetic protein (BMP) implant with and without platelet-rich plasma (PRP), which is supposed to accelerate fracture consolidation in the orbit fracture treatment. METHODS: Thirty-six white rabbits were subjected to orbital fracture and treated in three groups: BMP implant fracture repair (G1), BMP plus PRP implant fracture repair (G2), and fracture and spontaneous repair (G3). The animals were sacrificed at 7, 30, 90, and 180 days after surgery. A radiology evaluation was carried out on the 7th day after the fracture and at the sacrifice moments. After the animals' death, the orbital content material was removed and prepared for morphological and morphometric analysis. RESULTS: Radiology suggested intramembranous and progressive cavitation and ossification without a reduction in implant size and with signs of calcium deposition; these events were confirmed by histological analysis, which showed a lymphomononuclear inflammatory reaction in G1 and G2, more intense 7 days after surgery and reducing after 30 days. Associating PRP with BMP did not accelerate bone induction. CONCLUSION: BMP implant promotes bone induction, integration at fracture site, scarce inflammatory reaction, and may be a good alternative in orbit fracture reconstruction. The addition of PRP to the BMP plate did not accelerate the resolution, and its use is not necessary.

Infrared laser light further improves bone healing when associated with bone morphogenic proteins: an in vivo study in a rodent model.

OBJECTIVE: This study assessed histologically the effect of laser photobiomodulation (LPBM) on the repair of surgical defects created in the femurs of Wistar rats treated or not treated with bone morphogenic proteins (BMPs) and organic bovine bone graft. BACKGROUND DATA: This paper is part of an ongoing series of works in which biomaterials are used in association with LPBM. Several previous reports by our group have shown that the use of laser photobiomodulation improves the treatment of bone defects. MATERIALS AND METHODS: Forty-eight adult male Wistar rats were divided into four randomized groups: group I (control, n = 12); group II (LPBM, n = 12); group III (BMPs + organic bovine bone graft, n = 12); and group IV (BMPs + organic bovine bone graft + LPBM, n = 12). The irradiated groups received seven irradiations every 48 h, beginning immediately after the surgical procedure. The laser therapy (lambda = 830 nm, 40 mW CW, varphi = 0.6 mm) consisted of 16 J/cm(2) per session divided equally over four points (4 J/cm(2) each) around the defect. The subjects were sacrificed after 15, 21, and 30 d, and the specimens were routinely embedded in wax, stained with hematoxylin and eosin and sirius red, and analyzed under light microscopy. RESULTS: The results showed histological evidence of increased deposition of collagen fibers (at 15 and 21 d), as well as an increased amount of well-organized bone trabeculae at the end of the experimental period (30 d) in the irradiated animals versus the non-irradiated controls. CONCLUSION: The use of LPBM with BMPs and organic bovine bone grafts increases the positive biomodulating effects of laser light.

Bone healing process in critical-sized defects by rhBMP-2 using poloxamer gel and collagen sponge as carriers.

The bone morphogenetic protein type 2, is an osteoinduction protein, but new carriers to improve its actions are being studied in recent researches. The objective of this study was to evaluate the poloxamer gel as potential carrier of the rhBMP-2 during the bone healing process and verify if the collagen sponge can improve this process. Fifty-six male Wistar rats were used, which were divided into two groups, considering two periods of time. Thus, each one of these groups was divided in four groups with seven animals each, according to the treatment and the defect filled by 4 microg rhBMP-2 in aqueous solution, 4 microg rhBMP-2 in aqueous solution+collagen sponge, 4 microg rhBMP-2 combined with poloxamer gel, and 4 microg rhBMP-2 combined with poloxamer gel+collagen sponge. After 2 and 4 weeks, respectively, animals were perfused and the hemi-mandibles removed for histological analysis. Statistical analysis of the data showed significant difference between all analyzed groups (p<0.01), and between the periods of time (p=0.0118). There was no interaction between the applied treatment and considered periods of time (p=0.642). Results showed that the rhBMP-2 used in this study was able to induce bone regeneration and had its action optimized when combined to the used carriers, being the bone repair time-dependent.