Preprint Article Version 1 This version is not peer-reviewed

How Cadaver Bone Transplants Mineralize and Sclerotic Bone Fails

Version 1 : Received: 3 October 2018 / Approved: 15 October 2018 / Online: 15 October 2018 (10:39:43 CEST)

How to cite: Steiner, G. How Cadaver Bone Transplants Mineralize and Sclerotic Bone Fails. Preprints 2018, 2018100300 (doi: 10.20944/preprints201810.0300.v1). Steiner, G. How Cadaver Bone Transplants Mineralize and Sclerotic Bone Fails. Preprints 2018, 2018100300 (doi: 10.20944/preprints201810.0300.v1).

Abstract

Cadaver bone is possibly the most common transplant material used today. Common types of cadaver bone transplants are freeze dried bone allografts and xenografts. In the case of freeze dried bone allograft transplants, it was theorized that these materials mineralize by way of osteoinduction and stimulating osteogenesis. However, these theories have been proven false. It has been proposed that these materials mineralize via osteoconduction however, there are no studies to support this hypothesis. This study was undertaken to determine how these transplants mineralize and what type of bone they produce.  Materials and Methods: This study is a histological analysis of human cadaver bone graft healing from the incipient stages of mineralization through completed mineralization. All cadaver bone grafts used for evaluation in this study were particulate bone graft materials in the maxilla or mandible. No block grafts were evaluated. Results: The mineralization of cadaver bone transplants was produced by an inflammatory response to the transplanted tissue. The histologic findings of the mineralized bone produced by this process was sclerotic bone.  No resorption of cadaver bone graft particles was found. When loaded the sclerotic bone was found to fail through an accumulation of microfractures.Conclusions: Particulate freeze-dried bone allografts and xenografts do not heal via the normal processes of mineralization. Cadaver bone grafts produce significant inflammation and are hypothesized to mineralize by a process termed antigenic ossification. The process of antigenic ossification produces sclerotic bone that is not capable of self-repair which can ultimately lead to bone failure.

Subject Areas

allograft, xenograft, inflammation, sclerotic bone, implant failure, antigenic ossification

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Comment 1
Received: 29 October 2018
Commenter: Curtis Brookover
The commenter has declared there is no conflict of interests.
Comment: interesting
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Comment 2
Received: 30 October 2018
Commenter: Kevin R Hansen DDS
The commenter has declared there is no conflict of interests.
Comment: It is so great to have a valid comparison of the growth of bone in a natural environment created by using biocompatible grafting materials. The difference between synthetic grafting materials which stimulate the healthy, natural bone growth in the site which will minimize the inflammatory response vs the response of our tissues to cadaver bone is quite a contrast. Keep up the research which is insuring success in my grafting and implant procedures. Understanding bone biology and histological examination really are the keys to your success in research. Thank you!!
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Response 1 to Comment 2
Received: 13 November 2018
Commenter: Greg Steiner
Commenter's Conflict of Interests: author
Comment: Thank you for your comments!
Comment 3
Received: 11 November 2018
Commenter: Tonino Traini MDT-CDT;DDS;PhD
The commenter has declared there is no conflict of interests.
Comment: Very interesting publication, mainly because In the field of bone regeneration there are many uncertainties.
synthetic bone substitutes are mildly ineffective on the biological level, because they produce a repair and not a true regeneration of the bone tissue.
Having residual biomaterials in the repaired bone tissue, at best, will only work clinically as a wooden leg!! There is no osteocytic-vascular syncytium capable of mechanically and physiologically fully competent the "new bone".
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Response 1 to Comment 3
Received: 13 November 2018
Commenter: Greg Steiner
Commenter's Conflict of Interests: author
Comment: Dr. Traini
I agree with you that there are many uncertainties with the use of cadaver bone graft materials and it is unacceptable. We have used these materials for decades and we do not know how they produce mineralization, what type of bone they produce, weather or not they are resorbed and what the implant success rate is over time when implants are placed into socket grafted with these materials. How can we use these materials when we know nothing about what these materials are doing to our patients? I am sure that if your knowledge and experience is applied to these questions we could quickly gain the understanding we need.
In regard to your statement about synthetics I am again in agreement but only in regard to historical synthetic materials. Current synthetics mixed with biologically active compounds stimulate bone growth, are fully resorbed in a timely manner and produce normal healthy vital bone.
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