Demineralized Bone Matrix Or DBM

Demineralized bone matrix consists of most of the non-mineralized components of bone. It is obtained from allograft through the process of acid extraction, which removes the mineral compents of bone. This leaves many of the components that give allograft bone its osteoinductive potential such as collagen and BMP's.

It also retains the trabecular structure of its collagen which also gives it osteoconductive properties. It comes in many forms including gels, paste and putty. DMB results in rapid revasularization and causes release of local cytokines and growth factors that recruit mesenchymal stem cell that promote bone formation. DMB does not have the same osteoinductive potential as autograft, but is an alternative for patients for whom autograft is not an option or would result in significant morbidity.

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Bone Graft Substitutes

Bone graft substitutes are synthetic materials that possess osteoconductive and structural properties. They do not provide osteoinductive or osteogenic properties.

Calcium Phosphates
These are ceramic scaffolds that induce a biologic response similar to bone. Hydroxyapatite is a form of calcium phosphate that is stable, osteoconductive and resorbed very slowly. It is brittle and often combined with autograft to improve its resoptive properties.
Tricalcium phosphate resembles amorphous bone precursors in its structure and thus is resobed more quickly than the more ordered structure of hydroxyapatite. These products come in cements that provide support and a scaffold for osteoconduction. The compressive strength of these products is greater than that of cancellous bone.

Brushite is another calcium phosphate mineral that has the strength of hydroxapatite, but a higher solubility that allows for more rapid replacement by bone on the order of 2-4 years.
Coralline hydroxyapatite compounds are derived from processed sea coral. Specific species posses a calcium carbonate exoskeleton that is similar cancellous bone. This material is converted to calcium phosphate and comes in blocks, wedges or small pellets and may be used for structural support. However, coralline hydroxyapatite is brittle, has low tensile strength and resorbs slowly.

Calcium Sulfate
More commonly known as plaster of paris, this substance can be used as a bone void filler. It is rapidly resorbed and replaced by bone. It resorbs so quickly, on the order of a couple of weeks, that wound drainage may become an issue. The structure is mechanically unreliable, which prevents it use is unstable situations. It is mainly used for antibiotic delivery.

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