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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Demineralized Bone Matrix grafts in paste, putty, gel, and flex!
Bone Graft Substitutes
Bone graft substitutes are synthetic materials that possess
osteoconductive and structural properties. They do not provide osteoinductive
or osteogenic properties.
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.
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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