Advances in bone grafting

A study was conducted on various autologous grafts, including bone, cartilage, and teeth, with orthobiologics for fracture repairs in the department of veterinary surgery, University of Veterinary and Animal Sciences, Lahore.
Complicated fractures, delayed fractures, and non-unions are challenging problems that often require special attention. Autogenous bone grafts have been considered the gold standard, with viable osteoprogenitor cells, cytokines, and growth factors that result in osteogenesis, osteoinduction, and osteoconduction.
Under severe bone hypoxia and compromised blood supply, bone graft alternatives may be needed. One potential treatment may be an autogenous cartilage graft that recapitulates healing by endochondral ossification. Chondrocytes work under low oxygen and blood supply, but their metabolic activity matches that of other tissues. They promote vascularization, osteogenesis, and mineralization by secreting numerous factors. They transform into osteoblast cells, rendering cartilage a good bone graft substitute.
Extracted tooth is discarded as medical dust, but its inorganic and organic components are similar to bone, i.e., calcium, collagen, osteocalcin, sialoproteins, etc., which show biocompatible properties as bone graft material.
Orthobiologics are used to augment bone and soft tissue healing with multifactorial effects. We used three orthobiologics: Bone Marrow Aspirate (BMA), platelet-rich plasma (PRP), and Decellularized Fish Scale (DFS) in conjunction with autogenous bone, cartilage, and tooth grafts.
Bone-orthobiologic grafts revealed that the bone-BMA graft was excellent in terms of recovery speed and callus strength compared to the bone-PRP and Bone-DFS grafts, due to enormous osteoblasts, MSCs, multi-pluripotent cells, cytokines, etc. Bone-PRP was noted second for healing.
Cartilage-orthobiologic grafts showed that Cartilage-BMA grafts had sufficiently better healing potential. Cartilage-PRP facilitated better healing than Cartilage-DFS but was at par with Cartilage-BMA. We may suggest that cartilage graft combinations be clinically applicable, convenient, and cost-effective to regenerate osseous defects.
Tooth-orthobiologic grafts showed good osteoinductive and biocompatible properties with no tissue reactions. The tooth-BMA graft reasonably accelerated healing with stable calluses. In comparison, tooth BMA was found superior to tooth PRP.. Tooth-DFS graft revealed many beneficial properties, but it lagged behind both aforementioned regimens. So, autologous teeth may be a novel viable bone graft material that is helpful to treat various bone conditions.
Furthermore, as per studies, graft regimens clinical relevance in vivo, implication, and progression of these observations to a greater extent may require further large-scale trials to optimise these novel autografts for routine clinical usage.

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