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ePaper created 2017-12-06, 11:14:19 | version 1.38.0
| industry macro phages and MNGCs on the one side express pro-inflammatory molecules that are relevant for the degradation process, but also secrete antiin- flammatory substances needed for tissue regenera- tion.9 One of the most important signaling molecules is the vascular endothelial growth factor (VEGF), which has direct and indirect impact onto different processes important for successful tissue regenera- tion.8, 9 Thus, VEGF induces angiogenesis at the im- plant site, which has indirectly a positive influence on bone tissue growth, and also direct influence on the development and activity of osteoblasts.8, 10 In case of the xenogeneic bone substitute mate- rial cerabone®, it can be assumed that the observed higher numbers of MNGCs might have a positive effect on bone regeneration. Interestingly, an ini- tially improved bioactivity for cerabone® com- bined with a higher vascularisation at the implant site was demonstrated, which might be based on the increased number of MNGCs compared to Bio-Oss™.2 Thus, an improving effect on bone regen- eration could be concluded after the application of cerabone®. In combination with the hydrophilic na- ture of this material,1 which has been shown to sig- nificantly support the regeneration process by pro- moting the growth of osteoblasts, cerabone® can be considered as a reliable bone grafting material with an assured safety for both clinical user and patient. Summary Altogether, it can be concluded that the xeno- geneic bone substitute material cerabone® is able to ensure the highest possible safety from disease transmission due to the high temperature treat- ment. Furthermore, it is assumable that the relatively high numbers of multinucleated giant cells express high amounts of antiinflammatory molecules and support a fast and high implant bed vascularisation and therefore, might favour the bone regeneration process._ Author details contact Tab. 1 Tab. 1: Histomorphometrical results showing comparable values of newly formed bone, remaining bone grafting materials and connective tissue for Bio-Oss™ and cerabone® (based on previous publications2, 5). other pathogens are destroyed. Despite the treat- ment at high temperatures, the natural bone struc- ture is preserved (Figs. 1–3) making cerabone® a safe and reliable product for bone regeneration applications. Inflammation and bone regeneration Data from preclinical and clinical studies show comparable values for new bone formation, remain- ing bone grafting material and connective tissue for both xenogeneic bone substitutes mentioned above (Tab. 1).1, 2, 5 These results refer to similar biological ac- tivities of Bio-Oss™ and cerabone®. However, in case of cerabone® higher numbers of multinucleated gi- ant cells (MNGCs) were found within the first days after its implantation.2 Furthermore, the compari- son to different other studies shows that the initial number of MNGCs in case of cerabone® is signifi- cantly lower as found in the implant bed of fast de- gradable synthetic materials based on tricalcium phosphates. These results confirm several other studies claiming the long-term stability of xeno- geneic bone substitutes as it was shown that MNGCs are involved in the biodegradation of bone-grafting materials by phagocytosis.6, 7 Interestingly, the MNGCs were identified as for- eign body giant cells (FBGCs) based on their mole- cule expression.8 However, more information is still needed to get further conclusion regarding their dif- ferentiation.8, 9 Interestingly, the degradation pro- cess of bone substitutes and the process of bone tis- sue regeneration are closely connected via the relevant cell types such as macrophages and MNGCs (Fig. 4). In this context, it was shown that both Dr Mike Barbeck Julius Wolff Institute and Center for Musculoskeletal Surgery Berlin-Brandenburg Center for Regenerative Therapies Charité – Universitätsmedizin Berlin Augustenburger Platz 1 13353 Berlin, Germany Tel: +49 152 04165585 mike.barbeck@charite.de 36 implants 3 2017